bluuebunny/crossref_metadata_2025_split huggingface dataset:
1066 Rapid Eye Movement (REM) Sleep Duration in Posttraumatic Stress Disorder (PTSD) Varies Dynamically and Directly Within the Individual With Indices of Sleep Consolidation and Parasympathetic Tone
Authors: Gupta M A 
Published: May 2020

Abstract

Introduction
Autonomic arousal in posttraumatic stress disorder (PTSD) has been associated with functional hypoactivation of the medial prefrontal cortex and hyperactivity of the amygdala which can directly affect sleep physiology including REM sleep. REM sleep has been associated with reduced fear conditioning; and PTSD has been associated with REM sleep fragmentation. A case report of a drug-free PTSD patient (Gupta MA,2019) who underwent 10 home sleep apnea tests (HSATs) observed a dynamic and inverse relation between REM sleep duration and indices of sympathetic activation during sleep and sleep fragmentation. This study has examined the relationship between REM sleep duration and sleep parameters related to sleep consolidation and parasympathetic tone in 17 PTSD patients who had completed at least 10 HSATs each.

Methods
17 civilian PTSD patients (all female; mean±SD age: 47.59±10.52 years; 16 white) each completed 10 HSATs (WatchPAT200, Itamar)(over 1 to 45 months). The mean±SD initial PTSD Checklist for DSM-5 score was 49.24±13.08 (n=17), and Clinician Administered PTSD Scale for DSM-5 (CAPS-5) score was ≥55. Patients using benzodiazepines and/or narcotics were excluded.

Results
The overall mean±SD REM duration for all 10 visits (for 17x10 HSATs) was 84.40±8.65 minutes (range 69.13-96.97 min); the mean REM duration over the 10 HSATs correlated with other sleep indices as follows: sleep onset latency (Pearson r= -0.667, p=0.035); sleep efficiency (r=0.636, p=0.048); light sleep (NI+N2) percentage (r= -0.754, p=0.012); light sleep duration (r=0.692, p=0.027);deep sleep (N3) duration (r=0.635, p=0.048).

Conclusion
Over the 10 HSATs the average (n=17) REM sleep duration was directly related to indices of sleep consolidation (decreased sleep latency, increased sleep efficiency, increase in both light and deep sleep duration). The direct relation of REM sleep duration to duration of deep sleep, and inverse relation with light sleep percentage suggests REM sleep- related promotion of increased parasympathetic tone within the individual.

Support
None
1067 Replicative and Non-Replicative Nightmares in the Development of Posttraumatic Stress Disorder
Authors: Maeder T , Daffre C , Oliver K I , Lasko N B , Seo J , Ulsa C , Kleim B , Pace-Schott E F 
Published: May 2020

Abstract

Introduction
Nightmares are a frequent and disturbing symptom of posttraumatic stress disorder (PTSD). They are associated with sleep disruption and increased psychopathology. There is growing evidence that different types of nightmares may differ in their effects on psychopathology. Previous findings suggest that nightmares that are close replications of the experienced traumatic event might be especially important in the development of PTSD. This study investigated trauma-related (replicative) and non-trauma-related (non-replicative) nightmares as predictors of PTSD in a civilian sample.

Methods
Participants were recruited from the general public of the greater Boston area. The sample consisted of 108 participants who had experienced a psychological trauma in the past 2 years (e.g. sexual or physical assaults and accidents). The criteria for PTSD were met by 49% of participants. PTSD diagnosis was assessed using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders-Non-Patient Edition. Participants received an Actiwatch 2 (Philips Respironics, Bend, OR) and a sleep diary for sleep measurements over an average of 14 consecutive nights. The diary included a prospective nightmare assessment and an item assessing the relatedness of each nightmare to traumatic events. Logistic regression analyses were performed with PTSD as the categorical outcome variable.

Results
Our analyses showed that replicative nightmares were the only statistically significant predictor of PTSD (OR = 1.2, p = .027), while controlling for age, sex, time since the traumatic event, and actigraphy total sleep time and minutes awake after sleep onset. All of these variables, including non-replicative nightmares, did not significantly predict PTSD in our analyses.

Conclusion
This study confirms and adds to the existing knowledge of nightmares and the importance of the degree to which they replicate the trauma in the development of PTSD. These findings underline the potential role of specific nightmare treatments after traumatic events, with a special focus on replicative nightmares.

Support
R01MH109638
1071 Subjective Measures Of Hyperarousal Predict Subjective Longitudinal And Retrospective Measures Of Sleep Quality In Individuals Exposed To Trauma
Authors: Kram Mendelsohn A , Daffre C , Oliver K I , Seo J , Lasko N B , Pace-Schott E F 
Published: May 2020

Abstract

Introduction
Hyperarousal and disturbed sleep are intrinsic symptoms of posttraumatic stress disorder (PTSD). We explored whether self-reported indices of hyperarousal predict longitudinally measured objective, subjective, and retrospective evaluations of sleep quality in trauma-exposed individuals.

Methods
Individuals exposed to a DSM-5 PTSD Criterion-A traumatic event within the past two years (N=130, 91 females), aged 18-40 (mean 24.43, SD 5.30), 51.54% of whom met DSM-5 criteria for PTSD, completed 14 days of actigraphy and sleep diaries. Participants also completed the PTSD Checklist for DSM-5 (PCL-5), the Clinician-Administered PTSD Scale (CAPS-5), published Hyperarousal (HAS) and Hypervigilance (HVQ) scales, and the Pittsburgh Sleep Quality Index (PSQI) (N=108-125 for different scales). Mean total sleep time (TST), sleep onset latency (SOL), sleep efficiency (SE) and sleep midpoint were calculated from actigraphy and subjective SOL, SE, number of awakenings, and time spent awake from diaries. Simple regressions were used to predict associations of the PCL-5, HAS, and HVQ scores with measures of sleep quality.

Results
Hyperarousal indices predicted diary but not actigraphy measures of sleep quality. Longer diary-reported SOL was predicted by higher scores for: PCL-5 total score (R=0.290, p=0.001), PCL-5 hyperarousal items without the sleep item (R=0.261, p=0.004), and HAS without sleep items (R=0.220, p=0.016). Diary-reported number of awakenings and wake time after sleep onset were predicted by higher HAS scores without the sleep question: (R=0.373, p&lt;0.001; r=0.352, p&lt;0.001). Similarly, all hyperarousal indices significantly predicted PSQI global score (PCL-5: R=0.482, p&lt;0.001; PCL-5 hyperarousal: R=0.389, p&lt;0.001; HVQ: R=0.214, p=0.017; HAS without sleep question: R=0.415, p&lt;0.001).

Conclusion
Self-reported hyperarousal measures predict subjective longitudinal (especially SOL) and retrospective measures, but not objective measurements of sleep quality. Similar discrepancies between self-reported and objective measures of sleep quality have been reported in patients with insomnia disorder. Cognitive-behavioral therapy for insomnia may be especially effective in treating post-traumatic sleep disturbances.

Support
R01MH109638
1072 Post-traumatic Stress Disorder Is Associated With Increased Oscillatory Frequency Of Sleep Spindles
Authors: Wang C , Laxminarayan S , Ramakrishnan S , Dovzhenok A , Cashmere D , Germain A , Reifman J 
Published: May 2020

Abstract

Introduction
Patients with post-traumatic stress disorder (PTSD) often suffer from sleep disturbances. Sleep spindles are an electrophysiological hallmark of non-rapid eye movement sleep and believed to be involved in sleep protection and sleep-dependent memory consolidation. Here, we sought to examine whether sleep spindles are altered in PTSD and whether the findings are reproducible across nights and subsamples of the study population.

Methods
We obtained 64-channel electroencephalogram (EEG) recordings from 78 combat-exposed Veteran men with (n = 31) and without (n = 47) PTSD during two consecutive nights of sleep. We identified slow (10-13 Hz) and fast (13-16 Hz) sleep spindles during N2 and N3 sleep using an automatic algorithm and performed topographical analyses of spindle parameters (amplitude, duration, oscillatory frequency, and density) on both nights. To assess reproducibility, we used the first 47 consecutive participants (18 with PTSD) for initial discovery and the remaining 31 participants (13 with PTSD) for replication assessment.

Results
In the discovery analysis, compared to participants without PTSD, those with PTSD exhibited 1) increased oscillatory frequency of slow spindles over the antero-frontal regions on both nights (Night 1: p = .020, Cohen’s d = 0.92; Night 2: p = .014, Cohen’s d = 1.07) and 2) increased oscillatory frequency of fast spindles over the centro-parietal regions on the second night (p = .018, Cohen’s d = 0.76). Notably, these trends were preserved in the replication analysis. In contrast, we found no significant group differences in the amplitude, duration, or density of slow or fast spindles.

Conclusion
The elevated sleep-spindle frequency in PTSD may reflect reduced thalamocortical inhibition and, hence, deficient sleep protection. Our findings provide the basis for an initial understanding of sleep-spindle abnormalities in PTSD. The findings, if independently validated, may assist in the development of sleep-focused diagnostics and interventions for PTSD.

Support
This work was sponsored by U.S. Defense Health Program (grant No. W81XWH-14-2-0145) and managed by the U.S. Army Military Operational Medicine Program Area Directorate, Ft. Detrick, MD. The study was also supported by the Clinical and Translational Science Institute at the University of Pittsburgh (UL1 TR001857).
0109 Slow Wave Sleep Time and Its Oscillatory Features Show Opposite Associations with Emotional Memory Consolidation Following Stress
Authors: Denis D , Kim S Y , Kark S M , Daley R T , Alger S E , Kensinger E A , Payne J D 
Published: May 2020

Abstract

Introduction
Sleep and stress can both enhance emotional memory consolidation. During slow wave sleep (SWS), oscillatory features such as slow oscillations (SO), sleep spindles (SS), and critically, their coupling, are believed to facilitate consolidation. How they relate to emotional memory consolidation is less clear, and how stress interacts with these oscillations is unknown.

Methods
In this study, participants either underwent a psychosocial stressor (the Trier Social Stress Task; n = 32) or a control task (n=32). Next, they encoded 150 neutral, negative, and positive images while undergoing fMRI. Participants then spent the night in the lab with polysomnographic recording. The next day they were given a surprise recognition test.

Results
There was better memory for emotional compared to neutral items in the stress group. Within this group, % of time spent in SWS positively correlated with emotional memory consolidation (r=.37, p=.039). However, SO-SS coupling during SWS was negatively correlated with emotional memory consolidation in the stress group (r=-.47, p=.007). This was driven by participants who showed a high cortisol response following the stressor (cortisol * coupling interaction p=.03) Results were similar when negative and positive items were analyzed separately. No correlations with neutral item memory were found.

Conclusion
Sleep stage time and sleep oscillatory activity exert different effects on emotional memory following stress, and that SO-SS coupling does not always promote episodic memory consolidation. SO-SS coupling can impair emotional memories when encoded during periods of elevated stress, and accompanying neuromodulators such as cortisol are high.

Support
National Science Foundation, Grant/Award Number: BXS-1539361
1082 Offsprings Autistic Behaviors Modify The Relationships Between Maternal Peritraumatic Distress And Sleep Disturbance Following Trauma Exposure
Authors: Chanko N , Williams N , Jean-Louis G , Casimir G , Blanc J 
Published: May 2020

Abstract

Introduction
Neurodevelopmental impairments may alter parents’ sleep and add tremendous stress to their families’ routine. This study examined the relationship between peritraumatic distress, and sleep disturbances among mothers who were exposed to the 2010 Haitian earthquake during pregnancy and whether this relationship is moderated by offspring‘s autistic behaviors.

Methods
Sample includes 361 mother-offspring dyads [mean (SD) age= 27.31 (5.93); 3.1/2(3.88)] who survived the 2010 earthquake in Haiti. Maternal data were collected 3 years following the event via the Earthquake Experience Questionnaire (EEQ), the Peritraumatic Distress Inventory (PDI), and the sleep items of the PTSD Checklist (PCL-S) (such as trouble falling or staying asleep, and repeated disturbed dreams in response to the disaster exposure). Child-related data were obtained from maternal completion of the Echelle d’Evaluation des Comportements Autistiques Revisee (ECAR) (Autistic Behaviors Scale Revised). Pearson Correlations, multilinear regression and interaction effect analyses were conducted to explore the association between peritraumatic distress, offspring’s autistic behaviors and sleep disturbance among the participants.

Results
10.7% of mothers were caught under rubble or were seriously injured during the event. Three years later, 56.83% and 52.9% of them had consequent disturbed sleep and nightmares, respectively. Maternal sleep disturbance correlated positively with peritraumatic distress (r=.38, p=.01) and offspring autistic behaviors (r=.13, p=.05). As hypothesized, adjusting for covariates, peritramatic distress was the strongest predictor of maternal sleep disturbance (B=.310, p&lt;.001). The relationship between maternal peritraumatic distress and sleep disturbance was modified by offspring autistic behaviors (B=.138, p= .015).

Conclusion
This is the first study to document the prolonged effect of peritraumatic distress during the 2010 Haitian earthquake on mother’s sleep disturbance and whether this relationship is moderated by offspring autistic behaviors. The findings support the importance of a sleep component in maternal and child health in disaster preparedness program.

Support
This study was supported by funding from the NIH: T32HL129953
1091 The Effects Of Sleep Duration, Timing, And Depressed Mood On Daily Eating Patterns
Authors: Wescott D L , Dickman K D , Franzen P L , Hasler B P , Roecklein K A 
Published: May 2020

Abstract

Introduction
Insufficient sleep, circadian misalignment, and altered eating patterns are linked to depression. Despite the temporal association between the sleep/wake and feed/fast cycles, it is unclear how depression severity influences this relationship.

Methods
Sixty-eight participants ages 18-65 years across the depression continuum wore an Actiwatch for 5-17 nights and reported daily meal times (730 nights total). Multilevel models tested previous night’s sleep timing and duration as predictors of the length of the next day’s eating window. Within-person sleep duration and timing were entered as Level 1 predictors to account for nightly variation in sleep. Between-person sleep duration and timing were entered as Level 2 predictors. A three-way interaction between depression severity and Level 2 sleep duration/timing was entered. Covariates included age, gender, and day (weeknight/weekend).

Results
Across participants, average later sleep timing predicted a longer eating window (&#914;= -.222; p =.005). Earlier sleep timing (&#914;= -.186; p &lt; .001) and shorter sleep duration(&#914;= -.103; p &lt; .001) relative to a person’s average each predicted a longer next-day eating window. A three-way interaction was found between sleep duration, timing, and depression (&#914;= -.159; p = .002). At shorter sleep durations, individuals with higher depression severity had a positive relationship between sleep timing and eating window length, and individuals with low depression had a negative relationship between sleep timing and eating window length.

Conclusion
At shorter sleep durations (&lt; 6.5 hr), individuals with high depression and later sleep timing or low depression and early sleep timing had the longest eating windows, which have been linked to adverse metabolic health. Future experiments should test short sleep duration, sleep timing, and depression as potential causes of lengthened eating windows to determine if targeting sleep duration and timing could improve adverse metabolic markers in depression.

Support
NIMH K.A.R. MH103303
1104 Increasing Accessibility of Nightmare Treatment Via Mobile Health
Authors: Speed K J , Nadorff M , Bishop T , Stearns M , Pigeon W 
Published: May 2020

Abstract

Introduction
Nightmares have been tied to a myriad of adverse mental health outcomes and are known to persist after treatment of other concerns such as posttraumatic stress, depression, and anxiety. When reaching clinical levels, nightmare disorder is known to effect 2-6% of the general population, Although many treatments exist for nightmare disorder and posttraumatic nightmares, Imagery Rehearsal Therapy has consistently been cited as the first line treatment. Mobile health (mHealth) technology has emerged as a viable platform from which to deliver sleep medicine interventions.

Methods
We assessed the efficacy of an Imagery Rehearsal Therapy-based mobile application (Dream EZ) developed by the National Center for Telehealth and Technology. College students (n = 99) were recruited in a two-part online study and randomized to the treatment condition or waitlist control. Repeated measures analysis of variance were used to assess the efficacy of smartphone-based mHealth application treatment (Dream EZ) in reduction of psychological symptoms (nightmare distress, PTSD symptoms, and suicide risk) as compared to waitlist control.

Results
Findings support the use of Dream EZ for nightmares distress reduction (main effect: p =.004, d = .57; interaction: p =.049, d = .41). Results regarding effectiveness of Dream EZ in relation to reduction of PTSD symptoms (main effect: p = .415, d = .17; interaction: p =.262, d = .23) showed no significant interactions between PTSD symptoms and treatment group assignment. In relation to changes in suicidality (main effect: p =.007, d = .57; interaction: p =.758, d = .07), findings were nonsignificant.

Conclusion
Use of nightmare-focused treatment through a mHealth smartphone application may be a viable avenue for promoting management of nightmare distress in college students. These findings present an opportunity to explore further options for increasing accessibility of sleep-focused treatment options in a challenging and fast-paced population.

Support
No support to disclose.
1106 Associations Between Severe Mental Illness and Positive Airway Adherence in a Veteran Cohort
Authors: May A M , Gandotra K , Jaskiw G E 
Published: May 2020

Abstract

Introduction
Serious mental illness (SMI) is associated with excess morbidity and mortality irrespective of healthcare access. Adherence differences may contribute to this health disparity. In those with sleep disorders, adherence to positive airway pressure (PAP) can improve health outcomes. We hypothesized that SMI is associated with lower PAP adherence.

Methods
In this retrospective cohort study, 5047 veterans receiving a PAP machine from the VANEOHS (1/1/2010 - 6/31/2015) were evaluated for 90-day PAP adherence (% days used ≥4 hours). A composite variable of any billing diagnosis of psychotic spectrum disorder, bipolar disorder, post-traumatic stress disorder (PTSD), or major depression was examined via linear regression. Analyses were adjusted for demographics, comorbidities, and medications. We conducted sensitivity analyses of 30-day adherence as well as subset analyses of associations between each disorder and adherence.

Results
The group was 38.8 ± 11.9 years old, 3.9% female with 52.6% with major depression, 25.0% with PTSD. 58.4% of the cohort had at least one psychiatric disorder. PTSD with depression was the most common comorbidity in those with two or more psychiatric diagnoses. Unadjusted analyses showed worse adherence in those with any SMI (β = -7.5%, 95% CI: -9.8% -5.3%), which was mitigated in adjusted analyses (β = -1.6%, 95% CI: -5.1%, 1.9%). All individual SMIs were negatively associated with adherence, but only PTSD was associated with less adherence in adjusted analyses (β = -6.4%, 95%CI: -11.2%, -1.6%). Sensitivity analyses of 30-day adherence were similar to primary analyses.

Conclusion
In this large cohort of veterans, broadly defined SMI was associated with lower 30- and 90-day adherence in unadjusted but not adjusted analyses. Replication and refinement of the link between SMI, particularly PTSD, and adherence may provide opportunities for targeted interventions and improve health disparities.

Support
This work was supported in part by Career Development Award IK2CX001882 from the United States (U.S.) Department of Veterans Affairs Clinical Sciences Research and Development Service.
The contents of this work do not represent the views of the Department of Veterans Affairs or the United States government.
1108 Associations Between Insomnia And Anxiety Symptoms: Which Elements Of Insomnia Are Associated With Which Elements Of Anxiety?
Authors: Kapoor A , Perlis M L , Bastien C , Williams N , Hale L , Branas C , Barrett M , Killgore W D , Wills C C , Grandner M A 
Published: May 2020

Abstract

Introduction
It is still not clear which aspects of insomnia are associated with various aspects of anxiety problems. Knowing this could better guide treatment of insomnia comorbid with anxiety.

Methods
Data from the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) study were used, including N=1003 adults age 22-60. All participants completed the Insomnia Severity Index (ISI) and the GAD7 anxiety questionnaire. The ISI was divided into 3 sections, based on prior work: SLEEP symptoms (difficulty sleeping), DAYTIME symptoms (difficulty functioning), and PERCEPTION symptoms (dissatisfaction). GAD7 items included anxiety level, loss of control, worry about many things, difficulty relaxing, restlessness, irritability, and fear. Logistic regression analyses examined each symptom, with each component of the ISI as predictor, as well as age, sex, race/ethnicity and education as covariates.

Results
SLEEP symptoms were independently associated with control (OR=1.09, p=0.03), many worries (OR=1.1, p=0.017), restlessness (OR=1.1, p=0.009), and irritability (OR=1.1, p=0.04). DAYTIME symptoms were independently associated with anxiety level (OR=1.3, p&lt;0.0005), control (OR=1.2, p&lt;0.0005), many worries (OR=1.3, p&lt;0.0005), difficulty relaxing (OR=1.2, p=0.004), restlessness (OR=1.3, p=0.001), and irritability (OR=1.2, p&lt;0.0005). PERCEPTION symptoms were uniquely, independently associated with anxiety level (OR=1.1, p=0.03), control (OR=1.2, p=0.001), many worries (OR=1.2, p=0.001), difficulty relaxing (OR=1.4, p&lt;0.0005), irritability (OR=1.2, p=0.018), and feelings of fear (OR=1.2, p=0.002).

Conclusion
The DAYTIME and PERCEPTION symptoms of insomnia were strongly related to anxiety symptoms. Current treatments for insomnia focus mainly on improving sleep. Future research should test the hypothesis that treating daytime symptoms of insomnia may aid patients with comorbid anxiety.

Support
The SHADES study was funded by R21ES022931. Dr. Grandner is supported by R01MD011600.