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Lee Y, Park D, Kim S, Shin C, Suh S. Association of nightmares with cardio-cerebrovascular disease, hypertension and hyperlipidemia in older adults: A population-based cross-sectional study. J Psychosom Res 2024; 182:111669. [PMID: 38788282 DOI: 10.1016/j.jpsychores.2024.111669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/04/2024] [Accepted: 04/13/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE This cross-sectional study investigated the relationship of nightmares with cardio-cerebrovascular disease (CVD), hypertension and hyperlipidemia which are major preceding diseases of CVD in older adults. METHODS Participants (n = 2824; mean age 63.6 ± 6.6 years, females 49.3%) completed the Disturbing Dream and Nightmare Severity Index (DDNSI), which was used to divide the sample into either the Nightmare or Non-Nightmare group (cut-off score ≥ 10). Demographic information, history of CVD (cerebrovascular disease, myocardial infarction, congestive heart failure, coronary artery disease, and arrhythmia), hypertension, hyperlipidemia, and self-report questionnaires about stress (Perceived Stress Scale), depression (Beck Depression Inventory), sleep quality (Pittsburgh Sleep Quality Index), and insomnia symptoms were also collected. RESULTS Among the sample, 379 participants (13.4%) reported experiencing nightmares more than once a year, and 73 participants (2.6%) were classified as having nightmare disorder based on DDNSI scores (≥10). 11.3% of participants (n = 319) reported having more than one CVD. Approximately half of the participants reported a history of hypertension (52.1%, n = 1471) and hyperlipidemia (47.7%, n = 1346). Logistic regression analysis indicated the Nightmare group was 2.04 times at higher risk for hyperlipidemia (OR = 2.04, 95% CI 1.22-3.40, p = .006) after controlling for covariates compared to the Non-Nightmare group. Although non-significant, there was a trend toward a higher risk of hypertension in the Nightmare group (OR = 1.67, 95% CI 0.99-2.84, p = .056). CONCLUSIONS Results of this study indicate frequent nightmares in older adults may be associated with hyperlipidemia, which are risk factors for CVD. Further studies are needed to explore nightmares' directionality and health consequences in an aging population.
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Affiliation(s)
- Youjin Lee
- Department of Psychology, Sungshin Women's University, Seoul, Republic of Korea
| | - Dasom Park
- Department of Psychology, Sungshin Women's University, Seoul, Republic of Korea
| | - Soriul Kim
- Institute of Human Genomic Study, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Chol Shin
- Institute of Human Genomic Study, College of Medicine, Korea University, Seoul, Republic of Korea; Biomedical Research Center, Korea University Ansan Hospital, Ansan, Gyeonggi, Republic of Korea.
| | - Sooyeon Suh
- Department of Psychology, Sungshin Women's University, Seoul, Republic of Korea.
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Tomacsek V, Blaskovich B, Király A, Reichardt R, Simor P. Altered parasympathetic activity during sleep and emotionally arousing wakefulness in frequent nightmare recallers. Eur Arch Psychiatry Clin Neurosci 2024; 274:265-277. [PMID: 36862312 PMCID: PMC10914885 DOI: 10.1007/s00406-023-01573-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/13/2023] [Indexed: 03/03/2023]
Abstract
Nightmare disorder is characterized by dysfunctional emotion regulation and poor subjective sleep quality reflected in pathophysiological features such as abnormal arousal processes and sympathetic influences. Dysfunctional parasympathetic regulation, especially before and during rapid eye movement (REM) phases, is assumed to alter heart rate (HR) and its variability (HRV) of frequent nightmare recallers (NM). We hypothesized that cardiac variability is attenuated in NMs as opposed to healthy controls (CTL) during sleep, pre-sleep wakefulness and under an emotion-evoking picture-rating task. Based on the polysomnographic recordings of 24 NM and 30 CTL participants, we examined HRV during pre-REM, REM, post-REM and slow wave sleep, separately. Additionally, electrocardiographic recordings of resting state before sleep onset and under an emotionally challenging picture-rating task were also analyzed. Applying repeated measures analysis of variance (rmANOVA), a significant difference was found in the HR of NMs and CTLs during nocturnal segments but not during resting wakefulness, suggesting autonomic dysregulation, specifically during sleep in NMs. As opposed to the HR, the HRV values were not significantly different in the rmANOVA in the two groups, implying that the extent of parasympathetic dysregulation on a trait level might depend on the severeness of dysphoric dreaming. Nonetheless, in the group comparisons, the NM group showed increased HR and reduced HRV during the emotion-evoking picture-rating task, which aimed to model the nightmare experience in the daytime, indicating disrupted emotion regulation in NMs under acute distress. In conclusion, trait-like autonomic changes during sleep and state-like autonomic responses to emotion-evoking pictures indicate parasympathetic dysregulation in NMs.
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Affiliation(s)
- Vivien Tomacsek
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
- Institute of Psychology, ELTE Eötvös Loránd University, 46 Izabella Street, Budapest, 1064, Hungary.
| | - Borbála Blaskovich
- Institute of Medical Psychology, Faculty of Medicine, Ludwig Maximilian University of Munich, Munich, Germany
| | - Anna Király
- National Institute of Locomotor Diseases and Disabilities, Budapest, Hungary
| | - Richárd Reichardt
- Institute of Education and Psychology at Szombathely, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Péter Simor
- Institute of Psychology, ELTE Eötvös Loránd University, 46 Izabella Street, Budapest, 1064, Hungary
- UR2NF, Neuropsychology and Functional Neuroimaging Research Unit at CRCN-Center for Research in Cognition and Neurosciences and UNI-ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Campbell AA, Taylor KA, Augustine AV, Sherwood A, Wu JQ, Beckham JC, Hoerle JM, Ulmer CS. Nightmares: an independent risk factor for cardiovascular disease? Sleep 2023; 46:zsad089. [PMID: 36996027 DOI: 10.1093/sleep/zsad089] [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: 02/13/2023] [Indexed: 03/31/2023] Open
Abstract
STUDY OBJECTIVES Prior work has established associations between post-traumatic stress disorder (PTSD), disrupted sleep, and cardiovascular disease (CVD), but few studies have examined health correlates of nightmares beyond risks conferred by PTSD. This study examined associations between nightmares and CVD in military veterans. METHODS Participants were veterans (N = 3468; 77% male) serving since September 11, 2001, aged 38 years (SD = 10.4); approximately 30% were diagnosed with PTSD. Nightmare frequency and severity were assessed using the Davidson Trauma Scale (DTS). Self-reported medical issues were assessed using the National Vietnam Veterans Readjustment Study Self-report Medical Questionnaire. Mental health disorders were established using the Structured Clinical Interview for DSM-IV. The sample was stratified by the presence or absence of PTSD. Within-group associations between nightmare frequency and severity and self-reported CVD conditions, adjusting for age, sex, race, current smoking, depression, and sleep duration. RESULTS Frequent and severe nightmares during the past week were endorsed by 32% and 35% of participants, respectively. Those endorsing nightmares that were frequent, severe, and the combination thereof were more likely to also evidence high blood pressure (ORs 1.42, OR 1.56, and OR 1.47, respectively) and heart problems (OR 1.43, OR 1.48, and OR 1.59, respectively) after adjusting for PTSD diagnosis and other covariates. CONCLUSIONS Nightmare frequency and severity among veterans are associated with cardiovascular conditions, even after controlling for PTSD diagnosis. Study findings suggest that nightmares may be an independent risk factor for CVD. Additional research is needed to validate these findings using confirmed diagnoses and explore potential mechanisms.
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Affiliation(s)
| | - Kenneth A Taylor
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke University School of Medicine, Duke Clinical Research Institute, Durham, NC, USA
| | - Ann V Augustine
- Durham Veterans Affairs (VA) Healthcare System, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jade Q Wu
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jean C Beckham
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Veterans Affairs VA Mid-Atlantic MIRECC Workgroup, Durham, NC, USA
| | - Jeffrey M Hoerle
- Veterans Affairs VA Mid-Atlantic MIRECC Workgroup, Durham, NC, USA
| | - Christi S Ulmer
- Durham Veterans Affairs (VA) Healthcare System, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Durham Veterans Affairs Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, NC, USA
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Mäder T, Oliver KI, Daffre C, Kim S, Orr SP, Lasko NB, Seo J, Kleim B, Pace-Schott EF. Autonomic activity, posttraumatic and nontraumatic nightmares, and PTSD after trauma exposure. Psychol Med 2023; 53:731-740. [PMID: 34127168 PMCID: PMC9121310 DOI: 10.1017/s0033291721002075] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Nightmares are a hallmark symptom of posttraumatic stress disorder (PTSD). This strong association may reflect a shared pathophysiology in the form of altered autonomic activity and increased reactivity. Using an acoustic startle paradigm, we investigated the interrelationships of psychophysiological measures during wakefulness and PTSD diagnosis, posttraumatic nightmares, and nontraumatic nightmares. METHODS A community sample of 122 trauma survivors were presented with a series of brief loud tones, while heart rate (HRR), skin conductance (SCR), and orbicularis oculi electromyogram (EMGR) responses were measured. Prior to the tone presentations, resting heart rate variability (HRV) was assessed. Nightmares were measured using nightmare logs. Three dichotomous groupings of participants were compared: (1) current PTSD diagnosis (n = 59), no PTSD diagnosis (n = 63), (2) those with (n = 26) or without (n = 96) frequent posttraumatic nightmares, and (3) those with (n = 22) or without (n = 100) frequent nontraumatic nightmares. RESULTS PTSD diagnosis was associated with posttraumatic but not with nontraumatic nightmares. Both PTSD and posttraumatic nightmares were associated with a larger mean HRR to loud tones, whereas nontraumatic nightmare frequency was associated with a larger SCR. EMGR and resting HRV were not associated with PTSD diagnosis or nightmares. CONCLUSIONS Our findings suggest a shared pathophysiology between PTSD and posttraumatic nightmares in the form of increased HR reactivity to startling tones, which might reflect reduced parasympathetic tone. This shared pathophysiology could explain why PTSD is more strongly related to posttraumatic than nontraumatic nightmares, which could have important clinical implications.
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Affiliation(s)
- Thomas Mäder
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Katelyn I. Oliver
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Carolina Daffre
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Sophie Kim
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Scott P. Orr
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, USA
| | - Natasha B. Lasko
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, USA
| | - Jeehye Seo
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, USA
- Department of Psychological & Brain Sciences, University of Massachusetts, Amherst, MA, USA
| | - Birgit Kleim
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- Neuroscience Centre Zurich, University of Zurich, Zurich, Switzerland
| | - Edward Franz Pace-Schott
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, USA
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Schwartz S, Clerget A, Perogamvros L. Enhancing imagery rehearsal therapy for nightmares with targeted memory reactivation. Curr Biol 2022; 32:4808-4816.e4. [PMID: 36306786 DOI: 10.1016/j.cub.2022.09.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/14/2022] [Accepted: 09/15/2022] [Indexed: 11/21/2022]
Abstract
Nightmare disorder (ND) is characterized by dreams with strong negative emotions occurring during rapid eye movement (REM) sleep. ND is mainly treated by imagery rehearsal therapy (IRT), where the patients are asked to change the negative story line of their nightmare to a more positive one. We here used targeted memory reactivation (TMR) during REM sleep to strengthen IRT-related memories and accelerate remission of ND. Thirty-six patients with ND were asked to perform an initial IRT session and, while they generated a positive outcome of their nightmare, half of the patients were exposed to a sound (TMR group), while no such pairing took place for the other half (control group). During the next 2 weeks, all patients performed IRT every evening at home and were exposed to the sound during REM sleep with a wireless headband, which automatically detected sleep stages. The frequency of nightmares per week at 2 weeks was used as the primary outcome measure. We found that the TMR group had less frequent nightmares and more positive dream emotions than the control group after 2 weeks of IRT and a sustained decrease of nightmares after 3 months. By demonstrating the effectiveness of TMR during sleep to potentiate therapy, these results have clinical implications for the management of ND, with relevance to other psychiatric disorders too. Additionally, these findings show that TMR applied during REM sleep can modulate emotions in dreams.
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Affiliation(s)
- Sophie Schwartz
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland; Swiss Center for Affective Sciences, University of Geneva, 1202 Geneva, Switzerland
| | - Alice Clerget
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland
| | - Lampros Perogamvros
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland; Swiss Center for Affective Sciences, University of Geneva, 1202 Geneva, Switzerland; Center for Sleep Medicine, Geneva University Hospitals, 1225 Geneva, Switzerland; Department of Psychiatry, Geneva University Hospitals, 1225 Geneva, Switzerland.
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Bogdány T, Perakakis P, Bódizs R, Simor P. The heartbeat evoked potential is a questionable biomarker in nightmare disorder: A replication study. Neuroimage Clin 2022; 33:102933. [PMID: 34990964 PMCID: PMC8743245 DOI: 10.1016/j.nicl.2021.102933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/12/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022]
Abstract
Perogamvros et al. (2013) examined heart beat evoked potential (HEP) in nightmare sufferers. Increased HEP was proposed to be a robust biomarker in nightmare disorder. We aimed to replicate the original study in two separate and larger databases. We did not confirm the original finding showing differential HEP in REM sleep. Our data cast doubts on the utility of HEP as a biomarker in nightmare disorder.
Frequent nightmares are highly prevalent and constitute a risk factor for a wide range of psychopathological conditions. Despite its prevalence and clinical relevance however, the pathophysiological mechanisms of nightmares are poorly understood. A recent study (Perogamvros et, al 2019) examined the heart beat evoked potential (HEP) in a small group of nightmare sufferers (N = 11) and matched healthy controls (N = 11) and observed markedly different (Hedges’ g = 1.42 [0.62–2.22]) HEP response across the groups during Rapid Eye Movement (REM) sleep. Moreover, the HEP correlated with depression scores in the nightmare group only. The authors concluded that the HEP in REM sleep could be used as a trait-like biomarker reflecting pathological emotional-and sleep regulation in nightmare disorder. To replicate the above study, we performed the same analyses of HEPs in two separate, and larger databases comprising the polysomnographic recordings of nightmare sufferers and matched controls (NStudy 1 = 39 ; NStudy 2 = 41). In contrast to the original findings, we did not observe significant differences in HEP across the two groups in either of the two databases. Moreover, we found no associations between depression scores and HEP amplitudes in the relevant spatiotemporal cluster. Our data cast doubts on the utility of HEP as a biomarker in the diagnostic and treatment procedures of nightmare disorder and suggests that the interpretation of HEP as a marker of impaired arousal and emotional processing during REM sleep is premature and requires further validation.
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Affiliation(s)
- Tamás Bogdány
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Institute of Psychology, ELTE, Eötvös Loránd University, Budapest, Hungary
| | - Pandelis Perakakis
- Department of Social, Work, and Differential Psychology, Complutense University of Madrid, Spain
| | - Róbert Bódizs
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary; National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Péter Simor
- Institute of Psychology, ELTE, Eötvös Loránd University, Budapest, Hungary; UR2NF, Neuropsychology and Functional Neuroimaging Research Unit at CRCN - Center for Research in Cognition and Neurosciences and UNI - ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), Brussels, Belgium.
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7
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Ding L, Chen B, Dai Y, Li Y. A meta-analysis of the first-night effect in healthy individuals for the full age spectrum. Sleep Med 2022; 89:159-165. [PMID: 34998093 DOI: 10.1016/j.sleep.2021.12.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/12/2021] [Accepted: 12/14/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The first-night effect (FNE) affects the accuracy of polysomnography (PSG) findings. However, the levels of FNE in different ages are unclear. METHODS We searched PubMed, Cochrane Library, Embase and Web of Science. The studies that reported sleep parameters by PSG for at least 2 consecutive nights from healthy individuals were included. The weighted mean differences were used to assess the effect size of differences in each sleep parameters between the first and second nights, as well as between the second and the third. RESULTS A total of 53 studies from 1422 subjects with mean age of 9.2-85.5 years were included. Meta-analyses showed that prolonged sleep onset latency, wake time after sleep onset and rapid eye movement sleep (REM) latency, accompanied by decreased total sleep time, sleep efficiency, and REM and increased non-rapid eye movement sleep stage 1 (N1) during the first night compared to the second (all P-value ≤ 0.001). No significant differences were observed in N2 and slow wave sleep, apnea-hypopnea index or periodic limb movement index (all P-value > 0.5). A non-linear association between FNE and age was observed: young adults (age 20-29 years) had the lowest level of FNE compared to other age ranges. Moreover, no significant differences were observed in most sleep parameters between the second and third night except more N2 and less REM in the second night (both P-value < 0.05). CONCLUSIONS The FNE exists in most cases but only in the first night of PSG recording and is less pronounced among young adults.
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Affiliation(s)
- Lei Ding
- Department of Sleep Medicine, Shantou University Mental Health Center, Shantou, China; Sleep Medicine Center, Shantou University Medical College, Shantou, China
| | - Baixin Chen
- Department of Sleep Medicine, Shantou University Mental Health Center, Shantou, China
- Sleep Medicine Center, Shantou University Medical College, Shantou, China
| | - Yanyuan Dai
- Department of Sleep Medicine, Shantou University Mental Health Center, Shantou, China; Sleep Medicine Center, Shantou University Medical College, Shantou, China
| | - Yun Li
- Department of Sleep Medicine, Shantou University Mental Health Center, Shantou, China
- Sleep Medicine Center, Shantou University Medical College, Shantou, China
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Nardelli M, Catrambone V, Grandi G, Banfi T, Bruno RM, Scilingo EP, Faraguna U, Valenza G. Activation of brain-heart axis during REM sleep: a trigger for dreaming. Am J Physiol Regul Integr Comp Physiol 2021; 321:R951-R959. [PMID: 34704848 DOI: 10.1152/ajpregu.00306.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Dreams may be recalled after awakening from sleep following a defined electroencephalographic pattern that involves local decreases in low-frequency activity in the posterior cortical regions. While a dreaming experience implies bodily changes at many organ-, system-, and timescale-levels, the entity and causal role of such peripheral changes in a conscious dream experience are unknown. We performed a comprehensive, causal, multivariate analysis of physiological signals acquired during REM sleep at night, including high-density EEG and peripheral dynamics including electrocardiography and blood pressure. In this preliminary study, we investigated multiple recalls and non-recalls of dream experiences using data from nine healthy volunteers. The aim was not only to investigate the changes in central and autonomic dynamics associated with dream recalls and non-recalls, but also to characterize the central-peripheral dynamical and (causal) directional interactions, and the temporal relations of the related arousals upon awakening. We uncovered a brain-body network that drives a conscious dreaming experience that acts with specific interaction and time delays. Such a network is sustained by the blood pressure dynamics and the increasing functional information transfer from the neural heartbeat regulation to the brain. We conclude that bodily changes play a crucial and causative role in a conscious dream experience during REM sleep.
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Affiliation(s)
- Mimma Nardelli
- Bioengineering and Robotics Research Centre E. Piaggio and Department of Information Engineering, University of Pisa, Italy
| | - Vincenzo Catrambone
- Bioengineering and Robotics Research Centre E. Piaggio and Department of Information Engineering, University of Pisa, Italy
| | - Giulia Grandi
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Italy
| | - Tommaso Banfi
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Italy
| | - Rosa Maria Bruno
- INSERM U970 Team 7, Paris Cardiovascular Research Centre - PARCC, University Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Enzo Pasquale Scilingo
- Bioengineering and Robotics Research Centre E. Piaggio and Department of Information Engineering, University of Pisa, Italy
| | - Ugo Faraguna
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Italy.,Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Gaetano Valenza
- Bioengineering and Robotics Research Centre E. Piaggio and Department of Information Engineering, University of Pisa, Italy
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Otaiku AI. Dream Content Predicts Motor and Cognitive Decline in Parkinson's Disease. Mov Disord Clin Pract 2021; 8:1041-1051. [PMID: 34631940 DOI: 10.1002/mdc3.13318] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/08/2021] [Accepted: 07/22/2021] [Indexed: 12/22/2022] Open
Abstract
Background Dream content alterations in Parkinson's disease (PD) are associated with motor and cognitive dysfunction cross-sectionally. Although recent studies suggest abnormal dream content in PD might also predict cognitive decline, the relationship between dream content and motor decline in PD remains unknown. Objective To investigate whether abnormal dream content in PD predicts both motor and cognitive decline. Methods Data were obtained from the Parkinson's Progression Markers Initiative cohort study. Patients were evaluated at baseline and at the 60-month follow-up, with validated clinical scales, including the REM Sleep Behavior Disorder Screening Questionnaire (RBDSQ), Montreal Cognitive Assessment (MoCA), and the Movement Disorder Society-Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS III). Patients were dichotomized using RBDSQ item 2, which inquires whether they frequently experience aggression in their dreams. Regression analyses were used to assess whether frequent aggressive dreams at baseline predicted longitudinal changes in MDS-UPDRS III and MoCA scores as well as progression to Hoehn and Yahr stage 3 (H&Y ≥ 3) and cognitive impairment. Results Of the patients, 58/224 (25.9%) reported frequent aggressive dreams at baseline. Aggressive dreams predicted a faster increase in MDS-UPDRS III scores (β = 4.64; P = 0.007) and a faster decrease in MoCA scores (β = -1.49; P = 0.001). Furthermore, they conferred a 6-fold and 2-fold risk for progressing to H&Y ≥ 3 (odds ratio [OR] = 5.82; P = 0.005) and cognitive impairment (OR, 2.35; P = 0.023) within 60 months. These associations remained robust when adjusting for potential confounders. Conclusions This study demonstrates for the first time that frequent aggressive dreams in newly diagnosed PD may independently predict early motor and cognitive decline.
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Affiliation(s)
- Abidemi I Otaiku
- Department of Neurology Queen Elizabeth Hospital Birmingham Birmingham United Kingdom.,Centre for Human Brain Health University of Birmingham Birmingham United Kingdom
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10
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Rentz LE, Ulman HK, Galster SM. Deconstructing Commercial Wearable Technology: Contributions toward Accurate and Free-Living Monitoring of Sleep. SENSORS (BASEL, SWITZERLAND) 2021; 21:5071. [PMID: 34372308 PMCID: PMC8348972 DOI: 10.3390/s21155071] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/09/2021] [Accepted: 07/23/2021] [Indexed: 01/07/2023]
Abstract
Despite prolific demands and sales, commercial sleep assessment is primarily limited by the inability to "measure" sleep itself; rather, secondary physiological signals are captured, combined, and subsequently classified as sleep or a specific sleep state. Using markedly different approaches compared with gold-standard polysomnography, wearable companies purporting to measure sleep have rapidly developed during recent decades. These devices are advertised to monitor sleep via sensors such as accelerometers, electrocardiography, photoplethysmography, and temperature, alone or in combination, to estimate sleep stage based upon physiological patterns. However, without regulatory oversight, this market has historically manufactured products of poor accuracy, and rarely with third-party validation. Specifically, these devices vary in their capacities to capture a signal of interest, process the signal, perform physiological calculations, and ultimately classify a state (sleep vs. wake) or sleep stage during a given time domain. Device performance depends largely on success in all the aforementioned requirements. Thus, this review provides context surrounding the complex hardware and software developed by wearable device companies in their attempts to estimate sleep-related phenomena, and outlines considerations and contributing factors for overall device success.
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Affiliation(s)
| | | | - Scott M. Galster
- Human Performance Innovation Center, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26505, USA; (L.E.R.); (H.K.U.)
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Marquis LP, Julien SH, Daneault V, Blanchette-Carrière C, Paquette T, Carr M, Soucy JP, Montplaisir J, Nielsen T. Local Neuronal Synchronization in Frequent Nightmare Recallers and Healthy Controls: A Resting-State Functional Magnetic Resonance Imaging Study. Front Neurosci 2021; 15:645255. [PMID: 33815047 PMCID: PMC8012764 DOI: 10.3389/fnins.2021.645255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/25/2021] [Indexed: 11/25/2022] Open
Abstract
Nightmares are highly dysphoric dreams that are well-remembered upon awakening. Frequent nightmares have been associated with psychopathology and emotional dysregulation, yet their neural mechanisms remain largely unknown. Our neurocognitive model posits that nightmares reflect dysfunction in a limbic-prefrontal circuit comprising medial prefrontal and anterior cingulate cortices, hippocampus, and amygdala. However, there is a paucity of studies that used brain imaging to directly test the neural correlates of nightmares. One such study compared the regional homogeneity (ReHo) of resting-state functional magnetic resonance imaging blood-oxygen level-dependent signals between frequent nightmare recallers and controls. The main results were greater regional homogeneity in the left anterior cingulate cortex and right inferior parietal lobule for the nightmare recallers than for the controls. In the present study, we aimed to document the ReHo correlates of frequent nightmares using several nightmare severity measures. We acquired resting-state functional magnetic resonance imaging data from 18 frequent nightmare recallers aged 18-35 (3 males and 15 females) and 18 age- and sex-matched controls, as well as retrospective and prospective disturbed dreaming frequency estimates and scores on the Nightmare Distress Questionnaire. While there were inconsistent results for our different analyses (group comparisons, correlational analyses for frequency estimates/Nightmare Distress scores), our results suggest that nightmares are associated with altered ReHo in frontal (medial prefrontal and inferior frontal), parietal, temporal and occipital regions, as well as some subcortical regions (thalamus). We also found a positive correlation between retrospective disturbed dreaming frequency estimates and ReHo values in the hippocampus. These findings are mostly in line with a recent SPECT study from our laboratory. Our results point to the possibility that a variety of regions, including but not limited to the limbic-prefrontal circuit of our neurocognitive model, contribute to nightmare formation.
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Affiliation(s)
- Louis-Philippe Marquis
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM – Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Sarah-Hélène Julien
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM – Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Véronique Daneault
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM – Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Cloé Blanchette-Carrière
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM – Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Tyna Paquette
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM – Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Michelle Carr
- Department of Psychiatry, Sleep & Neurophysiology Research Laboratory, University of Rochester Medical Center, Rochester, NY, United States
| | | | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM – Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montreal, QC, Canada
| | - Tore Nielsen
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM – Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montreal, QC, Canada
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12
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Lin YQ, Lin ZX, Wu YX, Wang L, Zeng ZN, Chen QY, Wang L, Xie XL, Wei SC. Reduced Sleep Duration and Sleep Efficiency Were Independently Associated With Frequent Nightmares in Chinese Frontline Medical Workers During the Coronavirus Disease 2019 Outbreak. Front Neurosci 2021; 14:631025. [PMID: 33551736 PMCID: PMC7855305 DOI: 10.3389/fnins.2020.631025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/21/2020] [Indexed: 12/17/2022] Open
Abstract
Objectives Nightmares were related to emotion and behavioral problems and also emerged as one of the core features of post-traumatic stress disorder (PTSD). Our study aimed to investigate the associations of frequent nightmares with sleep duration and sleep efficiency among frontline medical workers in Wuhan during the coronavirus disease 2019 (COVID-19) outbreak. Methods A total of 528 health-care workers from the province of Fujian providing medical aid in Wuhan completed the online questionnaires. There were 114 doctors and 414 nurses. The age, sex, marital status, and work situation were recorded. A battery of scales including the Pittsburgh Sleep Quality Index (PSQI) and the 12-item General Health Questionnaire (GHQ-12) were used to evaluate subjects’ sleep and general mental health. Frequent nightmares were defined as the response of at least once a week in the item of “nightmare” of PSQI. Results Frequent nightmares were found in 27.3% of subjects. The frequent nightmare group had a higher score of PSQI-sleep duration and PSQI-habitual sleep efficiency (frequent nightmares vs. non-frequent nightmares: PSQI-sleep duration, 1.08 ± 0.97 vs. 0.74 ± 0.85, P < 0.001; PSQI-habitual sleep efficiency, 1.08 ± 1.10 vs. 0.62 ± 0.88, P < 0.001). Reduced sleep duration and reduced sleep efficiency were independently associated with frequent nightmares after adjustment for age, sex, poor mental health, and regular sleeping medication use (reduced sleep duration: OR = 1.96, 95% CI = 1.07–3.58, P = 0.029; reduced sleep efficiency: OR = 2.17, 95% CI = 1.09–4.32, P = 0.027). Subjects with both reduced sleep duration and sleep efficiency were also associated with frequent nightmares (OR = 2.70, 95% CI = 1.57–4.65, P < 0.001). Conclusion The present study found that sleep duration and sleep efficiency were both independently associated with frequent nightmares among frontline medical workers in Wuhan during the COVID-19 pandemic. We should pay attention to nightmares and even the ensuing PTSD symptoms among subjects with reduced sleep duration or sleep efficiency facing potential traumatic exposure.
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Affiliation(s)
- Yi-Qi Lin
- Department of Sleep Center, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Ze-Xin Lin
- Xinjiang Medical University Second Clinical College, Ürümqi, China
| | - Yong-Xi Wu
- Department of Sleep Center, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Lin Wang
- Department of Sleep Center, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Administrative Office, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Zhao-Nan Zeng
- Department of Sleep Center, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Center for Experimental Research in Clinical Medicine, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Qiu-Yang Chen
- Department of Sleep Center, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,The First Operating Room, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Ling Wang
- Department of Sleep Center, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Pharmacy, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Xiao-Liang Xie
- Department of Sleep Center, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,The First Operating Room, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Shi-Chao Wei
- Department of Sleep Center, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
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13
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Park D, Kim S, Shin C, Suh S. Prevalence of and factors associated with nightmares in the elderly in a population based cohort study. Sleep Med 2020; 78:15-23. [PMID: 33373930 DOI: 10.1016/j.sleep.2020.11.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 11/23/2020] [Accepted: 11/29/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Nightmares are extremely unpleasant and vivid recurring dreams that are accompanied with awakening during sleep. However, earlier studies were mostly conducted with children and adults, with very few studies on nightmares in older adults. This population-based study aims to investigate the prevalence of nightmares and its associated factors nightmares in the elderly. METHODS This study utilized a subsample from the Korean Genome and Epidemiology Study (KoGES). Participants (n = 2940; mean age 63.71 ± 6.73) completed the questionnaires on nightmares (Disturbing Dream and Nightmare Severity Index; DDNSI), depression, suicidal ideation, sleep quality and stress. RESULTS Among the sample, 2.7% (n = 79) were classified into the nightmare group (NG), which was classified with DDNSI scores. In the age group over 70, prevalence of nightmares was 6.3% (n = 37), which was significantly higher than other age groups. Marital status, employment status and family income were associated with nightmares. Additionally, NG reported significantly more sleep problems, higher suicidal ideation, depression and stress compared to the non-nightmare group (N-NG). Logistic regression analyses results indicated that the NG was 4.35 times at higher risk for depression, and 3.16 higher risks for stress, and 3.45 higher risks for suicidal ideation compared to the N-NG after controlling for covariates. CONCLUSIONS Our results indicate that psychological and demographic factors are associated with nightmares in the elderly. Furthermore, this population-based cohort study showed the prevalence of nightmares increased after age 70, which suggests the need for further studies of nightmares in older populations.
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Affiliation(s)
- Dasom Park
- Department of Psychology, Sungshin Women's University, Seoul, Republic of Korea
| | - Soriul Kim
- Institute for Human Genomic Study, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Chol Shin
- Institute for Human Genomic Study, College of Medicine, Korea University, Seoul, Republic of Korea; Division of Pulmonary Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea.
| | - Sooyeon Suh
- Department of Psychology, Sungshin Women's University, Seoul, Republic of Korea.
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14
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Garbarino S, Lanteri P, Prada V, Falkenstein M, Sannita WG. Circadian Rhythms, Sleep, and Aging. J PSYCHOPHYSIOL 2020. [DOI: 10.1027/0269-8803/a000267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Abstract. Circadian mechanisms and the sleep-wakefulness rhythms guarantee survival, adaptation, efficient action in everyday life or in emergencies and well-being. Disordered circadian processes at central and/or cellular levels, sleep disorders, and unhealthy wakefulness/sleep rhythms can impair the physiological circadian organization and result in subjective, professional, or behavioral changes ranging from functional inadequacy to higher risks at work or on the road to medical relevance. Circadian rhythms and the sleep organization change ontogenetically; major changes result from normal aging and from the multiple diseases that are often associated. There are circular functional interactions involving sleep/sleep disorders, the autonomic and immune systems, and the functional changes in the circadian system due to aging that deserve attention but have been overlooked thus far.
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Affiliation(s)
- Sergio Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences, University of Genova, Polyclinic Hospital San Martino IRCCS, Genova, Italy
| | - Paola Lanteri
- Department of Diagnostics and Applied Technology, Neurophysiopathology Center, Fondazione IRCCS, Istituto Neurologico C. Besta, Milano, Italy
| | - Valeria Prada
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences, University of Genova, Polyclinic Hospital San Martino IRCCS, Genova, Italy
| | | | - Walter G. Sannita
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences, University of Genova, Polyclinic Hospital San Martino IRCCS, Genova, Italy
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15
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Blaskovich B, Reicher V, Gombos F, Spoormaker VI, Simor P. Hyperarousal captured in increased number of arousal events during pre-REM periods in individuals with frequent nightmares. J Sleep Res 2019; 29:e12965. [PMID: 31860778 DOI: 10.1111/jsr.12965] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/07/2019] [Accepted: 11/20/2019] [Indexed: 11/29/2022]
Abstract
The aim of this study was to investigate hyperarousal in individuals with frequent nightmares (NM participants) by calculating arousal events during nocturnal sleep. We hypothesized an increased number of arousals in NM participants compared with controls, especially during those periods where the probability of spontaneous arousal occurrence is already high, such as non-rapid eye movement to rapid eye movement transitions (pre-rapid eye movement periods). Twenty-two NM participants and 23 control participants spent two consecutive nights in our sleep laboratory, monitored by polysomnography. Arousal number and arousal length were calculated only for the second night, for 10 min before rapid eye movement (pre-rapid eye movement) and 10 min after rapid eye movement (post-rapid eye movement) periods, as well as non-rapid eye movement and rapid eye movement phases separately. Repeated-measures ANOVA model testing revealed significant Group (NM participants, controls) × Phase (pre-rapid eye movement, post-rapid eye movement) interaction in case of the number of arousals. Furthermore, post hoc analysis showed a significantly increased number of arousals during pre-rapid eye movement periods in NM participants, compared with controls, a difference that disappeared in post-rapid eye movement periods. We propose that focusing the analyses of arousals specifically on state transitory periods offers a unique perspective into the fragile balance between the sleep-promoting and arousal systems. This outlook revealed an increased number of arousals in NM participants, reflecting hyperarousal during pre-rapid eye movement periods.
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Affiliation(s)
- Borbála Blaskovich
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany.,Department of Cognitive Science, Budapest University of Technology and Economics, Budapest, Hungary
| | - Vivien Reicher
- Department of Ethology, Eötvös Loránd University, Budapest, Hungary
| | - Ferenc Gombos
- Department of General Psychology, Pázmány Péter Catholic University, Budapest, Hungary.,MTA-PPKE Adolescent Development Research Group, Budapest, Hungary
| | - Victor I Spoormaker
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany.,IUBH University of Applied Sciences, Erfurt, Germany
| | - Péter Simor
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.,Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
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16
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Simor P, Blaskovich B. The pathophysiology of nightmare disorder: Signs of impaired sleep regulation and hyperarousal. J Sleep Res 2019; 28:e12867. [PMID: 31094047 DOI: 10.1111/jsr.12867] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Péter Simor
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.,Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary
| | - Borbála Blaskovich
- Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary.,Department of Cognitive Science, Budapest University of Technology and Economics, Budapest, Hungary
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17
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18
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Agorastos A, Heinig A, Stiedl O, Hager T, Sommer A, Müller JC, Schruers KR, Wiedemann K, Demiralay C. Vagal effects of endocrine HPA axis challenges on resting autonomic activity assessed by heart rate variability measures in healthy humans. Psychoneuroendocrinology 2019; 102:196-203. [PMID: 30579237 DOI: 10.1016/j.psyneuen.2018.12.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/26/2018] [Accepted: 12/12/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND The hypothalamic-pituitary-adrenal axis (HPA axis) and the autonomic nervous system (ANS) are considered to play the most crucial role in the pathophysiology of stress responsiveness and are increasingly studied together. However, only few studies have simultaneously assessed HPA axis and ANS activity to investigate their direct interaction in pathophysiology, while no study so far has assessed the dynamic interplay between the two systems in healthy subjects through endocrine challenges. METHODS The present study assessed the direct effects of overnight pharmacoendocrine HPA axis challenges with dexamethasone (suppression) and metyrapone (stimulation) on ANS activity at rest as determined by linear and nonlinear measures of heart rate variability (HRV) in 39 young healthy individuals. RESULTS Findings indicated significant effects of metyrapone, but not dexamethasone on autonomic activity at rest based on HRV measures. HRV after metyrapone was overall significantly reduced in comparison to baseline or post-dexamethasone conditions, while the combined metyrapone-related reduction of HRV measures RMSSD, NN50(%) and HF(%) with concomitant increase of the unifractal scaling coefficient αfast value jointly indicated a specifically diminished vagal activity. CONCLUSIONS We provide first data that HPA axis stimulation (metyrapone) is associated with reduced vagal tone, while HPA axis suppression (dexamethasone) has no effect on autonomic modulation of heart function. Our results support a vital role of the parasympathetic nervous system in the interplay between ANS and HPA axis and, thus, in the modulation of stress-related cardiovascular responsiveness and the susceptibility to stress-related disorders.
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Affiliation(s)
- Agorastos Agorastos
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, D-20246, Hamburg, Germany; Department of Psychiatry, Division of Neurosciences, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, GR-54124, Thessaloniki, Greece.
| | - Alexandra Heinig
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, D-20246, Hamburg, Germany
| | - Oliver Stiedl
- Center for Neurogenomics and Cognitive Research, VU University Amsterdam, NL-1081, HV, Amsterdam, the Netherlands; Department of Health, Safety and Environment, VU University Amsterdam, NL-1081, BT, Amsterdam, the Netherlands
| | - Torben Hager
- Center for Neurogenomics and Cognitive Research, VU University Amsterdam, NL-1081, HV, Amsterdam, the Netherlands
| | - Anne Sommer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, D-20246, Hamburg, Germany
| | - Jana C Müller
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, D-20246, Hamburg, Germany
| | - Koen R Schruers
- School of Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, NL-6200 MD, Maastricht, the Netherlands
| | - Klaus Wiedemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, D-20246, Hamburg, Germany
| | - Cüneyt Demiralay
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, D-20246, Hamburg, Germany
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19
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Paul F, Alpers GW, Reinhard I, Schredl M. Nightmares do result in psychophysiological arousal: A multimeasure ambulatory assessment study. Psychophysiology 2019; 56:e13366. [DOI: 10.1111/psyp.13366] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 01/18/2019] [Accepted: 02/22/2019] [Indexed: 01/23/2023]
Affiliation(s)
- Franc Paul
- Central Institute of Mental Health Medical Faculty Mannheim/Heidelberg University Mannheim Germany
- Department of Psychology, Clinical and Biological Psychology and Psychotherapy, School of Social Sciences University of Mannheim Mannheim Germany
| | - Georg W. Alpers
- Department of Psychology, Clinical and Biological Psychology and Psychotherapy, School of Social Sciences University of Mannheim Mannheim Germany
| | - Iris Reinhard
- Central Institute of Mental Health Medical Faculty Mannheim/Heidelberg University Mannheim Germany
| | - Michael Schredl
- Central Institute of Mental Health Medical Faculty Mannheim/Heidelberg University Mannheim Germany
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20
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Perogamvros L, Park HD, Bayer L, Perrault AA, Blanke O, Schwartz S. Increased heartbeat-evoked potential during REM sleep in nightmare disorder. NEUROIMAGE-CLINICAL 2019; 22:101701. [PMID: 30739843 PMCID: PMC6370851 DOI: 10.1016/j.nicl.2019.101701] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/13/2018] [Accepted: 01/28/2019] [Indexed: 01/11/2023]
Abstract
Nightmares are characterized by the experience of strong negative emotions occurring mainly during REM sleep. Some people suffer from nightmare disorder, which is defined by the repeated occurrence of nightmares and by significant distress in wakefulness. Yet, whether frequent nightmares relate to a general increase in emotional reactivity or arousal during sleep remains unclear. To address this question, we recorded heartbeat-evoked potentials (HEPs) during wakefulness, NREM and REM sleep in patients with nightmare disorder and healthy participants. The HEP represents a cortical (EEG) response to the heartbeat and indexes brain-body interactions, such as interoceptive processing and intrinsic levels of arousal. HEP amplitude is typically increased during states of high emotional arousal and motivation, and is decreased in depression. Here we compared the amplitude of HEPs between nightmare patients and healthy controls separately during AWAKE, NREM, REM periods, and found higher HEP amplitude in nightmare patients compared to healthy controls over a cluster of frontal regions only during REM sleep. This effect was not paralleled by any group difference in cardiac control measures (e.g. heart rate variability, interbeat interval). These findings corroborate the notion that nightmares are essentially a REM pathology and suggest that increased emotional arousal during REM sleep, as measured by HEP, is a physiological condition responsible for frequent nightmares. This result also supports that HEP may be used as a biomarker of increased emotional and sensory processing during REM sleep in these patients.
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Affiliation(s)
- Lampros Perogamvros
- Center for Sleep Medicine, Division of Pulmonology, Department of Medical Specialties, Geneva University Hospitals, Geneva, Switzerland; Department of Neuroscience, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland.
| | - Hyeong-Dong Park
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics and Brain Mind Institute, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Laurence Bayer
- Center for Sleep Medicine, Division of Pulmonology, Department of Medical Specialties, Geneva University Hospitals, Geneva, Switzerland
| | - Aurore A Perrault
- Department of Neuroscience, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | - Olaf Blanke
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics and Brain Mind Institute, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland; Department of Neurology, University of Geneva, Switzerland
| | - Sophie Schwartz
- Department of Neuroscience, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
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21
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Wang S, Gao H, Ru Z, Zou Y, Li Y, Cao W, Meng W, Li J, Yao Y, Zhang Y, Lang X, Zhang Y. Poor Sleep Quality Associated With High Risk Of Ventricular Tachycardia After Acute Myocardial Infarction. Nat Sci Sleep 2019; 11:281-289. [PMID: 31802960 PMCID: PMC6827508 DOI: 10.2147/nss.s222359] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/24/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Sleep disorders (SDs) are usually associated with an increase in frequency of ventricular tachycardia (VT). However, the relationship between SDs and the prevalence of VT within the first week of acute myocardial infarction (AMI) remains unclear. This study aimed to evaluate their associations and potential mechanisms. METHODS This structured questionnaire-based cross-sectional study enrolled 303 patients with AMI from a hospital in northern China. Pittsburgh Sleep Quality Index (PSQI) was used to determine sleep quality of subjects. Heart rate variability (HRV) of patients was investigated by ambulatory electrocardiography recorders. Enzyme-linked immunosorbent assay was used to measure the plasma levels of catecholamine in a subgroup including 80 patients with AMI. RESULTS After adjusting to basic cardiovascular characteristics, results of multivariate logistic regression demonstrated that the global PSQI score and its main components were positively associated with VT prevalence in inpatients with AMI. There were significantly different HRV parameters interpreted as autonomic nerve activity in two groups of AMI patients with different sleep quality. In addition, we found the influence of sleep quality on plasma concentrations of adrenaline and norepinephrine in AMI patients. CONCLUSION Sleep status was significantly associated with the initiation of VT within the first week of AMI, probably due to the effect of SDs on sympathetic nerve activity. Amelioration of sleep quality and sympathetic hyperactivity may be prospective strategy to curb arrhythmias after AMI.
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Affiliation(s)
- Shipeng Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China.,Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin 150086, People's Republic of China
| | - Hui Gao
- Department of Cardiology, People' Hospital of Xinzheng, Xinzheng, Henan Province 451150, People's Republic of China
| | - Zewen Ru
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China
| | - Yanan Zou
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China
| | - Yilan Li
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China
| | - Wei Cao
- Department of Cardiology, Heilongjiang Provincial Hospital Affiliated to Harbin Institute of Technology, Harbin 150036, People's Republic of China
| | - Wei Meng
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China
| | - Jihe Li
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, People's Republic of China
| | - Yuan Yao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China
| | - Yanxiu Zhang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China
| | - Xueyan Lang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China
| | - Yao Zhang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China.,Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin 150086, People's Republic of China
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22
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Sleep spindle and psychopathology characteristics of frequent nightmare recallers. Sleep Med 2018; 50:113-131. [DOI: 10.1016/j.sleep.2017.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/02/2017] [Indexed: 02/01/2023]
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23
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Marquis LP, Paquette T, Blanchette-Carrière C, Dumel G, Nielsen T. REM Sleep Theta Changes in Frequent Nightmare Recallers. Sleep 2017; 40:3885852. [PMID: 28651358 PMCID: PMC5806577 DOI: 10.1093/sleep/zsx110] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Study Objectives To replicate and expand upon past research by evaluating sleep and wake electroencephalographic spectral activity in samples of frequent nightmare (NM) recallers and healthy controls. Methods Computation of spectral activity for sleep (non-REM and REM) and wake electroencephalogram recordings from 18 frequent NM recallers and 15 control participants. Results There was higher "slow-theta" (2-5 Hz) for NM recallers than for controls during wake, non-REM sleep and REM sleep. Differences were clearest for frontal and central derivations and for REM sleep cycles 2-4. There was also higher beta activity during NREM sleep for NM recallers. Findings partially replicate past research by demonstrating higher relative "slow-theta" (3-4Hz) for NM recallers than for controls. Conclusions Findings are consistent with a neurocognitive model of nightmares that stipulates cross-state anomalies in emotion processing in NM-prone individuals.
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Affiliation(s)
- Louis-Philippe Marquis
- Department of Psychology, Université de Montréal, Québec, Canada
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM – Hôpital du Sacré-Coeur de Montréal, Québec, Canada
| | - Tyna Paquette
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM – Hôpital du Sacré-Coeur de Montréal, Québec, Canada
| | - Cloé Blanchette-Carrière
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM – Hôpital du Sacré-Coeur de Montréal, Québec, Canada
- Department of Biomedical Sciences, Université de Montréal, Montréal, Québec, Canada
| | - Gaëlle Dumel
- Department of Psychology, Université de Montréal, Québec, Canada
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM – Hôpital du Sacré-Coeur de Montréal, Québec, Canada
| | - Tore Nielsen
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM – Hôpital du Sacré-Coeur de Montréal, Québec, Canada
- Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada
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Chen HC, Hsu NW, Chou P. The Association Between Extreme Sleep Duration and Cardiac Autonomic Control in Community-Dwelling Older Adults: The Yilan Study, Taiwan. J Gerontol A Biol Sci Med Sci 2017; 72:929-936. [PMID: 28369199 DOI: 10.1093/gerona/glx045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 03/07/2017] [Indexed: 11/14/2022] Open
Abstract
Backgrounds The aims of the present study were to determine the associations and sex-specific relationships between extreme sleep duration and cardiac autonomic control in a cohort of older individuals. Methods A community-based survey was conducted in Yilan City, Taiwan. Community-dwelling older adults aged ≥65 were randomly selected to participate. Extreme sleep durations were defined as either short sleep (≤5 hours) or long sleep (≥8 hours). Cardiac autonomic control was evaluated using the parameters of frequency-domain analysis of heart rate variability. Results Of 1,721 participants, 58.7% were female. In multiple logistic regression analyses, short sleep duration did not correlate with any of the unhealthier parameters of heart rate variability. In contrast, long sleep duration was associated with elevated risk for poor high-frequency values (odds ratio [OR]: 1.83, 95% confidence interval [CI]: 1.34-2.50) and the unfavorable low-frequency values (OR: 1.44, 95% CI: 1.05-1.97). When stratified by sex, the associations between extreme sleep duration and poor heart rate variability were more robust in males. Conclusions Poor cardiac autonomic control may underlie the link between extreme sleep duration and adverse health outcomes in older adults. A sex-specific relationship between poor cardiac autonomic function and extreme sleep duration also was found.
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Affiliation(s)
- Hsi-Chung Chen
- Department of Psychiatry and Center of Sleep Disorders, National Taiwan University Hospital, Taipei
| | - Nai-Wei Hsu
- Division of Cardiology, Department of Internal Medicine and Community Medicine Center, National Yang-Ming University Hospital, Yilan County, Taiwan
- Department of Medicine, School of Medicine, National Yang-Ming University, Yilan County, Taiwan
| | - Pesus Chou
- Community Medicine Research Center and Institute of Public Health, College of Medicine, National Yang-Ming University, Taipei, Taiwan
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Positive Association Between Nightmares and Heart Rate Response to Loud Tones: Relationship to Parasympathetic Dysfunction in PTSD Nightmares. J Nerv Ment Dis 2017; 205:308-312. [PMID: 28129305 PMCID: PMC5373938 DOI: 10.1097/nmd.0000000000000641] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Seventy-three women with posttraumatic stress disorder (PTSD) resulting from rape or physical assault participated in a loud-tone procedure, while skin conductance (SC), heart rate, and electromyogram responses were recorded. Pearson correlations were examined between each psychophysiological response and Clinician-Administered PTSD Scale (CAPS) symptom scores. Significant correlations were adjusted for each remaining individual PTSD symptom score. Heart rate response (HRR) significantly correlated with CAPS total score and with CAPS nightmares. The relationship between HRR and nightmares remained significant after controlling for each of the other 16 individual PTSD symptoms, for the remaining reexperiencing cluster, and for CAPS total score. The zero-order correlations between SC response and nightmares and between electromyography response and nightmares were both not significant. The association of nightmares with larger HRR in the absence of an association with larger SC response likely reflects reduced parasympathetic tone. Thus, our findings indirectly support a role for reduced parasympathetic tone in PTSD nightmares.
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Suh S, Schneider M, Lee R, Joiner T. Perceived Interpersonal Burdensomeness as a Mediator between Nightmare Distress and Suicidal Ideation in Nightmare Sufferers. Front Psychol 2016; 7:1805. [PMID: 27917142 PMCID: PMC5114297 DOI: 10.3389/fpsyg.2016.01805] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/01/2016] [Indexed: 11/28/2022] Open
Abstract
Previous studies have supported the significant association between nightmares and suicidal ideation, but the underlying mechanisms are largely unknown. The purpose of the present study was to investigate perceived burdensomeness and thwarted belongingness as mediators in the relationship between nightmare distress and suicidal ideation. This sample consisted of 301 undergraduate students who endorsed experiencing nightmares (mean age 21.87 ± 2.17, 78.1% female). All participants completed questionnaires on nightmare distress (Nightmare Distress Questionnaire), unmet interpersonal needs (Interpersonal Needs Questionnaire), and suicidal ideation (Depressive Symptom Inventory – Suicidality Subscale). Analyses were performed using multiple mediation regression. Results indicated that nightmare distress was associated with perceived burdensomeness (r = 0.17, p < 0.001) and suicidal ideation (r = 0.24, p < 0.001), but was not related to thwarted belongingness (r = 0.10, p = 0.06). Multiple mediation analyses revealed that perceived burdensomeness partially mediated the relationship between nightmares and suicidal ideation, but thwarted belongingness did not. Additionally, this mediating relationship for perceived burdensomeness was moderated by gender, being significant only for females. These findings highlight the important role of interpersonal factors in the relationship between nightmares and suicidal ideation.
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Affiliation(s)
- Sooyeon Suh
- Department of Psychology, Sungshin Women's UniversitySeoul, South Korea; Department of Psychiatry, Stanford UniversityPalo Alto, CA, USA
| | - Matthew Schneider
- Department of Psychology, Florida State University Tallahassee, FL, USA
| | - Ruda Lee
- Department of Psychology, Sungshin Women's University Seoul, South Korea
| | - Thomas Joiner
- Department of Psychology, Florida State University Tallahassee, FL, USA
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27
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Rissling MB, Dennis PA, Watkins LL, Calhoun PS, Dennis MF, Beckham JC, Hayano J, Ulmer CS. Circadian Contrasts in Heart Rate Variability Associated With Posttraumatic Stress Disorder Symptoms in a Young Adult Cohort. J Trauma Stress 2016; 29:415-421. [PMID: 27603025 PMCID: PMC5108045 DOI: 10.1002/jts.22125] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 04/19/2016] [Accepted: 06/06/2016] [Indexed: 11/07/2022]
Abstract
Prior research has demonstrated that individuals exposed to trauma have shown impaired autonomic function. We sought to determine if heart rate variability (HRV), a marker of impaired autonomic function, differed across periods of wake, rest, and sleep as a function of the level of symptoms of posttraumatic stress disorder (PTSD). A sample of young adults (N = 209), 95 of whom met full criteria for current PTSD based on the Clinician Administered PTSD Scale (CAPS; Blake et al., 1995), were evaluated for ≈ 24 hr using actigraphy and electrocardiogram. Actigraphy data were categorized as active, rest, or sleep. Multilevel modeling analyses showed that individuals with high PTSD symptom severity had lower high-frequency HRV than individuals with low PTSD symptom severity during periods of sleep, t(1083) = 2.20, p = .028, Cohen's d = 0.12. No differences were found during periods of activity, t(1083) = 1.34, p = .499, d = 0.05, or rest, t(1083) = 1.34, p = .180, d = 0.09. Our findings extended the import of prior studies to suggest that those with elevated PTSD symptoms may have decreased parasympathetic control during sleep. Moreover, relative to periods of wake and rest, sleep may represent a state of increased vulnerability for decreased parasympathetic cardiac control. Individuals with elevated PTSD symptoms may benefit from early screening for detection of cardiovascular disease.
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Affiliation(s)
- Michelle B. Rissling
- Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
| | - Paul A. Dennis
- Durham Veterans Affairs Medical Center, Department of Research and Development, Durham, North Carolina, USA,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Lana L. Watkins
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Patrick S. Calhoun
- Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA,Durham Veterans Affairs Center for Health Services Research in Primary Care, Durham, North Carolina, USA
| | - Michelle F. Dennis
- Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA,Durham Veterans Affairs Medical Center, Department of Research and Development, Durham, North Carolina, USA,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Jean C. Beckham
- Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA,Durham Veterans Affairs Medical Center, Department of Research and Development, Durham, North Carolina, USA,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Junichiro Hayano
- Department of Medical Education, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Christi S. Ulmer
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA,Durham Veterans Affairs Center for Health Services Research in Primary Care, Durham, North Carolina, USA
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Pires GN, Bezerra AG, Tufik S, Andersen ML. Effects of experimental sleep deprivation on anxiety-like behavior in animal research: Systematic review and meta-analysis. Neurosci Biobehav Rev 2016; 68:575-589. [DOI: 10.1016/j.neubiorev.2016.06.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 06/18/2016] [Accepted: 06/20/2016] [Indexed: 01/15/2023]
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Kuo TBJ, Li JY, Kuo HK, Chern CM, Yang CCH. Differential changes and interactions of autonomic functioning and sleep architecture before and after 50 years of age. AGE (DORDRECHT, NETHERLANDS) 2016; 38:5. [PMID: 26728397 PMCID: PMC5005895 DOI: 10.1007/s11357-015-9863-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 12/07/2015] [Indexed: 06/05/2023]
Abstract
We hypothesize that the time when age-related changes in autonomic functioning and in sleep structure occur are different and that autonomic functioning modulates sleep architecture differently before and after 50 years of age. Sixty-eight healthy subjects (aged 20 to 79 years old, 49 of them women) were enrolled. Correlation analysis revealed that wake after sleep onset, the absolute and relative value of stage 1 (S1; S1%), and relative value of stage 2 (S2) were positively correlated with age; however, sleep efficiency, stage 3 (S3), S3%, and rapid-eye-movement latency (REML) were negatively correlated with age. Significant degenerations of sleep during normal aging were occurred after 50 years of age; however, significant declines of autonomic activity were showed before 50 years of age. Before 50 years of age, vagal function during sleep was negatively correlated with arousal index; however, after 50 years of age, it was positively correlated with S1 and S1%. In addition, sympathetic activity during wake stage was positively related to S2% only after 50 years of age. Our results imply that the age-related changes in autonomic functioning decline promptly as individuals leave the younger part of their adult life span and that age-related changes in sleep slowly develop as individuals enter the older part of their adult life span. Furthermore, while various aspects of sleep architecture are modulated by both the sympathetic and vagal nervous systems during adult life span, the sleep quality is mainly correlated with the sympathetic division after 50 years of age.
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Affiliation(s)
- T B J Kuo
- Institute of Brain Science, National Yang-Ming University, No. 155, Sec. 2, Li-Nong St., Taipei, 11221, Taiwan
- Sleep Research Center, National Yang-Ming University, No. 155, Sec. 2, Li-Nong St., Taipei, 11221, Taiwan
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
- Division of Translational Medicine, Stroke & Neurovascular Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan
- Institute of Translational and Interdisciplinary Medicine, National Central University, Taoyuan, Taiwan
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jia-Yi Li
- Institute of Brain Science, National Yang-Ming University, No. 155, Sec. 2, Li-Nong St., Taipei, 11221, Taiwan
- Sleep Research Center, National Yang-Ming University, No. 155, Sec. 2, Li-Nong St., Taipei, 11221, Taiwan
- Department of Health and Leisure Management, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Hsu-Ko Kuo
- Department of Geriatrics and Gerontology and Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chang-Ming Chern
- Institute of Brain Science, National Yang-Ming University, No. 155, Sec. 2, Li-Nong St., Taipei, 11221, Taiwan
- Sleep Research Center, National Yang-Ming University, No. 155, Sec. 2, Li-Nong St., Taipei, 11221, Taiwan
- Division of Translational Medicine, Stroke & Neurovascular Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - C C H Yang
- Institute of Brain Science, National Yang-Ming University, No. 155, Sec. 2, Li-Nong St., Taipei, 11221, Taiwan.
- Sleep Research Center, National Yang-Ming University, No. 155, Sec. 2, Li-Nong St., Taipei, 11221, Taiwan.
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan.
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan.
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30
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Jiang XL, Zhang ZG, Chen Y, Ye CP, Lei Y, Wu L, Zhang Y, Xiao ZJ. A blunted sympathetic and accentuated parasympathetic response to postural change in subjects with depressive disorders. J Affect Disord 2015; 175:269-74. [PMID: 25658503 DOI: 10.1016/j.jad.2015.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 01/08/2015] [Accepted: 01/08/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND In recent years, the bi-directional relationship between depression and ANS dysfunction has received considerable attention, but findings remain inconclusive. In this study, we aimed to examine the spectral HRV response to postural change in subjects with depressive disorders and in healthy controls, in order to gain insight into the characteristics of autonomic nervous system (ANS) response to postural change in subjects with depressive disorders. METHODS We compared HRV response to postural change between subjects with depressive disorders and healthy controls aged 20-37 years. Depression severity was assessed by the self-reported Beck Depression Inventory-II (BDI-II). Spectral HRV was analyzed at two moments: 10 min seated rest and 10 min at standing position, with spontaneous breathing. RESULTS No significant differences existed in the resting spectral HRV indices between subjects with depressive disorders and controls, however, following postural change, the increasing level of LF and LF/HF was lower and the decreasing level of HF power was higher, in the individuals with depression than that in healthy subjects. The differences in the LF power, HF power and the LF/HF ratio between seated rest before standing up and after postural change were found negatively correlated with depression severity. CONCLUSION We found a blunted sympathetic and accentuated parasympathetic response to postural change in subjects with depressive disorder, suggesting that the autonomic impairment and early ANS dysfunction may exist among depressed individuals. These findings indicated that spectral analysis of HRV associated with postural change may be a more sensitive method than resting HRV analysis for detecting ANS dysfunction in depressive disorders. LIMITATIONS Further studies are needed to expand the sample size and to clarify the mechanisms responsible for the autonomic dysfunction observed in individuals with depressive disorders.
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Affiliation(s)
- Xiao-ling Jiang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangdong Province 510515, China.
| | - Zheng-gang Zhang
- Department of Physiology, School of Basic Medical Sciences, Southern Medical University, Guangdong Province 510515, China
| | - Yuanyuan Chen
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangdong Province 510515, China
| | - Cui-Ping Ye
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangdong Province 510515, China
| | - Ying Lei
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangdong Province 510515, China
| | - Lei Wu
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangdong Province 510515, China
| | - Ying Zhang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangdong Province 510515, China
| | - Zhong-ju Xiao
- Department of Physiology, School of Basic Medical Sciences, Southern Medical University, Guangdong Province 510515, China.
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31
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Paul F, Schredl M, Alpers GW. Nightmares affect the experience of sleep quality but not sleep architecture: an ambulatory polysomnographic study. Borderline Personal Disord Emot Dysregul 2015; 2:3. [PMID: 26401306 PMCID: PMC4579510 DOI: 10.1186/s40479-014-0023-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 12/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nightmares and bad dreams are common in people with emotional disturbances. For example, nightmares are a core symptom in posttraumatic stress disorder and about 50% of borderline personality disorder patients suffer from frequent nightmares. Independent of mental disorders, nightmares are often associated with sleep problems such as prolonged sleep latencies, poorer sleep quality, and daytime sleepiness. It has not been well documented whether this is reflected in objectively quantifiable physiological indices of sleep quality. METHODS Questionnaires regarding subjective sleep quality and ambulatory polysomnographic recordings of objective sleep parameters were collected during three consecutive nights in 17 individuals with frequent nightmares (NM) and 17 healthy control participants (HC). RESULTS NM participants reported worse sleep quality, more waking problems and more severe insomnia compared to HC group. However, sleep measures obtained by ambulatory polysomnographic recordings revealed no group differences in (a) overall sleep architecture, (b) sleep cycle duration as well as REM density and REM duration in each cycle and (c) sleep architecture when only nights with nightmares were analyzed. CONCLUSIONS Our findings support the observation that nightmares result in significant impairment which is independent from disturbed sleep architecture. Thus, these specific problems require specific attention and appropriate treatment.
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Affiliation(s)
- Franc Paul
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, J5, Mannheim, 68159 Germany
| | - Michael Schredl
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, J5, Mannheim, 68159 Germany
| | - Georg W Alpers
- University of Mannheim, School of Social Sciences, Department of Psychology, Clinical and Biological Psychology and Psychotherapy, L13, 15-17, Mannheim, 68131 Germany
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Agorastos A, Kellner M, Stiedl O, Muhtz C, Wiedemann K, Demiralay C. Blunted autonomic reactivity to pharmacological panic challenge under long-term escitalopram treatment in healthy men. Int J Neuropsychopharmacol 2014; 18:pyu053. [PMID: 25522396 PMCID: PMC4376541 DOI: 10.1093/ijnp/pyu053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Central serotonergic pathways influence brain areas involved in vagal cardiovascular regulation and, thereby, influence sympathetic efferent activity. Selective serotonin reuptake inhibitors (SSRIs) affect multiple serotonergic pathways, including central autonomic pathways. However, only a few studies have assessed SSRI-mediated effects on autonomic reactivity in healthy individuals using heart rate variability (HRV). METHODS The present study assessed the influence of long-term treatment with escitalopram (ESC) on autonomic reactivity to an intravenous application of 50 µg cholecystokinin tetrapeptide (CCK-4) in 30 healthy young men using a double-blind, placebo (PLA)-controlled, randomized, within-subject cross-over design. Main outcome measures were time- and frequency-domain HRV parameters, assessed at both baseline and immediately after CCK-4 application. RESULTS Results showed substantial effects for the treatment × CCK-4 challenge interaction with respect to heart rate (p < 0.001; pη(2) = 0.499), SDNN (p < 0.001; pη(2) = 576), RMSSD (p = 0.015; pη(2) = 194), NN50% (p = 0.008; pη(2) = 0.224), and LF% (p = 0.014; pη(2) = 0.196), and moderate effects with respect HF% (p = 0.099; pη(2) = 0.094), with PLA subjects showing a higher increase in HR and SDNN and a higher decrease in RMSSD, NN50, LF and HF than subjects in the ESC condition. Thus, ESC treatment significantly blunted the autonomic reactivity to CCK-4. Secondary analysis indicated no effect of the 5-HTTLPR polymorphism on CCK-4-induced autonomic response. CONCLUSIONS Our results support findings suggesting an effect of SSRI treatment on autonomic regulation and provide evidence that ESC treatment is associated with blunted autonomic reactivity in healthy men.
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Affiliation(s)
- Agorastos Agorastos
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Drs Agorastos, Kellner, Muhtz, Wiedemann, and Demiralay); Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Dr Muhtz).
| | - Michael Kellner
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Drs Agorastos, Kellner, Muhtz, Wiedemann, and Demiralay); Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Dr Muhtz)
| | - Oliver Stiedl
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Drs Agorastos, Kellner, Muhtz, Wiedemann, and Demiralay); Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Dr Muhtz)
| | - Christoph Muhtz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Drs Agorastos, Kellner, Muhtz, Wiedemann, and Demiralay); Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Dr Muhtz)
| | - Klaus Wiedemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Drs Agorastos, Kellner, Muhtz, Wiedemann, and Demiralay); Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Dr Muhtz)
| | - Cüneyt Demiralay
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Drs Agorastos, Kellner, Muhtz, Wiedemann, and Demiralay); Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Dr Muhtz)
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Electroencephalographic and autonomic alterations in subjects with frequent nightmares during pre-and post-REM periods. Brain Cogn 2014; 91:62-70. [DOI: 10.1016/j.bandc.2014.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 08/16/2014] [Accepted: 08/18/2014] [Indexed: 11/21/2022]
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The 5-HTTLPR genotype modulates heart rate variability and its adjustment by pharmacological panic challenge in healthy men. J Psychiatr Res 2014; 50:51-8. [PMID: 24342768 DOI: 10.1016/j.jpsychires.2013.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 11/25/2013] [Accepted: 11/29/2013] [Indexed: 01/01/2023]
Abstract
Abnormal serotonin transporter (5-HTT) function and autonomic nervous system (ANS) dysregulation has been proposed in panic disorder. However, in contrast to hypothalamo-pituitary-adrenocortical (HPA) functioning, ANS reactivity during panic response has yet not been investigated in humans with respect to the 5-HTT genotype. The present study assessed the influence of challenging by cholecystokinin tetrapeptide (CCK-4) on heart rate variability (HRV) measures, to monitor autonomic reactivity and its relationship to 5-HTT-linked polymorphic region (5-HTTLPR) genotypes. We hypothesized substantial effects of the 5-HTTLPR genotype on autonomic reactivity. We studied 30 healthy young men, 15 of each with the long/long (l/l) or short/short (s/s) genotype for the 5-HTTLPR. All participants received an intravenous application of 50 μg CCK-4. HRV measures were assessed in both groups at baseline and immediately after CCK-4 application. Our results indicated lower parasympathetic activity in s/s carriers during baseline, time and frequency domain measures. CCK-4 application significantly enhanced the sympathetic tone in both groups, leading to diminished group differences. A significant treatment by genotype effect indicated reduced autonomic reactivity to CCK-4 challenge in the s/s compared to l/l carriers. Our findings show enhanced sympathetic and/or diminished cardiac vagal activity under basal conditions and blunted autonomic reactivity in s/s vs. l/l carriers. Our study provides novel data supporting claims that the s/s genotype represents a genetic vulnerability factor associated with inadequate hyporeactivity to stress and extends current knowledge on the impact of the central serotonergic activity on the sympathoadrenal pathway.
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Godin I, Montplaisir J, Gagnon JF, Nielsen T. Alexithymia associated with nightmare distress in idiopathic REM sleep behavior disorder. Sleep 2013; 36:1957-62. [PMID: 24293771 PMCID: PMC3825446 DOI: 10.5665/sleep.3238] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Idiopathic REM sleep behavior disorder (iRBD) is characterized by atypical REM sleep motor activity, vivid dreams and nightmares, and dream-enacting behaviors that can result in injuries to the patient and bed partner. It is also a known predictor of Parkinson disease (PD). Alexithymia has been associated with disturbances in sleep and dreaming (e.g., nightmares) and is a non-motor symptom of PD. We assessed alexithymia and disturbed dreaming in iRBD patients with the aim of determining if these two factors are elevated and interrelated among this population. DESIGN Questionnaire study of clinically diagnosed patients. SETTING Clinical sleep disorders center. PATIENTS OR PARTICIPANTS Thirty-two iRBD patients and 30 healthy age- and sex-matched control participants. MEASUREMENTS AND RESULTS Participants completed the 20-item Toronto Alexithymia Scale (TAS-20), the Dream Questionnaire, and the Beck Depression Inventory. iRBD patients obtained higher TAS-20 total scores (62.16 ± 13.90) than did controls (52.84 ± 7.62; F 1,59 = 10.44, P < 0.01), even when controlling for depressive symptoms, and more frequently attained the suggested cutoff for alexithymia than did controls (P < 0.01). iRBD patients obtained higher scores on the Difficulty Identifying Feelings alexithymia subscale. For both iRBD and control groups, the Difficulty Indentifying Feelings subscale correlated positively with the Nightmare Distress scale of the Dream Questionnaire. CONCLUSIONS Elevated alexithymia scores among idiopathic rapid eye movement sleep behavior disorder patients, and especially a difficulty in identifying feelings, parallels evidence of dysautonomia in this population. The higher incidence of distressing nightmares and the association of nightmares with alexithymia further extend similar findings for both clinical and non-clinical samples and suggest that an affect regulation disturbance may be common to the two sets of symptoms.
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Affiliation(s)
- Isabelle Godin
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Québec, Canada
- Department of Psychology, Université de Montréal, Québec, Canada
| | - Jaques Montplaisir
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Québec, Canada
- Department of Psychiatry, Université de Montréal, Québec, Canada
| | - Jean-François Gagnon
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Québec, Canada
- Department of Psychology, Université du Québec à Montréal, Québec, Canada
| | - Tore Nielsen
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Québec, Canada
- Department of Psychiatry, Université de Montréal, Québec, Canada
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Simor P, Horváth K, Ujma PP, Gombos F, Bódizs R. Fluctuations between sleep and wakefulness: Wake-like features indicated by increased EEG alpha power during different sleep stages in nightmare disorder. Biol Psychol 2013; 94:592-600. [DOI: 10.1016/j.biopsycho.2013.05.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 03/21/2013] [Accepted: 05/26/2013] [Indexed: 11/16/2022]
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Agorastos A, Boel JA, Heppner PS, Hager T, Moeller-Bertram T, Haji U, Motazedi A, Yanagi MA, Baker DG, Stiedl O. Diminished vagal activity and blunted diurnal variation of heart rate dynamics in posttraumatic stress disorder. Stress 2013; 16:300-10. [PMID: 23167763 DOI: 10.3109/10253890.2012.751369] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Affected autonomic heart regulation is implicated in the pathophysiology of cardiovascular diseases and is associated with posttraumatic stress disorder (PTSD). However, although sympathetic hyperactivation has been repeatedly shown in PTSD, research has neglected parasympathetic function. The objective of this study is the long-term assessment of heart rate (HR) dynamics and its diurnal changes as an index of autonomic imbalance in PTSD. Since tonic parasympathetic activity underlies long-range correlation of heartbeat interval fluctuations in the healthy state, we included nonlinear (unifractal) analysis as an important and sensitive readout to assess functional alterations. We conducted electrocardiogram recordings over a 24-h period in 15 deployed male subjects with moderate to high levels of combat exposure (PTSD: n = 7; combat controls: n = 8) in the supine position. HR dynamics were assessed in two 5-h sub-epochs in the time and frequency domains, and by nonlinear analysis based on detrended fluctuation analysis. Psychiatric symptoms were assessed using structured interviews, including the Clinician Administered PTSD Scale. Subjects with PTSD showed significantly higher baseline HR, higher LF/HF ratio in the frequency domain, blunted differences between day and night-time measures, as well as a higher scaling coefficient αfast during the day, indicating diminished tonic parasympathetic activity. Diminished diurnal differences and blunted tonic parasympathetic activity altering HR dynamics suggest central neuroautonomic dysregulation that could represent a possible link to increased cardiovascular disease in PTSD.
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Affiliation(s)
- Agorastos Agorastos
- Veterans Affairs Center of Excellence for Stress and Mental Health, VA San Diego, CA, USA
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Abstract
The hypothesis that rapid eye movement (REM) sleep disturbances are the hallmark of posttraumatic stress disorder (PTSD), proposed by Ross and colleagues in 1989, has stimulated a wealth of clinical, preclinical, and animal studies on the role of sleep in the pathophysiology of PTSD. The present review revisits this influential hypothesis in light of clinical and experimental findings that have since accumulated. Polysomnographic studies conducted in adults with PTSD have yielded mixed findings regarding REM sleep disturbances, and they generally suggest modest and nonspecific sleep disruptions. Prospective and treatment studies have provided more robust evidence for the relationship between sleep disturbances and psychiatric outcomes and symptoms. Experimental animal and human studies that have probed the relationship between REM sleep and fear responses, as well as studies focused more broadly on sleep-dependent affective and memory processes, also provide strong support for the hypothesis that sleep plays an important role in PTSD-relevant processes. Overall, the literature suggests that disturbed REM or non-REM sleep can contribute to maladaptive stress and trauma responses and may constitute a modifiable risk factor for poor psychiatric outcomes. Clinicians need to consider that the chronic sleep disruption associated with nightmares may affect the efficacy of first-line PTSD treatments, but targeted sleep treatments may accelerate recovery from PTSD. The field is ripe for prospective and longitudinal studies in high-risk groups to clarify how changes in sleep physiology and neurobiology contribute to increased risk of poor psychiatric outcomes.
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Affiliation(s)
- Anne Germain
- Department of Psychiatry, University of Pittsburgh, USA.
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Simor P. Nightmares in the bedroom of science: mapping of a neglected sleep disorder. Orv Hetil 2013; 154:497-502. [DOI: 10.1556/oh.2013.29573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Nightmares are intense and unpleasant dream experiences that characterize approximately 4 percent of the adult population at least on a weekly basis. Nightmare frequency is often co-morbid with other mental complaints; however, recent results indicate that nightmare disorder is independent from waking mental dysfunctions. Nightmare disorder is intimately related to poor subjective sleep quality, and according to polysomnographic studies nightmare subjects’ sleep is characterized by increased sleep fragmentation and hyper-arousal. These findings suggest that instead of the psychopathological perspective nightmare disorder should be viewed as a specific sleep disorder that requires targeted treatment. Nevertheless, in order to choose the adequate treatment procedure clinicians should examine the co-morbid mental disorders as well taking into consideration the severity of nightmare distress, the latter supposed to be the mediator between nightmare frequency and waking mental dysfunctions. Orv. Hetil., 2013, 154, 497–502.
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Affiliation(s)
- Péter Simor
- Budapesti Műszaki Egyetem, Természettudományi Kar Kognitív Pszichológia Tanszék Budapest Egry József u. 1., T épület, 5. emelet 1111
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Simor P, Bódizs R, Horváth K, Ferri R. Disturbed dreaming and the instability of sleep: altered nonrapid eye movement sleep microstructure in individuals with frequent nightmares as revealed by the cyclic alternating pattern. Sleep 2013; 36:413-9. [PMID: 23449753 DOI: 10.5665/sleep.2462] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Nightmares are disturbing mental experiences during sleep that usually result in abrupt awakenings. Frequent nightmares are associated with poor subjective sleep quality, and recent polysomnographic data suggest that nightmare sufferers exhibit impaired sleep continuity during nonrapid eye movement (NREM) sleep. Because disrupted sleep might be related to abnormal arousal processes, the goal of this study was to examine polysomnographic arousal-related activities in a group of nightmare sufferers and a healthy control group. DESIGN Sleep microstructure analysis was carried out by scoring the cyclic alternating pattern (CAP) in NREM sleep and the arousal index in rapid eye movement (REM) sleep on the second night of the polysomnographic examination. SETTING Hospital-based sleep research laboratory. PARTICIPANTS There were 17 in the nightmare (NMs) group and 23 in the healthy control (CTLs) group. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS The NMs group exhibited reduced amounts of CAP A1 subtype and increased CAP A2 and A3 subtypes, as well as longer duration of CAP A phases in comparison with CTLs. Moreover, these differences remained significant after controlling for the confounding factors of anxious and depressive symptoms. The absolute number and frequency of REM arousals did not differ significantly between the two groups. CONCLUSIONS The results of our study indicate that NREM sleep microstructure is altered during nonsymptomatic nights of nightmares. Disrupted sleep in the NMs group seems to be related to abnormal arousal processes, specifically an imbalance in sleep-promoting and arousing mechanisms during sleep. CITATION Simor P; Bódizs R; Horváth K; Ferri R. Disturbed dreaming and the instability of sleep: altered nonrapid eye movement sleep microstructure in individuals with frequent nightmares as revealed by the cyclic alternating pattern. SLEEP 2013;36(3):413-419.
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Affiliation(s)
- Péter Simor
- Department of Cognitive Sciences, Budapest University of Technology and Economics, Budapest, Hungary.
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Palma JA, Urrestarazu E, Iriarte J. Sleep loss as risk factor for neurologic disorders: a review. Sleep Med 2013; 14:229-36. [PMID: 23352029 DOI: 10.1016/j.sleep.2012.11.019] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 11/13/2012] [Accepted: 11/29/2012] [Indexed: 01/12/2023]
Abstract
Sleep loss refers to sleep of shorter duration than the average baseline need of seven to eight hours per night. Sleep loss and sleep deprivation have severe effects on human health. In this article, we review the main aspects of sleep loss, taking into account its effects on the central nervous system. The neurocognitive and behavioral effects of sleep loss are well known. However, there is an increasing amount of research pointing to sleep deprivation as a risk factor for neurologic diseases, namely stroke, multiple sclerosis, Alzheimer's disease, headache, epilepsy, pain, and somnambulism. Conversely, sleep loss has been reported to be a potential protective factor against Parkinson's disease. The pathophysiology involved in this relationship is multiple, comprising immune, neuroendocrine, autonomic, and vascular mechanisms. It is extremely important to identify the individuals at risk, since recognition and adequate treatment of their sleep problems may reduce the risk of certain neurologic disorders.
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Affiliation(s)
- Jose-Alberto Palma
- Sleep Unit, Clinical Neurophysiology Section, University Clinic of Navarra, School of Medicine, University of Navarra, Pamplona, Spain
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42
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Simor P, Horváth K, Gombos F, Takács KP, Bódizs R. Disturbed dreaming and sleep quality: altered sleep architecture in subjects with frequent nightmares. Eur Arch Psychiatry Clin Neurosci 2012; 262:687-96. [PMID: 22526731 DOI: 10.1007/s00406-012-0318-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Accepted: 04/14/2012] [Indexed: 01/30/2023]
Abstract
Nightmares are intense, emotionally negative mental experiences that usually occur during late-night sleep and result in abrupt awakenings. Questionnaire-based studies have shown that nightmares are related to impaired sleep quality; however, the polysomnographic profile of nightmare subjects has been only scarcely investigated. We investigated the sleep architecture of 17 individuals with frequent nightmares and 23 control subjects based on polysomnographic recordings of a second night spent in the laboratory after an adaptation night. Nightmare subjects in comparison with control subjects were characterized by impaired sleep architecture, as reflected by reduced sleep efficiency, increased wakefulness, a reduced amount of slow wave sleep, and increased nocturnal awakenings, especially from Stage 2 sleep. While these differences were independent of the effects of waking psychopathology, nightmare subjects also exhibited longer durations of REM sleep that was mediated by heightened negative affect. Our results support that nightmares are related to altered sleep architecture, showing impaired sleep continuity and emotion-related increase in REM propensity.
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Affiliation(s)
- Péter Simor
- Department of Cognitive Sciences, Budapest University of Technology and Economics, Budapest, Hungary.
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Agnati LF, Barlow PW, Baluška F, Tonin P, Guescini M, Leo G, Fuxe K. A new theoretical approach to the functional meaning of sleep and dreaming in humans based on the maintenance of 'predictive psychic homeostasis'. Commun Integr Biol 2012; 4:640-54. [PMID: 22448302 DOI: 10.4161/cib.17602] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Different theories have been put forward during the last decade to explain the functional meaning of sleep and dreaming in humans. In the present paper, a new theory is presented which, while taking advantage of these earlier theories, introduces the following new and original aspects: • Circadian rhythms relevant to various organs of the body affect the reciprocal interactions which operate to maintain constancy of the internal milieu and thereby also affect the sleep/wakefulness cycle. Particular attention is given to the constancy of natraemia and osmolarity and to the permissive role that the evolution of renal function has had for the evolution of the central nervous system and its integrative actions. • The resetting of neuro-endocrine controls at the onset of wakefulness leads to the acquisition of new information and its integration within previously stored memories. This point is dealt with in relation to Moore-Ede's proposal for the existence of a 'predictive homeostasis'. • The concept of 'psychic homeostasis' is introduced and is considered as one of the most important states since it is aimed at the well-being, or eudemonia, of the human psyche. Sleep and dreaming in humans are discussed as important functions for the maintenance of a newly proposed composite state: that of 'predictive psychic homeostasis'. On the basis of these assumptions, and in accordance with the available neurobiological data, the present paper puts forward the novel hypothesis that sleep and dreaming play important functions in humans by compensating for psychic allostatic overloads. Hence, both consolatory dreams and disturbing nightmares can be part of the vis medicatrix naturae, the natural healing power, in this case, the state of eudemonia.
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Simor P, Pajkossy P, Horváth K, Bódizs R. Impaired executive functions in subjects with frequent nightmares as reflected by performance in different neuropsychological tasks. Brain Cogn 2012; 78:274-83. [DOI: 10.1016/j.bandc.2012.01.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 12/06/2011] [Accepted: 01/09/2012] [Indexed: 11/15/2022]
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46
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Spoormaker VI, Schröter MS, Andrade KC, Dresler M, Kiem SA, Goya-Maldonado R, Wetter TC, Holsboer F, Sämann PG, Czisch M. Effects of rapid eye movement sleep deprivation on fear extinction recall and prediction error signaling. Hum Brain Mapp 2011; 33:2362-76. [PMID: 21826762 DOI: 10.1002/hbm.21369] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 04/01/2011] [Accepted: 05/02/2011] [Indexed: 02/05/2023] Open
Abstract
In a temporal difference learning approach of classical conditioning, a theoretical error signal shifts from outcome deliverance to the onset of the conditioned stimulus. Omission of an expected outcome results in a negative prediction error signal, which is the initial step towards successful extinction and may therefore be relevant for fear extinction recall. As studies in rodents have observed a bidirectional relationship between fear extinction and rapid eye movement (REM) sleep, we aimed to test the hypothesis that REM sleep deprivation impairs recall of fear extinction through prediction error signaling in humans. In a three-day design with polysomnographically controlled REM sleep deprivation, 18 young, healthy subjects performed a fear conditioning, extinction and recall of extinction task with visual stimuli, and mild electrical shocks during combined functional magnetic resonance imaging (fMRI) and skin conductance response (SCR) measurements. Compared to the control group, the REM sleep deprivation group had increased SCR scores to a previously extinguished stimulus at early recall of extinction trials, which was associated with an altered fMRI time-course in the left middle temporal gyrus. Post-hoc contrasts corrected for measures of NREM sleep variability also revealed between-group differences primarily in the temporal lobe. Our results demonstrate altered prediction error signaling during recall of fear extinction after REM sleep deprivation, which may further our understanding of anxiety disorders in which disturbed sleep and impaired fear extinction learning coincide. Moreover, our findings are indicative of REM sleep related plasticity in regions that also show an increase in activity during REM sleep.
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Affiliation(s)
- Victor I Spoormaker
- Max Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, Germany.
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47
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Stein PK, Pu Y. Heart rate variability, sleep and sleep disorders. Sleep Med Rev 2011; 16:47-66. [PMID: 21658979 DOI: 10.1016/j.smrv.2011.02.005] [Citation(s) in RCA: 272] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 02/24/2011] [Accepted: 02/25/2011] [Indexed: 11/15/2022]
Abstract
Heart rate (HR) is modulated by the combined effects of the sympathetic and parasympathetic nervous systems. Therefore, measurement of changes in HR over time (heart rate variability or HRV) provides information about autonomic functioning. HRV has been used to identify high risk people, understand the autonomic components of different disorders and to evaluate the effect of different interventions, etc. Since the signal required to measure HRV is already being collected on the electrocardiogram (ECG) channel of the polysomnogram (PSG), collecting data for research on HRV and sleep is straightforward, but applications have been limited. As reviewed here, HRV has been applied to understand autonomic changes during different sleep stages. It has also been applied to understand the effect of sleep-disordered breathing, periodic limb movements and insomnia both during sleep and during the daytime. HRV has been successfully used to screen people for possible referral to a Sleep Lab. It has also been used to monitor the effects of continuous positive airway pressure (CPAP). A novel HRV measure, cardiopulmonary coupling (CPC) has been proposed for sleep quality. Evidence also suggests that HRV collected during a PSG can be used in risk stratification models, at least for older adults. Caveats for accurate interpretation of HRV are also presented.
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Affiliation(s)
- Phyllis K Stein
- Washington University, School of Medicine HRV Laboratory, 4625 Lindell Boulevard, Suite 402, Saint Louis, MO 63108, USA.
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Cross NJ, McCrae CS, Smith KM, Conti JB, Sears SF. Comparison of actigraphic and subjective measures of sleep in implantable cardioverter defibrillator and coronary artery disease patients. Clin Cardiol 2011; 33:753-9. [PMID: 21184559 DOI: 10.1002/clc.20827] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Cardiac patients frequently have insomnia symptoms that may pose risk for future cardiac events. Poor sleep relates to hyperarousal, anxiety and depression, and the incidence of hypertension and myocardial infarction. HYPOTHESIS The authors hypothesized that implantable cardioverter defibrillator (ICD) patients would have poorer sleep than coronary artery disease (CAD) patients related to hypervigilance for device functioning and shock discharge. METHODS Authors investigated sleep efficiency and sleep latency in a sample of 60 patients (n = 30 CAD and n = 30 ICD) without obstructive sleep apnea at the University of Florida & Shands Hospital. For 14 days, participants completed a sleep diary. Additionally, half of the total sample also used actigraphy to objectively measure their sleep. Measures of somatic hypervigilance and psychosocial distress were administered. RESULTS Using actigraphy, mean sleep efficiency was poorer (69.76%) in CAD patients compared with ICD patients (82.80%). This difference was highly significant, F₁,₂₇ = 16.840, P < 0.001. CAD patients also had shorter mean total sleep times per sleep diaries compared with ICD patients (336.19 minutes or 5.60 hours, 430.65 minutes or 7.18 hours, respectively), F₁,₂₇ = 15.908, P < 0.001. CONCLUSIONS The finding that ICD patients slept more efficiently than CAD patients is surprising given that CAD patients had higher ejection fractions and no concerns about ICD shocks. This difference cannot be accounted for by differences in hypervigilance, depression, anxiety, or physical activity. Results suggest that CAD patients may have more sleep problems and may warrant increased research attention.
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Affiliation(s)
- Natalie J Cross
- Department of Veterans Affairs, Greenville Community Based Outpatient Clinic, North Carolina, USA.
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Carra MC, Macaluso GM, Rompré PH, Huynh N, Parrino L, Terzano MG, Lavigne GJ. Clonidine has a paradoxical effect on cyclic arousal and sleep bruxism during NREM sleep. Sleep 2011; 33:1711-6. [PMID: 21120152 DOI: 10.1093/sleep/33.12.1711] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
STUDY OBJECTIVE Clonidine disrupts the NREM/REM sleep cycle and reduces the incidence of rhythmic masticatory muscle activity (RMMA) characteristic of sleep bruxism (SB). RMMA/SB is associated with brief and transient sleep arousals. This study investigates the effect of clonidine on the cyclic alternating pattern (CAP) in order to explore the role of cyclic arousal fluctuation in RMMA/SB. DESIGN Polysomnographic recordings from a pharmacological study. SETTING University sleep research laboratory. PARTICIPANTS AND INTERVENTIONS Sixteen SB subjects received a single dose of clonidine or placebo at bedtime in a crossover design. MEASUREMENTS AND RESULTS Sleep variables and RMMA/SB index were evaluated. CAP was scored to assess arousal instability between sleep-maintaining processes (phase A1) and stronger arousal processes (phases A2 and A3). Paired t-tests, ANOVAs, and cross-correlations were performed. Under clonidine, CAP time, and particularly the number of A3 phases, increased (P≤0.01). RMMA/SB onset was time correlated with phases A2 and A3 for both placebo and clonidine nights (P≤0.004). However, under clonidine, this positive correlation began up to 40 min before the RMMA/SB episode. CONCLUSIONS CAP phase A3 frequency increased under clonidine, but paradoxically, RMMA/SB decreased. RMMA/SB was associated with and facilitated in CAP phase A2 and A3 rhythms. However, SB generation could be influenced by other factors besides sleep arousal pressure. NREM/REM ultradian cyclic arousal fluctuations may be required for RMMA/SB onset.
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Affiliation(s)
- Maria Clotilde Carra
- Faculté de Médecine Dentaire, Université de Montréal, and Centre d'étude du Sommeil et des Rythmes Biologiques, Hôpital du Sacré-Coeur de Montréal, Québec, Canada
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Trait And Neurobiological Correlates Of Individual Differences In Dream Recall And Dream Content. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2010; 92:155-80. [DOI: 10.1016/s0074-7742(10)92008-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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