bluuebunny/crossref_metadata_2025_split huggingface dataset:
0659 Nightmares in the acute aftermath of trauma predict later suicidal ideation in trauma survivors
Authors: Seymour Grace , Reffi Anthony , Moore David , Mahr Gregory , Drake Christopher 
Published: May 2023

Abstract

Introduction
Nightmares are a common occurrence after experiencing a traumatic event and are a symptom of post-traumatic stress disorder (PTSD). Additionally, nightmares are associated with higher levels of suicidal ideation, attempt, and death from suicide. Nightmares may be an early sign of suicide risk in populations that have experienced trauma, however, there are no studies that have investigated this potential link. This study aims to determine whether more severe nightmares in the aftermath of trauma will prospectively predict later suicidal ideation, independent of comorbid insomnia.

Methods
We recruited adults that were admitted to the intensive care unit at Henry Ford Hospital in Detroit after experiencing a DSM-5 Criterion A traumatic event (N = 76, Mage = 38.39, 65.8% male). Participants completed study surveys at three time points: T1 (an average of 6 days after trauma), T2 (two weeks after T1), and T3 (1 month after T1). Nightmare and insomnia severity were measured at T2 with the Nightmare Disorder Index (NDI) and Insomnia Severity Index (ISI), respectively. Suicidal ideation was measured at T3 using item nine on the Patient Health Questionnaire (PHQ-9).

Results
More severe nightmares in the acute aftermath of trauma (T2) predicted more severe SI two weeks later at T3 (β = 0.49, SE = .17, p = .004, R2 = .22). This association remained even after adjusting for T1 SI, T2 ISI, age, and sex (β = 0.36, SE = .18, p = .044, R2 = .31).

Conclusion
More severe nightmares in the acute aftermath of trauma predicted more severe SI one month after trauma, independent of comorbid insomnia symptoms and baseline suicidal ideation. These findings suggest that the onset of nightmares immediately after trauma may confer a unique risk for SI. In clinical practice, it may be useful to detect nightmares in the aftermath of trauma using brief measures such as the NDI. Trauma survivors that develop frequent and severe nightmares within the acute recovery phase could then be given targeted nightmare treatment to reduce the risk of later SI.

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0664 Association of Nightmares with Predisposing and Perpetuating Factors in an Outpatient Behavioral Sleep Medicine Clinic
Authors: Paquet Caitlin , Lenker Kristina , Calhoun Susan , Fernandez-Mendoza Julio 
Published: May 2023

Abstract

Introduction
While nightmares are well known to be associated with greater sleep disturbance and psychopathology relative to insomnia, this has primarily been observed in experimental samples and not well-studied in outpatient clinical samples. Several theories for the etiology and maintenance of nightmares have identified the roles of both hyperarousal and emotion dysregulation in explaining the association of nightmares to adverse psychiatric outcomes. Given that insomnia is also associated with similar predisposing and perpetuating factors such as greater trait arousability and sleep reactivity, it is important to understand how these factors compare between nightmares and insomnia.

Methods
A total of 445 patients (45.6±18.4 years old, 66.5% female, 13.0% minority) with diagnoses of nightmare disorder (n=32), insomnia disorder (n=274) and any other sleep disorder (n=139) were evaluated at the Behavioral Sleep Medicine (BSM) program of Penn State Health Sleep Research & Treatment Center. To measure symptoms of depression, anxiety, stress, hyperarousal, sleep reactivity, and dysfunctional beliefs about sleep, all patients completed the Depression Anxiety Stress Scale (DASS), Arousal Predisposition Scale (APS), Ford Insomnia Response to Stress Test (FIRST), Pre-sleep Arousal Scale, and Dysfunctional Beliefs and Attitudes about Sleep (DBAS), respectively. Analysis of variance (ANOVA) examined between-group differences in patient-reported outcomes.

Results
There were no significant between-group differences on sleep reactivity, pre-sleep cognitive arousal, dysfunctional beliefs and attitudes about sleep or depression scores (all ps&gt;0.12). However, patients with nightmare disorder showed greater arousability, in both trait anxiety and emotional reactivity, pre-sleep somatic symptoms, anxiety and perceived stress than patients with insomnia disorder or with any other sleep disorder (all ps&lt; 0.05).

Conclusion
While patients with nightmare disorder share predisposing and perpetuating factors common to patients with insomnia disorder, they do present with more severe forms of cognitive-emotional arousability, trait-anxiety, and somatic symptoms of anxiety that impact nighttime sleep. These data suggest that clinical evaluations for sleep disruption should include a thorough gathering of history to include the onset, course, and perpetuating factors. Cognitive-behavioral therapies for nightmares and insomnia should be tailored to target these specific factors in order to prevent relapses.

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0666 Need a novel method to reduce anger after combat? Treat sleep apnea
Authors: Miles Shannon , Martindale Sarah , Flanagan Julianne , Troyanskaya Maya , Reljic Tea , Gilmore Amanda , Wyant Hannah , Nakase-Richardson Risa 
Published: May 2023

Abstract

Introduction
Dysregulated anger can result in devastating health and interpersonal consequences for individuals, families, and communities. Compared to civilians, combat veterans and service members (C-V/SM) report higher levels of anger and often have risk factors for anger including posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), pain, alcohol use, and impaired sleep.

Methods
The current study examined the relative contributions of established variables associated with anger (e.g., combat exposure, current PTSD symptoms, history of TBI, pain interference, and hazardous alcohol use) in 1,263 C-V/SM. Sleep impairments, represented by poor sleep quality and obstructive sleep apnea (OSA) risk, were also evaluated as potential mediators of the relationships between established risk factors and anger, and therefore potential modifiable treatment targets.

Results
Multiple regression model results revealed that PTSD symptoms (β = 0.517, p &lt; .001), OSA risk (β = 0.057, p = .016), pain interference (β = 0.214, p &lt; .001), and hazardous alcohol use (β = 0.054, p = .009) were significantly associated with anger. Results of the mediation models revealed that OSA risk accounted for associations between PTSD and pain interference with anger.

Conclusion
Treating OSA may be a novel way to reduce anger in C-V/SM who have PTSD and/or pain interference. The current study extends previous literature by simultaneously examining factors associated with anger using a multivariable model in a large sample of C-V/SM.

Support (if any)
This work was supported by the Assistant Secretary of Defense for Health Affairs endorsed by the Department of Defense, through the Psychological Health/Traumatic Brain Injury Research Program Long-Term Impact of Military-Relevant Brain Injury Consortium (LIMBIC) Award/W81XWH-18-PH/TBIRP-LIMBIC and with resources and the use of facilities at the James A. Haley Veterans’ Hospital. The views expressed in this abstract are those of the authors and do not necessarily represent the official policy or position of the Defense Health Agency, Department of Defense, or any other U.S. government agency. For more information, please contact dha.TBICOEinfo@mail.mil. UNCLASSIFIED
0667 A digital prescription therapeutic device to treat nightmare disorders: A case series
Authors: Robertson Brian , Liem Andre 
Published: May 2023

Abstract

Introduction
Introduction: Nightmare disorder and post-traumatic stress disorder (PTSD)-associated nightmares can be treatment-resistant in many patients. There are no recommended treatments for these conditions currently.

Methods
Methods: NightWare is a novel FDA-approved class II medical device which improves sleep in patients with nightmare disorder and PTSD-associated nightmares. It uses data from a smart watch to determine when nightmares are happening using heart rate and movement sensors, and then intervenes to interrupt the nightmare and improve overall sleep quality. We report the 14 consecutive cases of patients using NightWare and the Clinical Global Impression (CGI) of Severity and Change in their sleep and reduction of nightmare burden.

Results
Results: Of the 14 patients in this series, 10 patients used the device for more than 7 days. 1 discontinued due to perceived lack of efficacy, 2 stopped in part due to a skin rash, and one stopped because he did not want to wear a watch to sleep. At baseline, the 10 patients included in the analysis had a mean CGI Severity score of 4.7 (SD 1.25), which indicates moderate to severe nightmares and daytime dysfunction. Improvement in the CGI Change score with NightWare exceeded that of prazosin for this group of patients. The patients in this series that used the device had a mean score of 2.20 (SD 0.79) on the CGI Change scale, which indicates there was significant improvement from baseline. Six of the 10 patients using NightWare were also taking prazosin prior to starting NightWare. The prazosin dose ranged from 1-8 mg nightly for these patients. These 6 patients had minimal improvement with prazosin alone (CGIC of 3.16 (SD 0.41).

Conclusion
Conclusion: In this case series, NightWare significantly improved the symptoms of nightmare disorder in 10 of the 14 patients in this series. Patient selection for sympathetic nervous system activation is important to ensure the device’s effectiveness.

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0668 Adverse Childhood Experiences Associated with Adult Insomnia and Nightmares
Authors: Rasmussen Elizabeth , Ricketts Emily , Joyce Daniel , Mensah-Osman Taylor , Gorovoy Suzanne , Granados Karla , Prather Aric , Hale Lauren , Branas Charles , Rojo-Wissar Darlynn , Grandner Michael 
Published: May 2023

Abstract

Introduction
Adverse childhood experiences can increase likelihood of hyperarousal, especially around periods of vulnerability. Survivors of trauma also experience more nightmares. These data explore whether adverse childhood events are associated with adult insomnia severity and nightmares.

Methods
Data were obtained from the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) study of N=1007 adults 22-60 years recruited from southeastern Pennsylvania. Adverse childhood experiences were defined as a self-reported history of child abuse, parent divorce, parent death, parent with depression, parent with anxiety disorder, and childhood poverty (yes/no). Insomnia severity was assessed using the Insomnia severity Index (ISI), evaluated both as a continuous variable and categorical: None (0-7) vs Mild (8-14) or Moderate-Severe (15+). Nightmares were assessed ordinally using the following anchors: Never, Seldom, Sometimes, Often, or Frequently. Covariates included age, sex, race/ethnicity, and education. Additional models included depression severity, assessed using a modified version of the Patient Health Questionnaire-9.

Results
Child abuse was associated with an additional 2.9 points on the ISI, and parental divorce, death, depression, and anxiety were associated with an additional 1.2, 1.7, 1.8, and 1.8 points, respectively (all p&lt; 0.005). After adjustment for depressed mood, relationships remained for child abuse, parent divorce, and parent death. In evaluating categorical insomnia, child abuse was associated with both mild (RRR=2.64, p&lt; 0.0005) and moderate-severe (RRR=3.37, p&lt; 0.0005) insomnia. Parent death was associated with an increased likelihood of moderate-severe insomnia (RRR=1.94, p=0.007). Parent divorce, depression, and anxiety were all associated with increased mild (RRR=1.44 [p=0.03], RRR=1.85 [p=0.001], and RRR=1.85 [p=0.004], respectively) and moderate-severe (RRR=1.50 [p=0.03], RRR=2.24 [p&lt; 0.0005], and RRR=2.40 [p&lt; 0.0005], respectively) insomnia. More frequent adult nightmares were reported by those who reported a history of child abuse (oOR=1.9, p&lt; 0.0005), parent death (oOR=1.6, p=0.007), parent depression (oOR=1.6, p&lt; 0.0005), and parent anxiety (oOR=1.8, p&lt; 0.0005). After adjustment for depression, relationships with child abuse and parent death were maintained. Child poverty was not associated with insomnia or nightmares.

Conclusion
Adverse childhood events may contribute to later risk for insomnia and nightmares. Further efforts are needed to establish causality and develop interventions, which may have residual effects on mental and physical health.

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0669 Disruptive Nocturnal Behaviors in PTSD Patients are Associated with More Severe Psychiatric Pathology
Authors: Gupta Madhulika , Anello Carmelina 
Published: May 2023

Abstract

Introduction
The similarities and differences between trauma associated sleep disorder (TASD) and REM sleep behavior disorder (RBD) are unclear. However, both REM sleep parasomnias are associated with disruptive nocturnal behaviors (DNB) that manifest as episodes of sleep-related vocalizations, and/or complex motor behaviors. Patients who have more DNB are more likely to have a higher prevalence of PTSD.

Methods
In a cross-sectional study, we examined the relationship between DNB severity and the severity of psychiatric symptoms in PTSD patients. 73 civilian patients with histories of complex developmental trauma (age 47.0 ±13.3 years; 89.6% female) met the DSM-5 criteria for moderate-to-severe PTSD. PTSD Checklist for DSM-5 (PCL-5) was used to obtain an index of current PTSD severity (37.41 ± 19.84; PCL-5 &gt;30 cutoff for PTSD). DNB was defined as the sum of the two items 1f and 1g in the Pittsburgh Sleep Quality Index PTSD Addendum (PTSD-A). The participants rated how often during the past 1 month they had trouble sleeping because of the following: (PTSD-A Item1f) “Had episodes of terror or screaming during sleep without fully awakening” and (PTSD-A Item1g) “Had episodes of ‘acting out’ their dreams, such as kicking, punching, running or screaming”. We used a stepwise multiple regression analysis with DNB as the dependent variable and the variables described below as independent variables.

Results
We determined the following relationships: 1. PCL-5 (r=0.359, p=0.002); 2. Brief Symptom Inventory which includes Somatization (r=0.476,p&lt; 0.001);Obsessive-compulsiveness (r=0.429, p&lt; 0.001); Interpersonal Sensitivity (r=0.337, p=0.004); Depression (r=0.398, p&lt; 0.001); Anxiety (r=0.449,p&lt; 0.001); Hostility (r=0.577, p&lt; 0.001); Phobic Anxiety (r=0.353, p=0.002); Paranoid Ideation (r=0.412, p&lt; 0.001); and Psychoticism (r=0.414, p&lt; 0.001); 3. Insomnia Severity Index (r=0.363, p=0.002); 4. Beck Suicide Scale or BSS (r=0.268, p=0.025); 5.Beck Anxiety Inventory (r=0.472, p&lt; 0.001); and 6. Fear of Sleep(r=0.493,p&lt; 0.001). Fear of Sleep Inventory (FOS) (Beta=0.442, t=4.258, p&lt; 0.001) and Beck Scale for Suicidal Ideation (BSS) (Beta=0.300, t=2.887, p=0.005) emerged as the significant predictors of DNB.

Conclusion
DNB was correlated with a wide range of psychiatric pathology in PTSD. This suggests that DNB could be an integral feature of severe PTSD. To our knowledge, this has not been previously reported.

Support (if any)
None
0670 Examination of neighborhood disadvantage and sleep in a sample of PTSD-diagnosed Veterans with trauma nightmares
Authors: Miller Katherine , So Christine , Brownlow Janeese , Gehrman Philip , Woodward Steven H 
Published: May 2023

Abstract

Introduction
The nature of sleep can leave sleepers vulnerable to environmental threats, requiring a balance between the demands for vigilance and the physiological requirement for sleep. Understanding the sleeping context is particularly relevant to understanding the dynamics of sleep disturbance observed in individuals with posttraumatic stress symptoms (PTSS) because of subsequent increased vigilance to threats. This study examined the associations between neighborhood disadvantage, sleep respiratory sinus arrhythmia (RSA), fear of sleep, and nightmare frequency in a sample of trauma-exposed Veterans.

Methods
Baseline data from an ongoing study examining sleep with trauma nightmares using ambulatory sleep measurement in a sample of U.S. military Veterans were analyzed. Participants completed assessments of nightmare frequency and fear of sleep, and slept on a mattress actigraphy system for at least seven nights, which captured sleep-period RSA as an index of autonomic activation. Neighborhood disadvantage was assessed with the Area Deprivation Index (ADI), a census-based socioeconomic index. For this study, participants’ zip codes were linked to 2020 ADI scores using the Neighborhood Atlas, and the census-block groups were ranked into state-level 1 to 10 deciles (split into halves- low and high). Higher ADI scores indicate greater disadvantage. The differences between the least and most disadvantaged groups were analyzed with binary logistic regression models.

Results
Data were available from 33 Veterans. The mean state-level ADI was 6.2 (SD = 2.7). Low and high state-level ADI scores were 4.3 (SD = 2, n = 19) and 8.7 (SD = 0.8, n = 14), respectively. Residing in zip codes with greater neighborhood disadvantage was associated with elevated fear of sleep (OR = 1.2, p = 0.04), and a trend for reduced sleep-period RSA (OR = 0.4, p = 0.05). No differences were observed for past week nightmare frequency.

Conclusion
In this sample of Veterans, living in the most disadvantaged neighborhoods was significantly associated with greater fear of sleep, and may be associated with reduced RSA. Sleep context may increase hypervigilance in turn serving as a mechanism by which trauma-induced sleep disruptions are maintained.

Support (if any)
Funded by the U.S. Department of Veterans Affairs, Veterans Health Administration Clinical Science Research and Development Service - IK2 CX001874.
0673 Sleep in PTSD: A Subjective Concern
Authors: Jacobus Brent , Brock Matthew 
Published: May 2023

Abstract

Introduction
Sleep complaints are a hallmark of posttraumatic stress disorder (PTSD). Prior studies examining sleep abnormalities in PTSD are inconsistent, with some reporting objective sleep changes including associated obstructive sleep apnea (OSA), possibly due to moderating variables including advancing age, traumatic brain injury (TBI), and medications. We sought to compare sleep disorders and objective and subjective sleep metrics in service members with and without PTSD while controlling for these potential confounders.

Methods
Case-controlled observational cohort study performed at an academic military sleep center. Detailed sleep history, sleep-related questionnaires, trauma history, and video-polysomnography was performed. Patients with a history of TBI, abnormal neuroimaging, or psychoactive medication use (antidepressants, antipsychotics, anxiolytics) were excluded.

Results
Patients (N=169, 124 males) were active duty service members (median age 37.1 years) reporting a sleep complaint. Of these, 43 (25.4%) had PTSD vs 126 (74.6%) without PTSD. In patients with PTSD vs no PTSD, there was no significant difference in the rate of OSA, mean total sleep time, sleep efficiency, mean apnea-hypopnea index, sleep stage percentage, or any other polysomnogram (PSG) variable. Stage N3 sleep was non-significantly increased in patients with PTSD (18% vs 14%, p=0.078). Subjective sleepiness was similar between those with and without PTSD (Epworth Sleepiness Score 12.9 vs 11.9, p=0.35). However, subjective insomnia symptoms (Insomnia Severity Index 20.4 vs 15.2, p&lt; 0.0001) and perceived sleep quality (Pittsburgh Sleep Quality Index 15.4 vs 11.1, p&lt; 0.0001) were worse in those with PTSD vs no PTSD.

Conclusion
In a relatively young active duty cohort with no history of psychoactive medication use or TBI, patients with PTSD had more subjective sleep complaints than those without PTSD but objective sleep parameters, including PSG variables and OSA rate, did not differ significantly. The higher stage N3 (slow wave) sleep percentage, though not statistically significant, suggests that PTSD patients sleep better in a monitored sleep lab than in their habitual sleeping environment.

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0680 Does Impulsivity Mediate the Association Between Sleep Disturbance and Binge Eating?
Authors: Lampe Elizabeth , Muench Alexandria , Seewald Mark , Boyle Julia , Perlis Michael , Grandner Michael , Tubbs Andrew , Manasse Stephanie 
Published: May 2023

Abstract

Introduction
It has been suggested that sleep continuity disturbance and/or short sleep duration is associated with increased impulsivity across clinical populations (i.e., The Mind After Midnight Theory). Consistent with this theory are the findings showing that sleep disturbance is associated with increased binge eating (BE; a subjective sense of loss of control over one’s eating) both cross-sectionally and longitudinally. To date, no study has examined whether impulsivity mediates the association between sleep disturbance and BE. Further, the extant literature has relied on retrospective self-report assessment of impulsivity which is subject to recall and social desirability biases. The aim of the present study was to examine whether performance on a behavioral measure of impulsivity (Go/No-Go task) mediated the association between sleep quality (SQ), sleep efficiency (SE%), and daytime dysfunction (DD), as measured by the PSQI, and BE frequency.

Methods
The parent study was a sample of 63 individuals (85.9% female; X̅age=40.6 years) seeking treatment for BE. Of note, individuals with extremely low levels of impulsivity were excluded from the parent study. Mediation models using the lavaan package in R (version 4.1.3) examined the effect of sleep disturbance on impulsivity and whether DD mediated this association.". The current analyses included the full available sample and all models co-varied for depressive symptoms.

Results
A negative direct effect of DD on impulsivity was observed (B=-55.43, S.E.=22.06, p=.01) and impulsivity did not significantly mediate the association between SQ (B=0.20, S.E.=0.59, p=0.73), SE (B=-0.02, S.E.= 0.14, p=0.92), or DD (B= 0.160, S.E.=1.14, p=0.51) and BE frequency.

Conclusion
While impulsivity did not mediate the association between sleep disturbance and BE in our sample, the current study may have been under-powered to detect even large effects due to its moderate sample size and low levels of insomnia symptoms. Future studies should evaluate these associations in large samples, using prospective measures of sleep continuity and do so in samples with clinical levels of insomnia. Further, such studies should take into account time of day considerations.

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