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Khalifian CE, Titone M, Wooldridge JS, Knopp K, Seibert G, Monson C, Morland L. The role of veterans' PTSD symptoms in veteran couples' insomnia. FAMILY PROCESS 2023; 62:1725-1739. [PMID: 36347178 DOI: 10.1111/famp.12835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/14/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023]
Abstract
Insomnia contributes to individual mental and physical health and relationship well-being. Veterans' PTSD symptoms are associated with their own insomnia. However, research has not explored whether and how veterans' PTSD symptoms are associated with their partners' insomnia. The present study examined the association between veterans' PTSD symptom severity and veterans' and partners' insomnia. Veterans (n = 192) and their partners (n = 192; total N = 384) completed baseline assessments in a PTSD treatment study for veterans with PTSD and their partners. Path analysis was used to examine the relation between veterans' PTSD symptom severity, as measured by the PTSD symptom checklist-5 (PCL-5) and veterans' and partners' insomnia, as measured by the Insomnia Severity Index (ISI). Veterans' full-scale PCL-5 was positively related to veterans' and partners' insomnia. For veterans, intrusion and arousal symptoms were positively related to their own insomnia severity, while veterans' negative alterations in cognition and mood were associated with partners' insomnia severity. In exploratory analyses, partners' depressive symptoms fully mediated the relation between veterans' negative cognitions and mood and partners' insomnia. PTSD symptoms impact both veterans' and partners' insomnia. However, different PTSD symptom clusters were related to insomnia for each partner, and the link for partners was explained by their own depression symptoms. PTSD, insomnia, and integrated treatments should consider strategies for including partners in treatment to address these interconnected problems.
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Affiliation(s)
- Chandra E Khalifian
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Madison Titone
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Jennalee S Wooldridge
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Kayla Knopp
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Gregory Seibert
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | | | - Leslie Morland
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
- National Center for PTSD -Pacific Islands division, Honolulu, Hawaii, USA
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2
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Rolling J, Rabot J, Reynaud E, Kolb O, Bourgin P, Schroder CM. Nightmares and Sleep Disturbances in Children with PTSD: A Polysomnographic and Actigraphy Approach Evaluation. J Clin Med 2023; 12:6570. [PMID: 37892709 PMCID: PMC10607571 DOI: 10.3390/jcm12206570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/18/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023] Open
Abstract
RATIONALE Sleep disturbances (insomnia and nightmare symptoms) are the most sensitive and persistent symptoms of pediatric post-traumatic stress disorder (PTSD). Untreated, these sleep disturbances (SD) associated with PTSD are predictive of PTSD persistence and increased psychiatric complications. The aim of this study was to evaluate sleep and circadian rhythms in children with PTSD under both laboratory and ecological conditions in comparison with a control population and to test for the first time the hypothesis that SD and circadian rhythms are positively correlated with PTSD severity and its comorbidities. METHOD This prospective pilot study evaluated PTSD, SD (insomnia, nightmares), and sleep-wake rhythms in 11 children with PTSD (aged 3-18), compared with the age and sex-matched control groups. Assessment of PTSD and subjective and objective measures of sleep and sleep-wake rhythms (questionnaires, 24-h in-laboratory video-polysomnography, 15-day at-home actigraphy recording) were performed between 1 and 6 months after the traumatic event. RESULTS Children with PTSD had higher sleep fragmentation (increased wake-after-sleep onset, increased number of sleep stage changes) compared to controls, with a change in sleep microarchitecture (micro-arousal index at 14.8 versus 8.2, p = 0.039). Sleep fragmentation parameters correlated with PTSD symptomatology, insomnia, and post-traumatic nightmare severity. The within-group comparison revealed a better sleep architecture in the controlled (sleep laboratory) than in the ecological condition (at home) (total sleep time 586 versus 464 min, p = 0.018). CONCLUSIONS Sleep and rhythm disturbances are strongly associated with PTSD in children. The assessment of SD in children with PTSD should be carried out systematically and preferentially under ecological conditions, and management of SD should integrate the environment (environmental design, psycho-education for the children and their parents) more fully into therapy focused on sleep and trauma.
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Affiliation(s)
- Julie Rolling
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospital, 67091 Strasbourg, France; (J.R.); (O.K.); (C.M.S.)
- Regional Center for Psychotraumatism Great East, Strasbourg University Hospital, 67091 Strasbourg, France
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France; (E.R.); (P.B.)
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France
| | - Juliette Rabot
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospital, 67091 Strasbourg, France; (J.R.); (O.K.); (C.M.S.)
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France; (E.R.); (P.B.)
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France
- Center for Research, Integrated University Health and Social Services Center (CIUSSS) Nord-de-l’Île-de-Montréal, Montréal, QC H2M 2W1, Canada
- Department of Psychiatry & Addictology, University of Montreal, Montreal, QC H3T 1C5, Canada
| | - Eve Reynaud
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France; (E.R.); (P.B.)
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France
- CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, Forgetting, Université Claude Bernard Lyon 1, 69500 Bron, France
| | - Oriane Kolb
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospital, 67091 Strasbourg, France; (J.R.); (O.K.); (C.M.S.)
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France; (E.R.); (P.B.)
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France
| | - Patrice Bourgin
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France; (E.R.); (P.B.)
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France
| | - Carmen M. Schroder
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospital, 67091 Strasbourg, France; (J.R.); (O.K.); (C.M.S.)
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France; (E.R.); (P.B.)
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France
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3
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Fattal D, Platti N, Hester S, Wendt L. Vivid dreams are associated with a high percentage of REM sleep: a prospective study in veterans. J Clin Sleep Med 2023; 19:1661-1668. [PMID: 37128719 PMCID: PMC10476037 DOI: 10.5664/jcsm.10642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/03/2023]
Abstract
STUDY OBJECTIVES Vivid dreams are dreams that feel real or are associated with dream enactment behavior. They are prevalent in veterans, especially in those with psychiatric disorders such as post-traumatic stress disorders. Such psychiatric disorders have known association with abnormalities in rapid eye movement (REM) sleep. Vivid dreams are also described in neurological conditions, such Lewy body dementias, which are also associated with REM sleep abnormality. Although vivid dreams occur in neuropsychiatric disorders that have REM sleep abnormalities, there are no studies that have directly investigated an association between vivid dreams and REM sleep. We sought to study vivid dreams and REM sleep in veterans. METHODS Veterans undergoing polysomnography at our hospital were invited to enroll. Participants completed a dream-related questionnaire the morning after their polysomnography. RESULTS We prospectively enrolled 505 veterans. After a night in the sleep laboratory, 196 of 504 (39%) reported experiencing a dream, and, of those, 117 of 190 (62%) described their dream as vivid. Discrepancies in patient totals are secondary to missing questionnaire data. Our novel finding is that participants with a high percentage of REM sleep (above 25%) were more than twice likely to report a vivid dream than participants with a lower percentage of REM sleep (P < .0001). Nonvivid dreams were not associated with a high percentage of REM sleep. CONCLUSIONS Vivid dreams are associated with a high percentage of REM sleep. Further research into the role of REM sleep abnormalities in vivid dreams may help to advance understanding of neuropsychiatric disorders. CITATION Fattal D, Platti N, Hester S, Wendt L. Vivid dreams are associated with a high percentage of REM sleep: a prospective study in veterans. J Clin Sleep Med. 2023;19(9):1661-1668.
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Affiliation(s)
- Deema Fattal
- Neurology Department, University of Iowa, Iowa City, Iowa
- Iowa City VA Medical Center, Iowa City, Iowa
| | - Nicole Platti
- University of Iowa Carver College of Medicine, Iowa City, Iowa
| | | | - Linder Wendt
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa
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Hunt C, Stout DM, Tie Z, Acheson D, Colvonen PJ, Nievergelt CM, Yurgil KA, Baker DG, Risbrough VB. Pre-deployment threat learning predicts increased risk for post-deployment insomnia: Evidence from the Marine Resiliency Study. Behav Res Ther 2022; 159:104223. [PMID: 36327523 PMCID: PMC9893737 DOI: 10.1016/j.brat.2022.104223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 02/04/2023]
Abstract
Insomnia is a common and impairing consequence of military deployment, but little is known about pre-deployment risk factors for post-deployment insomnia. Abnormal threat learning tendencies are commonly observed in individuals with insomnia and maladaptive responses to stress have been implicated in the development of insomnia, suggesting that threat learning could be an important risk factor for post-deployment insomnia. Here, we examined pre-deployment threat learning as a predictor of post-deployment insomnia and the potential mechanisms underlying this effect. Male servicemembers (N = 814) completed measures of insomnia, psychiatric symptoms, and a threat learning task before and after military deployment. Threat learning indices that differentiated participants with versus withoutinsomnia at post-deployment were tested as pre-deployment predictors of post-deployment insomnia. Post-deployment insomnia was linked to elevations on several threat learning indices at post-deployment, but only higher threat conditioning, as indexed by higher threat expectancy ratings to the danger cue, emerged as a pre-deployment predictor of post-deployment insomnia. This effect was independent of combat exposure levels and partially mediated by greater post-deployment nightmares. The tendency to acquire stronger expectations of aversive events following encounters with danger cues may increase risk for post-deployment insomnia, in part due to the development of more severe nightmares.
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Affiliation(s)
- Christopher Hunt
- VA San Diego Healthcare System, Center of Excellence for Stress and Mental Health, United States; University of California San Diego, Department of Psychiatry, United States
| | - Daniel M Stout
- VA San Diego Healthcare System, Center of Excellence for Stress and Mental Health, United States; University of California San Diego, Department of Psychiatry, United States
| | - Ziyun Tie
- University of California San Diego, Department of Psychiatry, United States
| | - Dean Acheson
- VA San Diego Healthcare System, Center of Excellence for Stress and Mental Health, United States; University of California San Diego, Department of Psychiatry, United States
| | - Peter J Colvonen
- VA San Diego Healthcare System, Center of Excellence for Stress and Mental Health, United States; University of California San Diego, Department of Psychiatry, United States
| | - Caroline M Nievergelt
- VA San Diego Healthcare System, Center of Excellence for Stress and Mental Health, United States; University of California San Diego, Department of Psychiatry, United States
| | - Kate A Yurgil
- Department of Psychological Sciences, Loyola University New Orleans, United States
| | - Dewleen G Baker
- VA San Diego Healthcare System, Center of Excellence for Stress and Mental Health, United States; University of California San Diego, Department of Psychiatry, United States
| | - Victoria B Risbrough
- VA San Diego Healthcare System, Center of Excellence for Stress and Mental Health, United States; University of California San Diego, Department of Psychiatry, United States.
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5
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Swift KM, Thomas CL, Balkin TJ, Lowery-Gionta EG, Matson LM. Acute sleep interventions as an avenue for treatment of trauma-associated disorders. J Clin Sleep Med 2022; 18:2291-2312. [PMID: 35678060 PMCID: PMC9435330 DOI: 10.5664/jcsm.10074] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022]
Abstract
Scientific evidence that acute, posttrauma sleep disturbances (eg, nightmares and insomnia) can contribute significantly to the pathogenesis of trauma-induced disorders is compelling. Sleep disturbances precipitating from trauma are uniquely predictive of daytime posttrauma symptom occurrence and severity, as well as subsequent onset of mental health disorders, including post-traumatic stress disorder. Conversely, adequate sleep during the acute posttrauma period is associated with reduced likelihood of adverse mental health outcomes. These findings, which are broadly consistent with what is known about the role of sleep in the regulation of emotion, suggest that the acute posttrauma period constitutes a "window of opportunity" during which treatment of sleep disturbances may be especially effective for preventing or mitigating progression of aberrant psychophysiological processes. At this point, the weight of the scientific evidence supporting this possibility warrants initiation of clinical trials to confirm the benefits of targeted prophylactic sleep enhancement, and to establish treatment guidelines as appropriate. CITATION Swift KM, Thomas CL, Balkin TJ, Lowery-Gionta EG, Matson LM. Acute sleep interventions as an avenue for treatment of trauma-associated disorders. J Clin Sleep Med. 2022;18(9):2291-2312.
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Affiliation(s)
- Kevin M. Swift
- Medical Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Connie L. Thomas
- Department of Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
- Department of Psychiatry, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | - Thomas J. Balkin
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Emily G. Lowery-Gionta
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Liana M. Matson
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
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6
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Mureșanu IA, Grad DA, Mureșanu DF, Dobran SA, Hapca E, Strilciuc Ș, Benedek I, Capriș D, Popescu BO, Perju-Dumbravă L, Cherecheș RM. Evaluation of post-traumatic stress disorder (PTSD) and related comorbidities in clinical studies. J Med Life 2022; 15:436-442. [PMID: 35646173 PMCID: PMC9126456 DOI: 10.25122/jml-2022-0120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/25/2022] [Indexed: 12/14/2022] Open
Abstract
Patients with traumatic brain injury (TBI) of varying severities are experiencing adverse outcomes during and after rehabilitation. Besides depression and anxiety, post-traumatic stress disorder (PTSD) is highly encountered in civilian and military populations. As more prospective and retrospective studies - focused on evaluating new or old psychological therapies in inpatient, outpatient, or controlled environments, targeting patients with PTSD with or without a history of TBI - are carried out, researchers are employing various scales to measure PTSD as well as other psychiatric diagnoses or cognitive impairments that might appear following TBI. We aimed to explore the literature published between January 2010 and October 2021 by querying three databases. Our preliminary results showed that several scales - such as the Clinician-Administered PTSD Scale (CAPS), the Posttraumatic Stress Disorder Checklist Military Version (PCL-M) as well as Specific Version (PCL-S), and Civilian Version (PCL-C) - have been frequently used for PTSD diagnosis and symptom severity. However, heterogeneity in the scales used when assessing and evaluating additional psychiatric comorbidities and cognitive impairments are due to the study aim and therapeutic approaches. Therefore, conducting an intervention focusing on post-TBI PTSD patients requires increased attention to patients' medical history in capturing multiple cognitive impairments and affected neuropsychological processes when designing the study and including validated instruments for measuring primary and secondary neuropsychological outcomes.
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Affiliation(s)
- Ioana Anamaria Mureșanu
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania,Corresponding Author: Ioana Anamaria Mureșanu, RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Cluj, Romania. Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. E-mail:
| | - Diana Alecsandra Grad
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Public Health, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Dafin Fior Mureșanu
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Elian Hapca
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ștefan Strilciuc
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Irina Benedek
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - David Capriș
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Bogdan Ovidiu Popescu
- Department of Neuroscience, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Răzvan Mircea Cherecheș
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Public Health, Babes-Bolyai University, Cluj-Napoca, Romania
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7
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Maher AR, Apaydin EA, Hilton L, Chen C, Troxel W, Hall O, Azhar G, Larkin J, Motala A, Hempel S. Sleep management in posttraumatic stress disorder: a systematic review and meta-analysis. Sleep Med 2021; 87:203-219. [PMID: 34634573 DOI: 10.1016/j.sleep.2021.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 08/04/2021] [Accepted: 08/12/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Post-traumatic stress disorder (PTSD) can lead to many negative secondary outcomes for patients, including sleep disturbances. The objective of this meta-analysis is (1) to evaluate the effect of interventions for adults with PTSD on sleep outcomes, PTSD outcomes, and adverse events, and (2) to evaluate the differential effectiveness of interventions aiming to improve sleep compared to those that do not. METHODS Nine databases were searched for relevant randomized controlled trials (RCTs) in PTSD from January 1980 to October 2019. Two independent reviewers screened 7176 records, assessed 2139 full-text articles, and included 89 studies in 155 publications for this review. Sleep, PTSD, and adverse event outcomes were abstracted and meta-analyses were performed using the Hartung-Knapp-Sidik-Jonkman method for random effects. RESULTS Interventions improved sleep outcomes (standardized mean difference [SMD] -0.56; confidence interval [CI] -0.75 to -0.37; 49 RCTs) and PTSD symptoms (SMD -0.48; CI -0.67 to -0.29; 44 RCTs) across studies. Adverse events were not related to interventions overall (RR 1.17; CI 0.91 to 1.49; 15 RCTs). Interventions targeting sleep improved sleep outcomes more than interventions that did not target sleep (p = 0.03). Improvement in PTSD symptoms did not differ between intervention types. CONCLUSIONS Interventions for patients with PTSD significantly improve sleep outcomes, especially interventions that specifically target sleep. Treatments for adults with PTSD directed towards sleep improvement may benefit patients who suffer from both ailments.
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Affiliation(s)
- Alicia Ruelaz Maher
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA; Southern California Evidence-based Practice Center, Health Care, RAND Corporation, Santa Monica, CA, USA
| | - Eric A Apaydin
- Southern California Evidence-based Practice Center, Health Care, RAND Corporation, Santa Monica, CA, USA; Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
| | - Lara Hilton
- Southern California Evidence-based Practice Center, Health Care, RAND Corporation, Santa Monica, CA, USA; Center for Work & Family Life, University of Southern California, Los Angeles, CA, USA
| | - Christine Chen
- Southern California Evidence-based Practice Center, Health Care, RAND Corporation, Santa Monica, CA, USA
| | - Wendy Troxel
- Southern California Evidence-based Practice Center, Health Care, RAND Corporation, Pittsburgh, PA, USA; Department of Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Owen Hall
- Southern California Evidence-based Practice Center, Health Care, RAND Corporation, Santa Monica, CA, USA
| | - Gulrez Azhar
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jody Larkin
- Southern California Evidence-based Practice Center, Health Care, RAND Corporation, Pittsburgh, PA, USA
| | - Aneesa Motala
- Southern California Evidence-based Practice Center, Health Care, RAND Corporation, Santa Monica, CA, USA; Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Susanne Hempel
- Southern California Evidence-based Practice Center, Health Care, RAND Corporation, Santa Monica, CA, USA; Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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8
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Li L, Wang X, Tan J, Li J, Yuan Y. Influence of sleep difficulty on post-traumatic stress symptoms among frontline medical staff during COVID-19 pandemic in China. PSYCHOL HEALTH MED 2021; 27:1924-1936. [PMID: 34541987 DOI: 10.1080/13548506.2021.1981411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Being a nurse was demonstrated to be a risk factor for post-traumatic stress symptoms (PTS) and insomnia among frontline staff during COVID-19 pandemic. The unidirectional relationship between insomnia and PTS highly suggested that insomnia could mediate the increasing risk of PTS among frontline nurses. However, no study had tried to clarify this mediation effect of insomnia during COVID-19 pandemic. This study aimed to investigate prevalence of insomnia and PTS among frontline doctors and nurses and to clarify the relationship between career (doctor/nurses), insomnia and PTS. A total of 211 frontline doctors and nurses completed the investigation. Insomnia was measured using a self-drafted questionnaire and PTS was assessed using primary care post-traumatic stress disorder screen (PC-PTSD). Three logistics regression models and one mediation model were performed to explore relationships between career, insomnia and PTS. The prevalence of PTS (PC-PTSD≥2) and insomnia (with 1 item in self-drafted insomnia questionnaire≥2) was 24.17% and 36.97%, respectively. Being a nurse was a shared risk factor of insomnia (OR = 4.16, 95%CI: 1.30 ~ 5.77, P = 0.023) and PTS (OR = 7.51, 95%CI: 1.89 ~ 40.50, P = 0.008). Compared to doctors, nurses had significantly higher prevalence of insomnia (46.32% vs. 20%, χ2 = 13.27, P < 0.001) and PTS (30.14% vs. 13.33%, χ2 = 6.57, P = 0.011). Insomnia was a significant partial mediator (B = 0.101, P = 0.026), which explained 32.53% proportions of relationship between being a nurse and PTS. PTS and insomnia were common symptoms, which should be considered in psychological aids among frontline medical staff. Insomnia might be a possible target of PTS intervention.
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Affiliation(s)
- Lei Li
- School of Medicine, Southeast University, Nanjing, China.,Department of Sleep Medicine, The Fourth People's Hospital of Lianyungang, Lianyungang, China
| | - Xiang Wang
- Department of Sleep Medicine, The Fourth People's Hospital of Lianyungang, Lianyungang, China
| | - Junhua Tan
- Department of Clinical Psychology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jijun Li
- Department of Clinical Psychology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yonggui Yuan
- School of Medicine, Southeast University, Nanjing, China.,Department of Psychiatry, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
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9
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Sullan MJ, Crocker LD, Thomas KR, Orff HJ, Davey DK, Jurick SM, Twamley EW, Norman SB, Schiehser DM, Aupperle R, Jak AJ. Baseline sleep quality moderates symptom improvement in veterans with comorbid PTSD and TBI receiving trauma-focused treatment. Behav Res Ther 2021; 143:103892. [PMID: 34091276 DOI: 10.1016/j.brat.2021.103892] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 02/07/2023]
Abstract
Poor sleep quality is common among Veterans with posttraumatic stress disorder (PTSD) and history of traumatic brain injury (TBI). However, the relationship between sleep quality and treatment outcomes following trauma-focused interventions is less well-understood in this population. We sought to better understand whether 1) sleep quality changed as a result of trauma-focused treatment and 2) if baseline sleep quality moderated psychological and neurobehavioral treatment outcomes. Our sample consisted of 100 Iraq/Afghanistan era Veterans with PTSD and history of mild to moderate TBI who were randomized to one of two trauma-focused treatments: 1) Cognitive Processing Therapy (CPT) or 2) combined CPT and Cognitive Symptom Management and Rehabilitation Therapy (SMART-CPT). Self-reported sleep quality, psychiatric symptoms (PTSD and depression), and neurobehavioral concerns were assessed at multiple timepoints throughout the study. Multilevel modeling showed sleep quality did not improve, regardless of treatment condition. However, worse baseline sleep quality was associated with less improvement in PTSD symptoms and cognitive complaints. There was no effect of baseline sleep quality on change in depression symptoms. These findings suggest that more targeted treatments to address sleep quality either prior to or in conjunction with trauma-focused therapy may help to improve treatment outcomes for Veterans with comorbid PTSD and TBI history.
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Affiliation(s)
- Molly J Sullan
- Psychology Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., San Diego, CA, 92093, USA
| | - Laura D Crocker
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., Building 13, San Diego, CA, 92161, USA
| | - Kelsey R Thomas
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., Building 13, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., San Diego, CA, 92093, USA
| | - Henry J Orff
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., Building 13, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., San Diego, CA, 92093, USA
| | - Delaney K Davey
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., Building 13, San Diego, CA, 92161, USA
| | - Sarah M Jurick
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., Building 13, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., San Diego, CA, 92093, USA
| | - Elizabeth W Twamley
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., Building 13, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., San Diego, CA, 92093, USA
| | - Sonya B Norman
- Psychology Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., San Diego, CA, 92093, USA; National Center for PTSD, White River Junction, VT, USA
| | - Dawn M Schiehser
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., Building 13, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., San Diego, CA, 92093, USA
| | - Robin Aupperle
- Laureate Institute for Brain Research, Tulsa, OK, USA; School of Community Medicine, University of Tulsa, Tulsa, OK, USA
| | - Amy J Jak
- Psychology Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., San Diego, CA, 92093, USA.
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10
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Garcia A, Reljic T, Pogoda TK, Kenney K, Agyemang A, Troyanskaya M, Belanger HG, Wilde EA, Walker WC, Nakase-Richardson R. Obstructive Sleep Apnea Risk Is Associated with Cognitive Impairment after Controlling for Mild Traumatic Brain Injury History: A Chronic Effects of Neurotrauma Consortium Study. J Neurotrauma 2020; 37:2517-2527. [PMID: 32709212 PMCID: PMC7698980 DOI: 10.1089/neu.2019.6916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The contribution of sleep disturbance to persistent cognitive symptoms following a mild traumatic brain injury (mTBI) remains unclear. Obstructive sleep apnea (OSA) is very common, yet its relationship between risk factors for developing OSA and cognitive performance in those with history of mTBI has not been investigated. The current study examined OSA risk levels and its association with cognitive performance in 391 combat-exposed, post-911 veterans and service members (median age = 37 years) enrolled in the Chronic Effects of Neurotrauma Consortium (CENC) prospective multi-center study. Participants included those with and without mTBI (n = 326 and 65, respectively). When using clinical cut-offs, those with history of mTBI were more likely to be categorized as high risk for OSA (mTBI positive = 65% vs. mTBI negative = 51%). After adjustment for TBI status and demographic variables, increased OSA risk was significantly associated with worse performance on measures of complex processing speed and executive functioning (Wechsler Adult Intelligence Scale Fourth Edition Coding, Trail Making Test, part B) and greater symptom burden (Neurobehavioral Symptom Inventory). Thus, OSA, a modifiable behavioral health factor, likely contributes to cognitive performance following mTBI. Accordingly, OSA serves as a potential point of intervention to improve clinical and cognitive outcomes after injury.
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Affiliation(s)
- Amanda Garcia
- Defense and Veterans Brain Injury Center, James A. Haley VA Hospital, Tampa, Florida, USA
- Mental Health and Behavioral Sciences and Defense and Veterans Brain Injury Center, James A. Haley VA Hospital, Tampa, Florida, USA
| | - Tea Reljic
- Morsani College of Medicine, Sleep and Pulmonary Division, University of South Florida, Tampa, Florida, USA
| | - Terri K. Pogoda
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University School of Public Health, Boston, Massachusetts, USA
| | - Kimbra Kenney
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Neurology, Uniformed Services University, Bethesda, Maryland, USA
| | - Amma Agyemang
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Maya Troyanskaya
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
- Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Heather G. Belanger
- United States Special Operations Command, Tampa, Florida, USA
- Department of Psychology and Psychiatry and Behavioral Neurosciences, Sleep and Pulmonary Division, University of South Florida, Tampa, Florida, USA
| | - Elisabeth A. Wilde
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
- George E. Wahlen VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
- Department of Neurology, TBI and Concussion Center, University of Utah, Salt Lake City, Utah, USA
| | - William C. Walker
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Risa Nakase-Richardson
- Defense and Veterans Brain Injury Center, James A. Haley VA Hospital, Tampa, Florida, USA
- Mental Health and Behavioral Sciences and Defense and Veterans Brain Injury Center, James A. Haley VA Hospital, Tampa, Florida, USA
- Department of Internal Medicine, Sleep and Pulmonary Division, University of South Florida, Tampa, Florida, USA
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11
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Swift KM. Sleep and PTSD: delving deeper to understand a complicated relationship. Sleep 2020. [DOI: 10.1093/sleep/zsaa074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kevin M Swift
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD
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12
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Dieter JN, Engel SD. Traumatic Brain Injury and Posttraumatic Stress Disorder: Comorbid Consequences of War. Neurosci Insights 2019; 14:1179069519892933. [PMID: 32363347 PMCID: PMC7176398 DOI: 10.1177/1179069519892933] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 11/11/2019] [Indexed: 12/14/2022] Open
Abstract
Scientific literature is reviewed supporting a “consequence of war syndrome (CWS)” in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn soldiers. CWS constituents include chronic pain and insomnia, other physical complaints, posttraumatic stress disorder (PTSD), anxiety, depression, and neuropsychological deficits. The foundation of CWS lies with the chronic stressors inherent to deployment and the cascade of biological events mediated and maintained by hypothalamic-pituitary-adrenal (HPA) axis dysregulation. Such dysregulation is modified by the individual’s specific experiences at war, difficulty reintegrating to post-deployment life, and the onset or exacerbation of the chronic and comorbid physical, emotional, and cognitive disorders. The circuit network between the prefrontal cortex (PFC), amygdala, and hippocampus is particularly sensitive to the consequences of war. The review’s specific conclusions are as follows: HPA axis dysregulation contributes to the chronic insomnia and hyperarousal seen in soldiers. There is considerable symptom overlap between PTSD and blast-related head injury, and it is difficult to determine the relative contributions of the two disorders to abnormal imaging studies. In some cases, traumatic brain injury (TBI) may directly precipitate PTSD symptoms. While not intuitive, the relationship between TBI and postconcussion syndrome appears indirect and mediated through PTSD. Blast-related or conventional head injury may have little long-term impact on neuropsychological functioning; contrarily, PTSD particularly accounts for current cognitive deficits. The psychological experience of CWS includes a “war-within” where soldiers continue to battle an internalized enemy. Successful treatment of CWS entails transdisciplinary care that addresses each of the constituent disorders.
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Affiliation(s)
- John Ni Dieter
- Intrepid Spirit Center, Carl R. Darnall Army Medical Center, U.S. Army, Fort Hood, TX, USA
| | - Scot D Engel
- Intrepid Spirit Center, Carl R. Darnall Army Medical Center, U.S. Army, Fort Hood, TX, USA
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13
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Wallace DM, Wohlgemuth WK. Predictors of Insomnia Severity Index Profiles in United States Veterans With Obstructive Sleep Apnea. J Clin Sleep Med 2019; 15:1827-1837. [PMID: 31855168 PMCID: PMC7099195 DOI: 10.5664/jcsm.8094] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 08/23/2019] [Accepted: 08/23/2019] [Indexed: 12/19/2022]
Abstract
STUDY OBJECTIVES The Insomnia Severity Index (ISI) has been used to define insomnia symptoms in individuals with obstructive sleep apnea (OSA). However, whether distinct ISI profiles exist in individuals with OSA is unclear. The aims of this study were to determine (1) empirically-based ISI profiles in veterans with OSA and (2) predictors of these ISI profiles. METHODS Participants were 630 veterans with a new diagnosis of OSA over a 12-month period. Individuals completed the ISI and other questionnaires on the polysomnography (PSG) night. Latent profile analysis was performed to detect ISI subgroups based on individual ISI items. Age, Charlson Comorbidity Index, apnea-hypopnea index (AHI), mood disorder, posttraumatic stress disorder, and chronic pain diagnoses were used to predict between ISI profiles. RESULTS Latent profile analysis identified five ISI subgroups in veterans with OSA. The "asymptomatic" group (12% prevalence) had low scores across all ISI items. The "moderate insomnia" (30% prevalence) and "severe insomnia" (44% prevalence) groups had elevated scores for all ISI items but differing in severity. Last, the "moderate" (6% prevalence) and "severe daytime symptoms" groups (8% prevalence) were characterized by absence of nocturnal complaints but high scores on daytime impairment items. Age, AHI, mood disorder, posttraumatic stress disorder and chronic pain diagnoses discriminated between ISI profiles. CONCLUSIONS We describe data-driven ISI profiles in veterans with OSA. Older age was associated with lower insomnia and daytime symptom complaints whereas psychological comorbidities were related to more severe insomnia. Caution should be used in interpreting the ISI score in individuals with OSA because a subset had elevated total scores without insomnia.
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Affiliation(s)
- Douglas M. Wallace
- Department of Neurology, Sleep Medicine Division, University of Miami Miller School of Medicine, Miami, Florida
- Neurology Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida
| | - William K. Wohlgemuth
- Neurology Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida
- Psychology Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida
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14
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Miller MB, Metrik J, Borsari B, Jackson KM. Longitudinal Associations between Sleep, Intrusive Thoughts, and Alcohol Problems Among Veterans. Alcohol Clin Exp Res 2019; 43:2438-2445. [PMID: 31560410 PMCID: PMC6824952 DOI: 10.1111/acer.14191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/04/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Research suggests bidirectional associations between symptoms of posttraumatic stress disorder (PTSD) and sleep disturbance, both of which have been associated with alcohol problems. However, few studies have examined the interplay of these conditions in predicting alcohol problems over time. This study tested 2 competing models: (i) sleep disturbance as a mediator of the association between intrusive thoughts about trauma and alcohol problems and (ii) intrusion symptoms as the mediator of the sleep/alcohol problem association. METHODS Veterans (N = 325, 93% male, 81% White) completed assessments at baseline, 6 months, and 12 months as part of a larger observational study. Zero-inflated-negative binomial models were used to examine indirect effects of baseline predictors on (i) yes/no likelihood and (ii) number of 12-month alcohol problems through 6-month mediators. Models controlled for past-year cannabis use and drinks consumed per week at baseline. RESULTS The only significant predictor of alcohol problem likelihood was baseline drinking quantity. Baseline PTSD intrusions had a direct effect on number of alcohol problems at 12 months, with no indirect (mediated) effect through 6-month sleep disturbance. In the competing model, baseline sleep disturbance had a marginally significant direct effect on 12-month alcohol problems, with a significant indirect effect through 6-month PTSD intrusions. CONCLUSIONS PTSD intrusions are associated with more alcohol problems and help explain the long-term association between sleep and alcohol problems among veterans. Because sleep disturbances are associated with more intrusive thoughts about trauma, we recommend that treatments targeting sleep in the context of PTSD and alcohol use include a cognitive component.
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Affiliation(s)
- Mary Beth Miller
- Department of Psychiatry, 1 Hospital Dr DC 067.00, University of Missouri, Columbia, MO 65212
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02903
| | - Jane Metrik
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02903
- Providence VA Medical Center, Providence, RI 02908
| | - Brian Borsari
- Mental Health Service (116B), San Francisco VA Health Care System, 4150 Clement St., San Francisco, CA 94121
- Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143
| | - Kristina M. Jackson
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02903
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15
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Mascarel P, Poirot I, Lardinois M, Debien C, Vaiva G. [Sleep disorders and their treatment in post-traumatic stress disorder]. Presse Med 2019; 48:1051-1058. [PMID: 31473024 DOI: 10.1016/j.lpm.2019.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 07/12/2019] [Accepted: 08/02/2019] [Indexed: 12/31/2022] Open
Abstract
Subjects suffering from post-traumatic stress disorder present sleeping disorders like a chronic insomnia, traumatic nightmares, but also less expected, sleep breathing disorders. Sleep problems are a factor of development and maintenance of PTSD, but also a factor of resistance to treatment. After a therapy focused on PTSD, they represent frequent residual symptoms. It is necessary to couple, with the usual management of PTSD, targeted approaches for sleep problems. These targeted approaches allow an improvement of the nocturnal properties but also diurnal specific symptoms of PTSD. Stakes around primary, secondary and tertiary prevention of PTSD emerge around these sleep disorders.
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Affiliation(s)
- Pauline Mascarel
- CHU de Lille, secteur des urgences psychiatriques, pôle de l'urgence, 59037 Lille, France.
| | - Isabelle Poirot
- CHU de Lille, service de psychiatrie adulte, médecine légale et médecine en milieu pénitentiaire, pôle de psychiatrie, 59037 Lille, France
| | - Marine Lardinois
- Centre hospitalier de Versailles, service de psychiatrie adulte, 78150 Le Chesnay, France
| | - Christophe Debien
- CHU de Lille, service de psychiatrie adulte, médecine légale et médecine en milieu pénitentiaire, pôle de psychiatrie, 59037 Lille, France; Centre national de ressources et de résilience pour le psychotraumatisme (CN2R), 59000 Lille, France
| | - Guillaume Vaiva
- CHU de Lille, service de psychiatrie adulte, médecine légale et médecine en milieu pénitentiaire, pôle de psychiatrie, 59037 Lille, France; Centre national de ressources et de résilience pour le psychotraumatisme (CN2R), 59000 Lille, France
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16
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The effect of treating obstructive sleep apnea with continuous positive airway pressure on posttraumatic stress disorder: A systematic review and meta-analysis with hypothetical model. Neurosci Biobehav Rev 2019; 102:172-183. [DOI: 10.1016/j.neubiorev.2019.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 02/24/2019] [Accepted: 03/24/2019] [Indexed: 12/14/2022]
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17
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Rizzo M, Robertson B, Collen JF. Distinct Disorder? Or Mash Up of Several? J Clin Sleep Med 2019; 15:181-182. [PMID: 30736890 DOI: 10.5664/jcsm.7610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/04/2019] [Indexed: 11/13/2022]
Affiliation(s)
- Meagan Rizzo
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Brian Robertson
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Jacob F Collen
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
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18
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Papathanasiou ES, Cronin T, Seemungal B, Sandhu J. Electrophysiological testing in concussion: A guide to clinical applications. JOURNAL OF CONCUSSION 2018. [DOI: 10.1177/2059700218812634] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The diagnosis of mild traumatic brain injury in concussion is difficult since it is often unwitnessed, the patient’s recall is unreliable and initial clinical examination is often unrevealing, correlating poorly with the extent of brain injury. At present, there are no objective biomarkers of mild traumatic brain injury in concussion. Thus, a sensitive gold standard test is required to enable the effective and safe triage of patients who present to the acute services. As well as triage, objective monitoring of patients’ recovery over time and separate from clinical features that patients may develop following the injury (e.g. depression and migraine) is also needed. In contrast to neuroimaging, which is widely used to investigate traumatic brain injury patients, electrophysiology is readily available, is cheap and there are internationally recognized standardised methodologies. Herein, we review the existing literature on electrophysiological testing in concussion and mild traumatic brain injury; specifically, electroencephalogram, polysomnography, brainstem auditory evoked potentials, electro- and videonystagmography, vestibular evoked myogenic potentials, visually evoked potentials, somatosensory evoked potentials and transcranial magnetic stimulation.
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Affiliation(s)
- Eleftherios S Papathanasiou
- Clinical Neurophysiology Laboratory, Clinic B, The Cyprus Institute of Neurology & Genetics, Nicosia, Cyprus
| | - Thomas Cronin
- Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Barry Seemungal
- Division of Brain Sciences, St Mary’s and Charing Cross Hospitals, Imperial College London, London, UK
| | - Jaswinder Sandhu
- Sheffield Institute of Translational Neuroscience, University of Sheffield, Sheffield, UK
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19
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Kalmbach DA, Conroy DA, Falk H, Rao V, Roy D, Peters ME, Van Meter TE, Korley FK. Poor sleep is linked to impeded recovery from traumatic brain injury. Sleep 2018; 41:5057802. [PMID: 30053263 PMCID: PMC6890523 DOI: 10.1093/sleep/zsy147] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/14/2018] [Indexed: 01/11/2023] Open
Abstract
Study Objectives While disruptions in sleep are common after mild traumatic brain injury (TBI), the longitudinal relationships between sleep problems and global functioning after injury are poorly understood. Here, we prospectively investigate risk for functional impairment during the first 6 months of TBI recovery based on sleep onset insomnia symptoms and short sleep. Methods Patients presenting to the Emergency Department (ED) at Johns Hopkins Hospital within 24 hours of head injury and evaluated for TBI were eligible for our study. Demographic and injury-related information were collected in the ED. Patients then completed in-person surveys and phone interviews to provide follow-up data on global functioning, sleep, and depressive symptoms at 1, 3, and 6 months post-injury. A total of 238 patients provided sufficient data for analysis, and hypotheses were tested using mixed effects modeling. Results Sleep quality and global functioning improved over the 6 months of TBI recovery, but patients were at increased risk for functional impairment when sleeping poorly (odds ratio [OR] = 7.69, p < .001). Sleep onset insomnia symptoms and short sleep both independently corresponded to poor global functioning. Functional impairment was highest among those with both insomnia and short sleep (43%-79%) compared to good sleepers (15%-25%) and those with short sleep (29%-33%) or insomnia alone (33%-64%). A bidirectional relationship between sleep quality and functioning was observed. Conclusions Functionally impaired patients diagnosed predominantly with mild TBI exhibit high rates of insomnia and short sleep, which may impede TBI recovery. Monitoring sleep after head injury may identify patients with poor prognoses and allow for early intervention to improve functional outcomes.
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Affiliation(s)
- David A Kalmbach
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - Deirdre A Conroy
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - Hayley Falk
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Vani Rao
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Durga Roy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Matthew E Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Frederick K Korley
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI
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20
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Colvonen PJ, Straus LD, Stepnowsky C, McCarthy MJ, Goldstein LA, Norman SB. Recent Advancements in Treating Sleep Disorders in Co-Occurring PTSD. Curr Psychiatry Rep 2018; 20:48. [PMID: 29931537 PMCID: PMC6645398 DOI: 10.1007/s11920-018-0916-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Comorbidity of posttraumatic stress disorder (PTSD) and insomnia, nightmares, and obstructive sleep apnea (OSA) is high. We review recent research on psychotherapeutic and pharmacological interventions for sleep disorders in PTSD. RECENT FINDINGS PTSD treatments decrease PTSD severity and nightmare frequency, but do not resolve OSA or insomnia. Research on whether insomnia hinders PTSD treatment shows mixed results; untreated OSA does interfere with PTSD treatment. Cognitive behavioral therapy for insomnia is the recommended treatment for insomnia; however, optimal ordering with PTSD treatment is unclear. PTSD treatment may be most useful for PTSD-related nightmares. CPAP therapy is recommended for OSA but adherence can be low. Targeted treatment of sleep disorders in the context of PTSD offers a unique and underutilized opportunity to advance clinical care and research. Research is needed to create screening protocols, determine optimal order of treatment, and elucidate mechanisms between sleep and PTSD treatments.
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Affiliation(s)
- Peter J. Colvonen
- VA San Diego Healthcare System, University of California San Diego, 3350 La Jolla Village Dr. (116B), San Diego, CA 92161, USA,Center of Excellence for Stress and Mental Health, University of California San Diego, San Diego, CA, USA,Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Laura D. Straus
- Sierra Pacific Mental Illness Research Education and Clinical Centers, San Francisco VA Healthcare System, San Francisco, CA, USA,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Carl Stepnowsky
- VA San Diego Healthcare System, University of California San Diego, 3350 La Jolla Village Dr. (116B), San Diego, CA 92161, USA,Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Michael J. McCarthy
- VA San Diego Healthcare System, University of California San Diego, 3350 La Jolla Village Dr. (116B), San Diego, CA 92161, USA,Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Lizabeth A. Goldstein
- Sierra Pacific Mental Illness Research Education and Clinical Centers, San Francisco VA Healthcare System, San Francisco, CA, USA,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Sonya B. Norman
- VA San Diego Healthcare System, University of California San Diego, 3350 La Jolla Village Dr. (116B), San Diego, CA 92161, USA,Center of Excellence for Stress and Mental Health, University of California San Diego, San Diego, CA, USA,Department of Psychiatry, University of California San Diego, San Diego, CA, USA,National Center for PTSD, Boston, MA, USA
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21
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Rachakonda TD, Balba NM, Lim MM. Trauma-Associated Sleep Disturbances: a Distinct Sleep Disorder? CURRENT SLEEP MEDICINE REPORTS 2018; 4:143-148. [PMID: 30656131 PMCID: PMC6330699 DOI: 10.1007/s40675-018-0119-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE OF REVIEW This paper describes a newly proposed sleep disorder, trauma-associated sleep disorder (TSD). Whether or not this represents a truly unique condition is controversial. In this paper, we describe the overlapping features and differences between TSD, post-traumatic stress disorder (PTSD) and Rapid Eye Movement (REM) sleep behavior disorder (RBD). RECENT FINDINGS While REM sleep without atonia (RWA) and dream enactment are part of the diagnostic criteria for both RBD and TSD, only TSD features nightmares that occur both in non-REM and REM. A key difference between TSD and PTSD is the presence of symptoms during wakefulness in the latter, though the relationship between the two disorders is, as of yet, unclear. It is unknown whether or not a relationship exists between TSD and neurodegeneration, thus this needs to be explored further. SUMMARY Additional research, such as application of TSD diagnostic criteria to more diverse population, would help to determine whether or not TSD is a distinct clinical entity, its relationships to PTSD, as well as the association of this condition with the development of neurodegeneration.
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Affiliation(s)
| | - Nadir M. Balba
- VA Portland Health Care System
- Oregon Health & Science University
| | - Miranda M. Lim
- VA Portland Health Care System
- Oregon Health & Science University
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22
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Weymann KB, Lim MM. Sleep Disturbances in TBI and PTSD and Potential Risk of Neurodegeneration. CURRENT SLEEP MEDICINE REPORTS 2017. [DOI: 10.1007/s40675-017-0077-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Zhang Y, Weed JG, Ren R, Tang X, Zhang W. Prevalence of obstructive sleep apnea in patients with posttraumatic stress disorder and its impact on adherence to continuous positive airway pressure therapy: a meta-analysis. Sleep Med 2017; 36:125-132. [DOI: 10.1016/j.sleep.2017.04.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/12/2017] [Accepted: 04/20/2017] [Indexed: 12/13/2022]
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24
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King PR, Donnelly KT, Warner G, Wade M, Pigeon WR. The natural history of sleep disturbance among OEF/OIF veterans with TBI and PTSD and the role of proxy variables in its measurement. J Psychosom Res 2017; 96:60-66. [PMID: 28545794 DOI: 10.1016/j.jpsychores.2017.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 03/16/2017] [Accepted: 03/22/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Sleep disturbance crosscuts post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). Though previous cross-sectional findings demonstrate a compounding effect of PTSD and TBI comorbidity, relatively little is known about the longitudinal trajectory of sleep-related complaints in veterans with TBI history and current PTSD symptoms. In this study, we explored patterns and predictors of sleep complaints in a sample of combat veterans with and without TBI and PTSD. METHODS Secondary analysis of data gathered during a longitudinal study of U.S. veterans of Operations Enduring and Iraqi Freedom (OEF/OIF) with and without TBI. Data from a subsample of 291 participants with sleep self-report data were analyzed using multinomial logistic regression logit testing and linear mixed models. RESULTS Over an 18-month period, we observed an average 23-28% reduction in sleep symptoms in our sample as measured by two proxy scales, with the bulk of change (12-14% overall reduction) detected at the first six-month follow-up assessment. TBI history emerged, overall, as the most prominent predictor of worse general sleep symptoms, though baseline PTSD and pain status also demonstrated an association with worse sleep symptoms. CONCLUSION Whereas changes in PTSD symptoms over time were associated with worsening sleep symptoms, improvement in sleep reports was most consistently predicted by the passage of time. Our data also provide preliminary support for using three-to-four core items (i.e., trouble sleeping, changes in sleep, fatigue, and nightmares) to screen for sleep complaints in veterans with TBI and PTSD and/or track sleep-related outcomes.
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Affiliation(s)
- Paul R King
- Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, NY, United States; Department of Counseling, School, and Educational Psychology, University at Buffalo, State University of New York, Buffalo, NY, United States.
| | - Kerry T Donnelly
- Department of Counseling, School, and Educational Psychology, University at Buffalo, State University of New York, Buffalo, NY, United States; Behavioral Health Careline, VA Western New York Healthcare System, Buffalo, NY, United States.
| | - Gary Warner
- Behavioral Health Careline, Canandaigua VA Medical Center, Canandaigua, NY, United States.
| | - Michael Wade
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, United States.
| | - Wilfred R Pigeon
- VA Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States.
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Cox RC, Tuck BM, Olatunji BO. Sleep Disturbance in Posttraumatic Stress Disorder: Epiphenomenon or Causal Factor? Curr Psychiatry Rep 2017; 19:22. [PMID: 28321643 DOI: 10.1007/s11920-017-0773-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW The goal of this review is to integrate recent findings on sleep disturbance and PTSD, examine sleep disturbance as a causal factor in the development of PTSD, and identify future directions for research, treatment, and prevention. RECENT FINDINGS Recent research highlights a relationship between both objective and subjective sleep disturbance and PTSD across diverse samples. Sleep disturbance also predicts PTSD over time. Finally, treatments targeting sleep disturbance lead to decreased PTSD symptoms, while standard PTSD treatments conclude with residual sleep disturbance. Sleep disturbance may be more than a mere epiphenomenon of PTSD. Future research examining the causal role of sleep disturbance in the development of PTSD, as well as the utility of targeting sleep disturbance in prevention and treatment, is necessary to fully understand the likely bidirectional relationship between sleep disturbance and PTSD.
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Affiliation(s)
- Rebecca C Cox
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA
| | - Breanna M Tuck
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA
| | - Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA.
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Mysliwiec V, Brock MS, Creamer JL, O'Reilly BM, Germain A, Roth BJ. Trauma associated sleep disorder: A parasomnia induced by trauma. Sleep Med Rev 2017; 37:94-104. [PMID: 28363448 DOI: 10.1016/j.smrv.2017.01.004] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 01/12/2017] [Accepted: 01/20/2017] [Indexed: 10/20/2022]
Abstract
Nightmares and disruptive nocturnal behaviors that develop after traumatic experiences have long been recognized as having different clinical characteristics that overlap with other established parasomnia diagnoses. The inciting experience is typically in the setting of extreme traumatic stress coupled with periods of sleep disruption and/or deprivation. The limited number of laboratory documented cases and symptomatic overlap with rapid eye movement sleep behavior disorder (RBD) and posttraumatic stress disorder (PTSD) have contributed to difficulties in identifying what is a unique parasomnia. Trauma associated sleep disorder (TSD) incorporates the inciting traumatic experience and clinical features of trauma related nightmares and disruptive nocturnal behaviors as a novel parasomnia. The aims of this theoretical review are to 1) summarize the known cases and clinical findings supporting TSD, 2) differentiate TSD from clinical disorders with which it has overlapping features, 3) propose criteria for the diagnosis of TSD, and 4) present a hypothetical neurobiological model for the pathophysiology of TSD. Hyperarousal, as opposed to neurodegenerative changes in RBD, is a component of TSD that likely contributes to overriding atonia during REM sleep and the comorbid diagnosis of insomnia. Lastly, a way forward to further establish TSD as an accepted sleep disorder is proposed.
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Affiliation(s)
- Vincent Mysliwiec
- San Antonio Military Medical Center, Department of Sleep Medicine, 2200 Bergquist Drive, Suite 1, JBSA Lackland, TX 78236, USA.
| | - Matthew S Brock
- San Antonio Military Medical Center, Department of Sleep Medicine, 2200 Bergquist Drive, Suite 1, JBSA Lackland, TX 78236, USA
| | - Jennifer L Creamer
- Madigan Army Medical Center, Department of Pulmonary, Critical Care, and Sleep Medicine, Tacoma, WA, USA
| | - Brian M O'Reilly
- Madigan Army Medical Center, Department of Pulmonary, Critical Care, and Sleep Medicine, Tacoma, WA, USA
| | - Anne Germain
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA; University of Pittsburgh School of Medicine, Department of Psychology, Pittsburgh, PA, USA
| | - Bernard J Roth
- Madigan Army Medical Center, Department of Pulmonary, Critical Care, and Sleep Medicine, Tacoma, WA, USA
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A Qualitative Study of Sleep-Wake Disturbance Among Veterans With Post-Acute Moderate to Severe Traumatic Brain Injury. J Head Trauma Rehabil 2017; 31:126-35. [PMID: 26959666 DOI: 10.1097/htr.0000000000000216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Examine sleep-wake disturbance (SWD) characteristics, factors, consequences, and management strategies from the perspective of veterans with chronic stage, moderate/severe traumatic brain injury (TBI). SETTING VA Medical Center, Rocky Mountain. US PARTICIPANTS Nineteen male veterans with post-acute TBI and SWD in the VA Health Administration. DESIGN Qualitative descriptive. MEASURES Semistructured interviews, Ohio State University TBI-Identification Method, Insomnia Severity Index. RESULTS Two main dimensions emerged: "Messed up sleep" and Surviving and Managing SWD. Sleep-wake disturbance has long-term multidimensional features, etiology, consequences, and practice implications. Although SWD may not be consistently discussed with providers, the problem appears to be pervasive in many aspects of the lives of the informants. Difficulty falling asleep, frequent awakenings, and poor sleep quality were common symptoms that were described as intrusive, isolating, and difficult to self-manage. Veterans discussed a host of physical symptoms, mental health issues, environmental, and behavioral factors that contributed to SWD. Medications, sleep apnea treatment, and self-imposed isolation were frequent management strategies. Veterans expressed a willingness to try new approaches and work with providers. CONCLUSION Sleep-wake disturbance among veterans with chronic stage TBI is a multidimensional phenomenon with interplay between comorbidities, contributing factors, effects on functioning, and sleep management strategies. Implications for practice include early and routine evaluation, monitoring, and treatment of SWD. Research is needed to test interventions that address SWD and common TBI comorbidities.
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Raikes AC, Schaefer SY. Sleep Quantity and Quality during Acute Concussion: A Pilot Study. Sleep 2016; 39:2141-2147. [PMID: 27748242 DOI: 10.5665/sleep.6314] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/08/2016] [Indexed: 01/20/2023] Open
Abstract
STUDY OBJECTIVES A number of subjective and objective studies provide compelling evidence of chronic post-concussion changes in sleep, yet very little is known about the acute effects of concussion on sleep quality and quantity. Therefore, the purpose of this prospective pilot study was to use actigraphy to examine the changes in sleep quality and quantity acutely following concussion at home rather than in a hospital or sleep laboratory. METHODS Seventeen young adults (7 with acute concussion, 10 controls) were recruited for this study. All participants completed two 5-day testing sessions separated by 30 days from intake (controls) or day of injury (concussion). Participants wore actigraphs and kept a sleep journal. Sleep parameter outcomes included nighttime total sleep time (nTST), 24-h total sleep time (TST), wake after sleep onset (WASO), and sleep efficiency (SE). The coefficient of variation (CV) for each sleep parameter was computed for each session. RESULTS nTST and TST CV was significantly greater in the concussion group. There is the additional indication that individuals with a concussion may require and obtain more sleep shortly after injury and subsequently have a shorter duration of sleep at 1 mo post-injury. This pattern was not seen in the measures of sleep quality (WASO, SE). CONCLUSIONS Individuals with a concussion demonstrated increased nighttime sleep duration variability. This increase persisted at 1 mo post-injury and may be associated with previously documented self-reports of poor sleep quality lasting months and years after a concussion. Additionally, this increase may predispose individuals to numerous negative health outcomes if left untreated.
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Affiliation(s)
- Adam C Raikes
- Motor Rehabilitation and Learning Laboratory, College of Education and Human Services, Utah State University, Logan, UT
| | - Sydney Y Schaefer
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ
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Lins L, Carvalho FM. SF-36 total score as a single measure of health-related quality of life: Scoping review. SAGE Open Med 2016; 4:2050312116671725. [PMID: 27757230 PMCID: PMC5052926 DOI: 10.1177/2050312116671725] [Citation(s) in RCA: 521] [Impact Index Per Article: 65.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 08/10/2016] [Indexed: 12/12/2022] Open
Abstract
According to the 36-Item Short Form Health Survey questionnaire developers, a global measure of health-related quality of life such as the “SF-36 Total/Global/Overall Score” cannot be generated from the questionnaire. However, studies keep on reporting such measure. This study aimed to evaluate the frequency and to describe some characteristics of articles reporting the SF-36 Total/Global/Overall Score in the scientific literature. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses method was adapted to a scoping review. We performed searches in PubMed, Web of Science, SCOPUS, BVS, and Cochrane Library databases for articles using such scores. We found 172 articles published between 1997 and 2015; 110 (64.0%) of them were published from 2010 onwards; 30.0% appeared in journals with Impact Factor 3.00 or greater. Overall, 129 (75.0%) out of the 172 studies did not specify the method for calculating the “SF-36 Total Score”; 13 studies did not specify their methods but referred to the SF-36 developers’ studies or others; and 30 articles used different strategies for calculating such score, the most frequent being arithmetic averaging of the eight SF-36 domains scores. We concluded that the “SF-36 Total/Global/Overall Score” has been increasingly reported in the scientific literature. Researchers should be aware of this procedure and of its possible impacts upon human health.
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Baglioni C, Nanovska S, Regen W, Spiegelhalder K, Feige B, Nissen C, Reynolds CF, Riemann D. Sleep and mental disorders: A meta-analysis of polysomnographic research. Psychol Bull 2016; 142:969-990. [PMID: 27416139 PMCID: PMC5110386 DOI: 10.1037/bul0000053] [Citation(s) in RCA: 540] [Impact Index Per Article: 67.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Investigating sleep in mental disorders has the potential to reveal both disorder-specific and transdiagnostic psychophysiological mechanisms. This meta-analysis aimed at determining the polysomnographic (PSG) characteristics of several mental disorders. Relevant studies were searched through standard strategies. Controlled PSG studies evaluating sleep in affective, anxiety, eating, pervasive developmental, borderline and antisocial personality disorders, attention-deficit-hyperactivity disorder (ADHD), and schizophrenia were included. PSG variables of sleep continuity, depth, and architecture, as well as rapid-eye movement (REM) sleep were considered. Calculations were performed with the "Comprehensive Meta-Analysis" and "R" software. Using random effects modeling, for each disorder and each variable, a separate meta-analysis was conducted if at least 3 studies were available for calculation of effect sizes as standardized means (Hedges' g). Sources of variability, that is, sex, age, and mental disorders comorbidity, were evaluated in subgroup analyses. Sleep alterations were evidenced in all disorders, with the exception of ADHD and seasonal affective disorders. Sleep continuity problems were observed in most mental disorders. Sleep depth and REM pressure alterations were associated with affective, anxiety, autism and schizophrenia disorders. Comorbidity was associated with enhanced REM sleep pressure and more inhibition of sleep depth. No sleep parameter was exclusively altered in 1 condition; however, no 2 conditions shared the same PSG profile. Sleep continuity disturbances imply a transdiagnostic imbalance in the arousal system likely representing a basic dimension of mental health. Sleep depth and REM variables might play a key role in psychiatric comorbidity processes. Constellations of sleep alterations may define distinct disorders better than alterations in 1 single variable. (PsycINFO Database Record
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Affiliation(s)
- Chiara Baglioni
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Svetoslava Nanovska
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Wolfram Regen
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Kai Spiegelhalder
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Bernd Feige
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Christoph Nissen
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | | | - Dieter Riemann
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
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Improved Cardiorespiratory Fitness With Aerobic Exercise Training in Individuals With Traumatic Brain Injury. J Head Trauma Rehabil 2016; 30:382-90. [PMID: 24901330 DOI: 10.1097/htr.0000000000000062] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To examine cardiorespiratory fitness in individuals with traumatic brain injury (TBI), before and following participation in a supervised 12-week aerobic exercise training program. METHODS Ten subjects with nonpenetrating TBI (TBI severity: mild, 50%; moderate, 40%; severe, 10%; time since injury [mean ± SD]: 6.6 ± 6.8 years) performed exercise training on a treadmill 3 times a week for 30 minutes at vigorous intensity (70%-80% of heart rate reserve). All subjects completed a cardiopulmonary exercise test, with pulmonary gas exchange measured and a questionnaire related to fatigue (Fatigue Severity Scale) at baseline and following exercise training. RESULTS After training, increases (P < .01) in peak oxygen consumption ((Equation is included in full-text article.); +3.1 ± 2.4 mL/min/kg), time to volitional fatigue (+1.4 ± 0.8 minutes), and peak work rate (+59 ± 43 W) were observed. At the anaerobic threshold, (Equation is included in full-text article.)(+3.6 ± 2.1 mL/kg/min), treadmill time (+1.8 ± 1.1 minutes), and work rate (+37 ± 39 W) were higher (P < .01) following exercise training. Subjects also reported significantly lower (P < .05) Fatigue Severity Scale composite scores (-0.9 ± 1.3) following exercise training. CONCLUSION These findings suggest that individuals with TBI may benefit from participation in vigorous aerobic exercise training with improved cardiorespiratory fitness and diminished fatigue.
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32
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Sleep disorders related to deployment in active duty service members and veterans. CURRENT PULMONOLOGY REPORTS 2016. [DOI: 10.1007/s13665-016-0147-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Improving the Significance and Direction of Sleep Management in Traumatic Brain Injury. J Head Trauma Rehabil 2016; 31:79-81. [DOI: 10.1097/htr.0000000000000235] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Sleep disturbances are frequently identified following traumatic brain injury, affecting 30%-70% of persons, and often occur after mild head injury. Insomnia, fatigue, and sleepiness are the most frequent sleep complaints after traumatic brain injury. Sleep apnea, narcolepsy, periodic limb movement disorder, and parasomnias may also occur after a head injury. In addition, depression, anxiety, and pain are common brain injury comorbidities with significant influence on sleep quality. Two types of traumatic brain injury that may negatively impact sleep are acceleration/deceleration injuries causing generalized brain damage and contact injuries causing focal brain damage. Polysomnography, multiple sleep latency testing, and/or actigraphy may be utilized to diagnose sleep disorders after a head injury. Depending on the disorder, treatment may include the use of medications, positive airway pressure, and/or behavioral modifications. Unfortunately, the treatment of sleep disorders associated with traumatic brain injury may not improve neuropsychological function or sleepiness.
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Affiliation(s)
- Mari Viola-Saltzman
- Department of Neurology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Camelia Musleh
- Department of Neurology, NorthShore University HealthSystem, Evanston, IL, USA
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Ouellet MC, Beaulieu-Bonneau S, Morin CM. Sleep-wake disturbances after traumatic brain injury. Lancet Neurol 2015; 14:746-57. [PMID: 26067127 DOI: 10.1016/s1474-4422(15)00068-x] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 04/18/2015] [Accepted: 04/27/2015] [Indexed: 12/15/2022]
Abstract
Sleep-wake disturbances are extremely common after a traumatic brain injury (TBI). The most common disturbances are insomnia (difficulties falling or staying asleep), increased sleep need, and excessive daytime sleepiness that can be due to the TBI or other sleep disorders associated with TBI, such as sleep-related breathing disorder or post-traumatic hypersomnia. Sleep-wake disturbances can have a major effect on functional outcomes and on the recovery process after TBI. These negative effects can exacerbate other common sequelae of TBI-such as fatigue, pain, cognitive impairments, and psychological disorders (eg, depression and anxiety). Sleep-wake disturbances associated with TBI warrant treatment. Although evidence specific to patients with TBI is still scarce, cognitive-behavioural therapy and medication could prove helpful to alleviate sleep-wake disturbances in patients with a TBI.
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Affiliation(s)
- Marie-Christine Ouellet
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec, QC, Canada; École de Psychologie, Université Laval, Québec, QC, Canada.
| | - Simon Beaulieu-Bonneau
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec, QC, Canada; École de Psychologie, Université Laval, Québec, QC, Canada; Centre de Recherche de l'Institut Universitaire en Santé Mentale de Québec, Québec, QC, Canada
| | - Charles M Morin
- École de Psychologie, Université Laval, Québec, QC, Canada; Centre de Recherche de l'Institut Universitaire en Santé Mentale de Québec, Québec, QC, Canada
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Farrell-Carnahan L, Barnett S, Lamberty G, Hammond FM, Kretzmer TS, Franke LM, Geiss M, Howe L, Nakase-Richardson R. Insomnia symptoms and behavioural health symptoms in veterans 1 year after traumatic brain injury. Brain Inj 2015; 29:1400-8. [PMID: 26287761 DOI: 10.3109/02699052.2015.1063161] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Insomnia and behavioural health symptoms 1 year after traumatic brain injury (TBI) were examined in a clinical sample representative of veterans who received inpatient treatment for TBI-related issues within the Veterans Health Administration. METHODS This was a cross-sectional sub-study (n = 112) of the Polytrauma Rehabilitation Centres' traumatic brain injury model system programme. Prevalence estimates of insomnia, depression, general anxiety, nightmares, headache and substance use, stratified by injury severity, were derived. Univariate logistic regression was used to examine unadjusted effects for each behavioural health problem and insomnia by injury severity. RESULTS Participants were primarily male, < 30 years old and high school educated. Twenty-nine per cent met study criteria for insomnia; those with mild TBI were significantly more likely to meet criteria (43%) than those with moderate/severe TBI (22%), χ(2)(1, n = 112) = 5.088, p ≤ 0.05. Univariable logistic regression analyses revealed depressive symptoms and general anxiety were significantly associated with insomnia symptoms after TBI of any severity. Headache and binge drinking were significantly inversely related to insomnia symptoms after moderate/severe TBI, but not MTBI. CONCLUSIONS Veterans with history of TBI, of any severity, and current insomnia symptoms may be at increased risk for depression and anxiety 1 year after TBI.
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Affiliation(s)
- Leah Farrell-Carnahan
- a Hunter Holmes McGuire Veterans Affairs Medical Center , Richmond , VA , USA .,b Virginia Commonwealth University , Richmond , VA , USA
| | - Scott Barnett
- c James A. Haley Veterans Hospital , Tampa , FL , USA
| | - Gregory Lamberty
- d Minneapolis Veterans Affairs Health Care System , Minneapolis , MN , USA .,e University of Minnesota Medical School , Minneapolis , MN , USA
| | - Flora M Hammond
- f Indiana University School of Medicine , Indianapolis , IN , USA
| | | | - Laura M Franke
- a Hunter Holmes McGuire Veterans Affairs Medical Center , Richmond , VA , USA .,b Virginia Commonwealth University , Richmond , VA , USA .,g Defense and Veterans Brain Injury Center , Richmond , VA , USA , and
| | - Meghan Geiss
- a Hunter Holmes McGuire Veterans Affairs Medical Center , Richmond , VA , USA
| | - Laura Howe
- h VA Palo Alto Health Care System , Palo Alto , CA , USA
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Wooten NR. Military Social Work: Opportunities and Challenges for Social Work Education. JOURNAL OF SOCIAL WORK EDUCATION 2015; 51:S6-S25. [PMID: 26089628 PMCID: PMC4469218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Military social work is a specialized field of practice spanning the micro-macro continuum and requiring advanced social work knowledge and skills. The complex behavioral health problems and service needs of Iraq and Afghanistan veterans highlight the need for highly trained social work professionals who can provide militarily-relevant and culturally-responsive evidence-informed services. Responding to the military behavioral health workforce and service needs of recently returned veterans presents both opportunities and challenges for military social work education. This article discusses the rationale for a military social work specialization, the need for military social work education, and opportunities and challenges for social work education. An integrated model of intellectual capital is proposed to guide strategic planning for future military social work education.
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Affiliation(s)
- Nikki R Wooten
- University of South Carolina/District of Columbia Army National Guard
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38
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Gilbert KS, Kark SM, Gehrman P, Bogdanova Y. Sleep disturbances, TBI and PTSD: Implications for treatment and recovery. Clin Psychol Rev 2015; 40:195-212. [PMID: 26164549 DOI: 10.1016/j.cpr.2015.05.008] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 04/27/2015] [Accepted: 05/13/2015] [Indexed: 12/26/2022]
Abstract
Post-Traumatic Stress Disorder (PTSD), traumatic brain injury (TBI), and sleep problems significantly affect recovery and functional status in military personnel and Veterans returning from combat. Despite recent attention, sleep is understudied in the Veteran population. Few treatments and rehabilitation protocols target sleep, although poor sleep remains at clinical levels and continues to adversely impact functioning even after the resolution of PTSD or mild TBI symptoms. Recent developments in non-pharmacologic sleep treatments have proven efficacious as stand-alone interventions and have potential to improve treatment outcomes by augmenting traditional behavioral and cognitive therapies. This review discusses the extensive scope of work in the area of sleep as it relates to TBI and PTSD, including pathophysiology and neurobiology of sleep; existing and emerging treatment options; as well as methodological issues in sleep measurements for TBI and PTSD. Understanding sleep problems and their role in the development and maintenance of PTSD and TBI symptoms may lead to improvement in overall treatment outcomes while offering a non-stigmatizing entry in mental health services and make current treatments more comprehensive by helping to address a broader spectrum of difficulties.
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Affiliation(s)
- Karina Stavitsky Gilbert
- Psychology Research, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Sarah M Kark
- Psychology Research, VA Boston Healthcare System, Boston, MA, United States
| | - Philip Gehrman
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States; Philadelphia VA Medical Center, Philadelphia, PA, United States
| | - Yelena Bogdanova
- Psychology Research, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States.
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Wallace DM, Wohlgemuth WK. Does race-ethnicity moderate the relationship between CPAP adherence and functional outcomes of sleep in US veterans with obstructive sleep apnea syndrome? J Clin Sleep Med 2014; 10:1083-91. [PMID: 25317089 DOI: 10.5664/jcsm.4106] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Little is known about the association of race-ethnicity and the relationship of continuous positive airway pressure (CPAP) adherence with functional outcomes of sleep in American samples with obstructive sleep apnea syndrome (OSAS). This retrospective study examines whether race-ethnicity moderates the relationship between CPAP adherence and functional outcomes of sleep in OSAS. METHODS Over 4 months, consecutive OSAS patients had CPAP data downloads and completed questionnaires (demographics, Functional Outcomes of Sleep Questionnaire [FOSQ], Epworth Sleepiness Scale [ESS], Insomnia Severity Index [ISI]) at the Miami VA sleep center. Medical diagnoses and polysomnography data were obtained from medical record. CPAP adherence was measured as mean daily hours of use. Hierarchical regression modeling was used to explore the differential impact of race-ethnicity and CPAP adherence on functional outcomes of sleep. RESULTS Two hundred twenty-seven veterans (93% male, age 59 ± 11 years) were included; 142 (63%) participants self-reported as white or Hispanic, and 85 participants (37%) as black. Hierarchical regression analyses failed to show main effects for race-ethnicity or CPAP use and FOSQ scores; however, the interaction of race-ethnicity with CPAP adherence was significantly associated with the total FOSQ (p = 0.04), Social (p = 0.02), and Intimacy (p = 0.01) subscale scores. For blacks, in adjusted analyses, CPAP adherence was positively associated with Social and Intimacy FOSQ subscales; however, no significant relationship was noted between CPAP use and FOSQ scores in whites/Hispanics. CONCLUSIONS Race-ethnicity may moderate the relationship between CPAP adherence and some functional outcomes of sleep; however, further studies are needed.
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Affiliation(s)
- Douglas M Wallace
- Neurology Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL ; Department of Neurology, University of Miami Miller School of Medicine, Miami, FL
| | - William K Wohlgemuth
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL ; Psychology Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL
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Mysliwiec V, O'Reilly B, Polchinski J, Kwon HP, Germain A, Roth BJ. Trauma associated sleep disorder: a proposed parasomnia encompassing disruptive nocturnal behaviors, nightmares, and REM without atonia in trauma survivors. J Clin Sleep Med 2014; 10:1143-8. [PMID: 25317096 DOI: 10.5664/jcsm.4120] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To characterize the clinical, polysomnographic and treatment responses of patients with disruptive nocturnal behaviors (DNB) and nightmares following traumatic experiences. METHODS A case series of four young male, active duty U.S. Army Soldiers who presented with DNB and trauma related nightmares. Patients underwent a clinical evaluation in a sleep medicine clinic, attended overnight polysomnogram (PSG) and received treatment. We report pertinent clinical and PSG findings from our patients and review prior literature on sleep disturbances in trauma survivors. RESULTS DNB ranged from vocalizations, somnambulism to combative behaviors that injured bed partners. Nightmares were replays of the patient's traumatic experiences. All patients had REM without atonia during polysomnography; one patient had DNB and a nightmare captured during REM sleep. Prazosin improved DNB and nightmares in all patients. CONCLUSIONS We propose Trauma associated Sleep Disorder (TSD) as a unique sleep disorder encompassing the clinical features, PSG findings, and treatment responses of patients with DNB, nightmares, and REM without atonia after trauma.
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Affiliation(s)
| | - Brian O'Reilly
- Madigan Army Medical Center, Department of Pulmonary, Critical Care, and Sleep Medicine, Tacoma, WA
| | - Jason Polchinski
- Madigan Army Medical Center, Department of Pulmonary, Critical Care, and Sleep Medicine, Tacoma, WA
| | - Herbert P Kwon
- Madigan Army Medical Center, Department of Pulmonary, Critical Care, and Sleep Medicine, Tacoma, WA
| | - Anne Germain
- University of Pittsburgh School of Medicine, Departments of Psychiatry & Psychology, Pittsburgh, PA
| | - Bernard J Roth
- Madigan Army Medical Center, Department of Pulmonary, Critical Care, and Sleep Medicine, Tacoma, WA
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Abstract
The military population is particularly vulnerable to a multitude of sleep-related disorders owing to the type of work performed by active duty servicemembers (ADSMs). Inadequate sleep, due to insufficient quantity or quality, is increasingly recognized as a public health concern. Traditionally, ADSMs have been encouraged that they can adapt to insufficient sleep just as the body adapts to physical training, but there is a substantial body of scientific literature which argues that this is not possible. Additionally, the military work environment creates unique challenges with respect to treatment options for common sleep disorders like obstructive sleep apnea, restless legs syndrome, and parasomnias. This review highlights sleep disorders which are prevalent in the modern military force and discusses the impact of poor sleep on overall performance. Medical treatments and recommendations for unit leaders are also discussed.
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Abstract
Insomnia is a prevalent disorder that greatly impacts military personnel, especially those deployed in support of combat efforts. Deployment-related stressors like combat exposure, mild traumatic brain injury (mTBI) irregular sleep-wake schedules, and adjustment to the return home all contribute to insomnia. However, insomnia can also exacerbate the deployment experience and is a risk factor for traumatic stress reactions such as PTSD, depression, and suicide. Military personnel with mTBI are significantly impacted by insomnia; the majority experience sleep disruption and this can impede recovery and rehabilitation. As more service members return home from deployment, treatment is vital to reduce the impact of insomnia. Preliminary outcome data, showing positive results for reduction of sleep disruption, has been found with treatments such as combined cognitive behavioral treatment of insomnia (CBTI) and imagery rehearsal therapy (IRT), preference-based interventions, as well as efforts to broadly disseminate CBTI. The recent literature on the impact and treatment of deployment-related insomnia is reviewed.
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Kaestner EJ, Wixted JT, Mednick SC. Pharmacologically increasing sleep spindles enhances recognition for negative and high-arousal memories. J Cogn Neurosci 2013; 25:1597-610. [PMID: 23767926 DOI: 10.1162/jocn_a_00433] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Sleep affects declarative memory for emotional stimuli differently than it affects declarative memory for nonemotional stimuli. However, the interaction between specific sleep characteristics and emotional memory is not well understood. Recent studies on how sleep affects emotional memory have focused on rapid eye movement sleep (REM) but have not addressed non-REM sleep, particularly sleep spindles. This is despite the fact that sleep spindles are implicated in declarative memory as well as neural models of memory consolidation (e.g., hippocampal neural replay). Additionally, many studies examine a limited range of emotional stimuli and fail to disentangle differences in memory performance because of variance in valence and arousal. Here, we experimentally increase non-REM sleep features, sleep spindle density, and SWS, with pharmacological interventions using zolpidem (Ambien) and sodium oxybate (Xyrem) during daytime naps. We use a full spread of emotional stimuli to test all levels of valence and arousal. We find that increasing sleep spindle density increases memory discrimination (da) for highly arousing and negative stimuli without altering measures of bias (ca). These results indicate a broader role for sleep in the processing of emotional stimuli with differing effects based on arousal and valence, and they raise the possibility that sleep spindles causally facilitate emotional memory consolidation. These findings are discussed in terms of the known use of hypnotics in individuals with emotional mood disorders.
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Abstract
Sleep disturbance is common after traumatic brain injury (TBI). Insomnia, fatigue, and sleepiness are the most frequent post-TBI sleep complaints with narcolepsy (with or without cataplexy), sleep apnea (obstructive or central), periodic limb movement disorder, and parasomnias occurring less commonly. In addition, depression, anxiety, and pain are common TBI comorbidities with substantial influence on sleep quality. Diagnosis of sleep disorders after TBI may involve polysomnography, multiple sleep latency testing, or actigraphy. Treatment is disorder-specific and includes the use of medications, continuous positive airway pressure, or behavioral modifications. Unfortunately, treatment of sleep disorders associated with TBI often does not improve sleepiness or neuropsychologic function.
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Affiliation(s)
- Mari Viola-Saltzman
- Pritzker School of Medicine, NorthShore University Health System, Department of Neurology, 2650 Ridge Avenue, Evanston, IL 60201, USA
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Lopez MR, Cheng JY, Kanner AM, Carvalho DZ, Diamond JA, Wallace DM. Insomnia symptoms in South Florida military veterans with epilepsy. Epilepsy Behav 2013; 27:159-64. [PMID: 23434722 DOI: 10.1016/j.yebeh.2013.01.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 01/10/2013] [Accepted: 01/12/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite the high prevalence of insomnia in veterans with epilepsy, it remains understudied. Our aim was to identify the associations of insomnia with epilepsy, comorbidities, and treatment-related variables in South Florida veterans. METHODS We performed a cross-sectional analysis of veterans attending an epilepsy clinic over 18 months. Participants completed standardized assessments of seizure and sleep. Insomnia was defined as 1) difficulty with sleep onset, maintenance, or premature awakenings with daytime consequences or 2) sedative-hypnotic use on most nights of the previous month. RESULTS One hundred sixty-five veterans (87% male, age 56 ± 15 years) were included: 66 reporting insomnia (40%). In logistic regression analysis, insomnia was significantly associated with post-traumatic seizure etiology, lamotrigine prescription, and mood and psychotic disorders. Female gender and levetiracetam treatment were associated with lower odds for insomnia. CONCLUSION Insomnia was associated with post-traumatic epilepsy, mood/psychotic comorbidities, and antiepileptic regimen. Insomnia represents an under-recognized opportunity to improve comprehensive epilepsy care.
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Affiliation(s)
- M R Lopez
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
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Griesbach GS, Tio DL, Nair S, Hovda DA. Temperature and heart rate responses to exercise following mild traumatic brain injury. J Neurotrauma 2013; 30:281-91. [PMID: 23009619 DOI: 10.1089/neu.2012.2616] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We have previously reported that mild fluid percussion injury (FPI) is associated with a heightening of the hypothalamic-pituitary-adrenal axis response during the first post-injury weeks. This is the same time period when rehabilitative exercise has been strongly suggested to be ineffective. Here, we explored whether cardiac and temperature autonomic function may also be compromised during this early post-injury period. Following an FPI or sham injury, rats were exercised with forced (fRW) or voluntary (vRW) running wheels on post-injury days 0-4 and 7-11. Results indicated that overall activity levels were decreased and circadian rhythm was affected after FPI. Autonomic disruptions became evident when exercise was introduced, and these disruptions were dependent upon the characteristics of exercise. Elevations in heart rate (HR) and core body temperature (CBT) were observed as a response to vRW and fRW. FPI animals had more pronounced increases in HR as a result of vRW. Likewise, increases in HR were observed with fRW in all animals. A strong stress response has recently been associated with fRW exercise. FPI rats exposed to fRW were more responsive to experimental manipulations and had higher a CBT after the FRW session. The results suggest that subacute exercise, particularly if linked to a strong stress response, may be counterproductive. Here we show that cardiac and temperature autonomic function are compromised during the subacute period following a mild TBI.
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Affiliation(s)
- Grace S Griesbach
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-7039, USA.
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Traumatic Brain Injury and Disturbed Sleep and Wakefulness. Neuromolecular Med 2012; 14:205-12. [DOI: 10.1007/s12017-012-8178-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 03/03/2012] [Indexed: 11/26/2022]
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