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Daffre C, Oliver KI, Nazareno JRS, Mäder T, Seo J, Dominguez JP, Gannon K, Lasko NB, Orr SP, Pace-Schott EF. Rapid eye movement sleep parasympathetic activity predicts wake hyperarousal symptoms following a traumatic event. J Sleep Res 2023; 32:e13685. [PMID: 35915961 PMCID: PMC9851935 DOI: 10.1111/jsr.13685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 06/09/2022] [Accepted: 06/17/2022] [Indexed: 02/03/2023]
Abstract
Heart rate variability (HRV) can be used to assess changes in output of the parasympathetic nervous system (PNS). Considering that patients with post-traumatic stress disorder (PTSD) often experience disturbances in sleep, arousal, and autonomic functioning, we sought to explore the association of PNS activity during sleep with hyperarousal symptoms of PTSD. Because a broad literature supports the importance of rapid eye movement (REM) sleep in PTSD, REM-sleep features were specifically examined as predictors of PTSD symptom severity. A total of 90 participants, primarily civilian and female, aged 18-40 years who had experienced a traumatic event in the last 2 years, underwent an ambulatory polysomnography (PSG) acclimation night followed by a second PSG night from which sleep physiological measures were computed. Participants underwent an ambulatory polysomnography (PSG) acclimation night followed by a second PSG night from which sleep physiological measures were computed. PTSD severity was measured using the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5). Dependent variables were total PCL-5 score as well as its hyperarousal symptom subscore. Predictors included REM latency, percentage, density, segment length, and an index of parasympathetic tone (root mean square of the successive differences in the R-R interval or RMSSD). Hierarchical regression models were conducted to analyse the association of REM features with PCL-5 total and hyperarousal subscales. Using hierarchical regression, REM-sleep RMSSD accounted for a significant proportion of the variation in outcome variables, even when accounting for other REM-sleep features. The present findings support hypothesised relationships between PTSD symptomatology and REM-sleep physiology and, specifically, that lowered parasympathetic tone in REM may be an important associate of the hyperarousal symptom cluster in PTSD.
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Affiliation(s)
- Carolina Daffre
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
| | - Katelyn I. Oliver
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
| | - Jovi R. S. Nazareno
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
| | - Thomas Mäder
- Department of Psychology, University of Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Jeehye Seo
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
- Korea University, Department of Brain & Cognitive Engineering, Seongbuk-gu, Seoul, KR
| | - Jarrod P. Dominguez
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
| | - Karen Gannon
- Department of Neurology, Massachusetts General Hospital, Charlestown, MA
| | - Natasha B. Lasko
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
- Department of Psychiatry, Harvard Medical School, Charlestown, MA
| | - Scott P. Orr
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
- Department of Psychiatry, Harvard Medical School, Charlestown, MA
| | - Edward F. Pace-Schott
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
- Department of Psychiatry, Harvard Medical School, Charlestown, MA
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Simmons C, Mckee P, Antonios I, Smith A, Sinnott-armstrong W. Bad dream frequency predicts mental health needs during the SARS-CoV-2 pandemic. Journal of Affective Disorders Reports 2022. [DOI: 10.1016/j.jadr.2022.100448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/09/2022] [Accepted: 11/19/2022] [Indexed: 11/21/2022] Open
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Geldenhuys C, van den Heuvel LL, Steyn P, Seedat S. Pharmacological Management of Nightmares Associated with Posttraumatic Stress Disorder. CNS Drugs 2022; 36:721-37. [PMID: 35688992 DOI: 10.1007/s40263-022-00929-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/03/2022]
Abstract
Posttraumatic stress disorder (PTSD) can be a chronic and disabling condition. Post-traumatic nightmares (PTNs) form a core component of PTSD and are highly prevalent in this patient population. Nightmares in PTSD have been associated with significant distress, functional impairment, poor health outcomes, and decreased quality of life. Nightmares in PTSD are also an independent risk factor for suicide. Nightmare cessation can lead to improved quality of life, fewer hospital admissions, lower healthcare costs, and reduced all-cause mortality. Effective treatment of nightmares is critical and often leads to improvement of other PTSD symptomatology. However, approved pharmacological agents for the treatment of PTSD have modest effects on sleep and nightmares, and may cause adverse effects. No pharmacological agent has been approved specifically for the treatment of PTNs, but multiple agents have been studied. This current narrative review aimed to critically appraise proven as well as novel pharmacological agents used in the treatment of PTNs. Evidence of varying quality exists for the use of prazosin, doxazosin, clonidine, tricyclic antidepressants, trazodone, mirtazapine, atypical antipsychotics (especially risperidone, olanzapine and quetiapine), gabapentin, topiramate, and cyproheptadine. Evidence does not support the use of venlafaxine, β-blockers, benzodiazepines, or sedative hypnotics. Novel agents such as ramelteon, cannabinoids, ketamine, psychedelic agents, and trihexyphenidyl have shown promising results. Large randomized controlled trials (RCTs) are needed to evaluate the use of these novel agents. Future research directions are identified to optimize the treatment of nightmares in patients with PTSD.
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Denis D, Bottary R, Cunningham TJ, Zeng S, Daffre C, Oliver KL, Moore K, Gazecki S, Kram Mendelsohn A, Martinez U, Gannon K, Lasko NB, Pace-Schott EF. Sleep Power Spectral Density and Spindles in PTSD and Their Relationship to Symptom Severity. Front Psychiatry 2021; 12:766647. [PMID: 34867552 PMCID: PMC8640175 DOI: 10.3389/fpsyt.2021.766647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 10/26/2021] [Indexed: 01/03/2023] Open
Abstract
Sleep disturbances are common in post-traumatic stress disorder (PTSD), although which sleep microarchitectural characteristics reliably classify those with and without PTSD remains equivocal. Here, we investigated sleep microarchitectural differences (i.e., spectral power, spindle activity) in trauma-exposed individuals that met (n = 45) or did not meet (n = 52) criteria for PTSD and how these differences relate to post-traumatic and related psychopathological symptoms. Using ecologically-relevant home sleep polysomnography recordings, we show that individuals with PTSD exhibit decreased beta spectral power during NREM sleep and increased fast sleep spindle peak frequencies. Contrary to prior reports, spectral power in the beta frequency range (20.31-29.88 Hz) was associated with reduced PTSD symptoms, reduced depression, anxiety and stress and greater subjective ability to regulate emotions. Increased fast frequency spindle activity was not associated with individual differences in psychopathology. Our findings may suggest an adaptive role for beta power during sleep in individuals exposed to a trauma, potentially conferring resilience. Further, we add to a growing body of evidence that spindle activity may be an important biomarker for studying PTSD pathophysiology.
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Affiliation(s)
- Dan Denis
- Department of Psychology, University of Notre Dame, Notre Dame, IN, United States
| | - Ryan Bottary
- Department of Psychology and Neuroscience, Boston College, Chestnut Hill, MA, United States
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States
| | - Tony J. Cunningham
- Department of Psychology and Neuroscience, Boston College, Chestnut Hill, MA, United States
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, Beth Israel Deaconess Medical School, Boston, MA, United States
| | - Shengzi Zeng
- Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Carolina Daffre
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, United States
| | - Kaitlyn L. Oliver
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, United States
| | - Kylie Moore
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, United States
| | - Samuel Gazecki
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, United States
| | - Augustus Kram Mendelsohn
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, United States
| | - Uriel Martinez
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, United States
| | - Karen Gannon
- Department of Neurology, Massachusetts General Hospital, Charlestown, MA, United States
| | - Natasha B. Lasko
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, United States
| | - Edward F. Pace-Schott
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, United States
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States
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Seo J, Oliver KI, Daffre C, Moore KN, Gazecki S, Lasko NB, Milad MR, Pace-Schott EF. Associations of sleep measures with neural activations accompanying fear conditioning and extinction learning and memory in trauma-exposed individuals. Sleep 2021; 45:6414032. [PMID: 34718807 DOI: 10.1093/sleep/zsab261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Sleep disturbances increase risk of posttraumatic stress disorder (PTSD). Sleep effects on extinction may contribute to such risk. Neural activations to fear extinction were examined in trauma-exposed participants and associated with sleep variables. METHODS Individuals trauma-exposed within the past 2 years (N=126, 63 PTSD) completed 2 weeks actigraphy and sleep diaries, 3 nights ambulatory polysomnography and a 2-day fMRI protocol with Fear-Conditioning, Extinction-Learning and, 24h later, Extinction-Recall phases. Activations within the anterior cerebrum and regions of interest (ROI) were examined within the total, PTSD-diagnosed and trauma-exposed control (TEC) groups. Sleep variables were used to predict activations within groups and among total participants. Family wise error was controlled at p<0.05 using nonparametric analysis with 5000 permutations. RESULTS Initially, Fear Conditioning activated broad subcortical and cortical anterior-cerebral regions. Within-group analyses showed: (1) by end of Fear Conditioning activations decreased in TEC but not PTSD; (2) across Extinction Learning, TEC activated medial prefrontal areas associated with emotion regulation whereas PTSD did not; (3) beginning Extinction Recall, PTSD activated this emotion-regulatory region whereas TEC did not. However, the only between-group contrast reaching significance was greater activation of a hippocampal ROI in TEC at Extinction Recall. A greater number of sleep variables were associated with cortical activations in separate groups versus the entire sample and in PTSD versus TEC. CONCLUSIONS PTSD non-significantly delayed extinction learning relative to TEC possibly increasing vulnerability to pathological anxiety. The influence of sleep integrity on brain responses to threat and extinction may be greater in more symptomatic individuals.
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Affiliation(s)
- Jeehye Seo
- Massachusetts General Hospital, Department of Psychiatry, Charlestown MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA.,Harvard Medical School, Department of Psychiatry, Charlestown, MA, USA.,Korea University, Department of Brain & Cognitive Engineering, Seongbuk-gu, Seoul, KR
| | - Katelyn I Oliver
- Massachusetts General Hospital, Department of Psychiatry, Charlestown MA, USA.,Emory University, Atlanta, GA, USA
| | - Carolina Daffre
- Massachusetts General Hospital, Department of Psychiatry, Charlestown MA, USA.,Duke University, Durham, NC, USA
| | - Kylie N Moore
- Massachusetts General Hospital, Department of Psychiatry, Charlestown MA, USA.,Boston University, Boston, MA, USA
| | - Samuel Gazecki
- Massachusetts General Hospital, Department of Psychiatry, Charlestown MA, USA.,University of New England, College of Osteopathic Medicine, Biddeford, ME, USA
| | - Natasha B Lasko
- Massachusetts General Hospital, Department of Psychiatry, Charlestown MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA.,Harvard Medical School, Department of Psychiatry, Charlestown, MA, USA
| | - Mohammed R Milad
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA.,Nathan Kline Institute for Psychiatric Research, Rockland, NY, USA
| | - Edward F Pace-Schott
- Massachusetts General Hospital, Department of Psychiatry, Charlestown MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA.,Harvard Medical School, Department of Psychiatry, Charlestown, MA, USA
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