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1.
Artigo em Inglês | MEDLINE | ID: mdl-34855522

RESUMO

Simulated military operational stress (SMOS) provides a useful model to better understand resilience in humans as the stress associated with caloric restriction, sleep deficits, and fatiguing exertion degrades physical and cognitive performance. Habitual physical activity may confer resilience against these stressors by promoting favorable use-dependent neuroplasticity, but it is unclear how physical activity, resilience, and corticospinal excitability (CSE) relate during SMOS. PURPOSE: To examine associations between corticospinal excitability, physical activity, and physical performance during SMOS. METHODS: Fifty-three service members (age: 26±5yrs, 13 women) completed a five day and night intervention composed of familiarization, baseline, SMOS (two nights/days), and recovery days. During SMOS, participants performed rigorous physical and cognitive activities while receiving half of normal sleep (two 2h blocks) and caloric requirements. Lower and upper limb CSE were determined with transcranial magnetic stimulation (TMS) stimulus-response curves. Self-reported resilience, physical activity, military-specific physical performance (TMT) and endocrine factors were compared in individuals with high (HIGH) and low CSE based on a median split of lower limb CSE at baseline. RESULTS: HIGH had greater physical activity and better TMT performance throughout SMOS. Both groups maintained physical performance despite substantial psychophysiological stress. Physical activity, resilience, and TMT performance were directly associated with lower limb CSE. CONCLUSION: Individual differences in physical activity coincide with lower (but not upper) limb CSE. Such use-dependent corticospinal excitability directly relates to resilience and physical performance during SMOS. Future studies may use non-invasive neuromodulation to clarify the interplay among CSE, physical activity, and resilience and improve physical and cognitive performance.

3.
Rehabil Psychol ; 66(4): 600-610, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34398631

RESUMO

PURPOSE/OBJECTIVE: The role of perceived social support from specific sources (e.g., families, friends, and significant others) on the development of postinjury posttraumatic stress disorder (PTSD) and associated psychological symptoms (e.g., depression and anxiety) remains relatively unexplored. We examined the predictive role of social support from specific sources on psychological symptoms among emergency department (ED) patients following motor vehicle crash (MVC). Research Methods/Design: Sixty-three injured patients (63.5% female; 37 years old on average) with moderately painful complaints were recruited in the EDs of two Level-1 trauma centers within 24 hr post-MVC. In the ED, participants completed surveys of baseline psychological symptoms and perceived social support; follow-up surveys were completed at 90 days postinjury. RESULTS: Most of the sample (84.1%) was discharged home from the ED with predominantly mild injuries and did not require hospitalization. After adjusting for race, sex, age, and baseline symptoms, hierarchical regression analyses demonstrated that lower perceived social support in the ED predicted higher PTSD symptoms and depressive symptoms (but not anxiety) at 90 days. This effect seemed to be specific to significant others and friends but not family. CONCLUSIONS/IMPLICATIONS: MVC-related injuries are robust contributors to psychological sequelae. These findings extend prior work by highlighting that perceived social support, particularly from significant others and friends, provides unique information regarding the development of psychological symptoms following predominantly mild MVC-related injuries. This data may serve to inform recovery expectations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

4.
Sleep ; 2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-34432067

RESUMO

STUDY OBJECTIVES: Within-subject stability of certain sleep features across multiple nights is thought to reflect the trait-like behavior of sleep. However, to be considered a trait, a parameter must be both stable and robust. Here, we examined the stability (i.e., across the same sleep opportunity periods) and robustness (i.e., across sleep opportunity periods that varied in duration and timing) of different sleep parameters. METHODS: Sixty-eight military personnel (14 W) spent 5 nights in the sleep laboratory during a simulated military operational stress protocol. After an adaptation night, participants had an 8-hour sleep opportunity (23:00-07:00) followed by 2 consecutive nights of sleep restriction and disruption which included two 2-hour sleep opportunities (01:00-03:00; 05:00-07:00) and, lastly, another 8-hour sleep opportunity (23:00-07:00). Intra-class correlation coefficients were calculated to examine differences in stability and robustness across different sleep parameters. RESULTS: Sleep architecture parameters were less stable and robust than absolute and relative spectral activity parameters. Further, relative spectral activity parameters were less robust than absolute spectral activity. Absolute alpha and sigma activity demonstrated the highest levels of stability that were also robust across sleep opportunities of varying duration and timing. CONCLUSIONS: Stability and robustness varied across different sleep parameters, but absolute NREM alpha and sigma activity demonstrated robust trait-like behavior across variable sleep opportunities. Reduced stability of other sleep architecture and spectral parameters during shorter sleep episodes as well as across different sleep opportunities has important implications for study design and interpretation.

5.
JAMA Netw Open ; 4(7): e2115707, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34236411

RESUMO

Importance: Veterans from recent and past conflicts have high rates of posttraumatic stress disorder (PTSD). Adaptive testing strategies can increase accuracy of diagnostic screening and symptom severity measurement while decreasing patient and clinician burden. Objective: To develop and validate a computerized adaptive diagnostic (CAD) screener and computerized adaptive test (CAT) for PTSD symptom severity. Design, Setting, and Participants: A diagnostic study of measure development and validation was conducted at a Veterans Health Administration facility. A total of 713 US military veterans were included. The study was conducted from April 25, 2017, to November 10, 2019. Main Outcomes and Measures: The participants completed a PTSD-symptom questionnaire from the item bank and provided responses on the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (PCL-5). A subsample of 304 participants were interviewed using the Clinician-Administered Scale for PTSD for DSM-5. Results: Of the 713 participants, 585 were men; mean (SD) age was 52.8 (15.0) years. The CAD-PTSD reproduced the Clinician-Administered Scale for PTSD for DSM-5 PTSD diagnosis with high sensitivity and specificity as evidenced by an area under the curve of 0.91 (95% CI, 0.87-0.95). The CAT-PTSD demonstrated convergent validity with the PCL-5 (r = 0.88) and also tracked PTSD diagnosis (area under the curve = 0.85; 95% CI, 0.79-0.89). The CAT-PTSD reproduced the final 203-item bank score with a correlation of r = 0.95 with a mean of only 10 adaptively administered items, a 95% reduction in patient burden. Conclusions and Relevance: Using a maximum of only 6 items, the CAD-PTSD developed in this study was shown to have excellent diagnostic screening accuracy. Similarly, using a mean of 10 items, the CAT-PTSD provided valid severity ratings with excellent convergent validity with an extant scale containing twice the number of items. The 10-item CAT-PTSD also outperformed the 20-item PCL-5 in terms of diagnostic accuracy. The results suggest that scalable, valid, and rapid PTSD diagnostic screening and severity measurement are possible.

6.
J Psychiatr Res ; 141: 301-308, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34304033

RESUMO

Posttraumatic stress disorder-related sleep disturbances may increase daytime sleepiness and compromise performance in individuals with posttraumatic stress disorder. We investigated nighttime sleep predictors of sleepiness in Veterans with and without posttraumatic stress disorder. Thirty-seven post-9/11 Veterans with posttraumatic stress disorder and 47 without posttraumatic stress disorder (Control) completed a 48-h lab stay. Nighttime quantitative EEG and sleep architecture parameters were collected with polysomnography. Data from daytime sleepiness batteries assessing subjective sleepiness (global vigor questionnaire), objective sleepiness (Multiple Sleep Latency Tests) and alertness (psychomotor vigilance task) were included in analyses. Independent samples t-tests and linear regressions were performed to identify group differences in sleepiness and nighttime sleep predictors of sleepiness in the overall sample and within each group. Participants with posttraumatic stress disorder had higher subjective sleepiness (t = 4.20; p < .001) and lower alertness (psychomotor vigilance task reaction time (t = -3.70; p < .001) and lapses: t = -2.13; p = .04) than the control group. Objective daytime sleepiness did not differ between groups (t = -0.79, p = .43). In the whole sample, higher rapid eye movement delta power predicted lower alertness quantified by psychomotor vigilance task reaction time (ß = 0.372, p = .013) and lapses (ß = 0.388, p = .013). More fragmented sleep predicted higher objective sleepiness in the posttraumatic stress disorder group (ß = -.467, p = .005) but no other nighttime sleep measures influenced the relationship between group and sleepiness. Objective measures of sleep and sleepiness were not associated with the increased subjective sleepiness and reduced alertness of the posttraumatic stress disorder group.


Assuntos
Transtornos de Estresse Pós-Traumáticos , Atenção , Humanos , Desempenho Psicomotor , Sono , Sonolência , Transtornos de Estresse Pós-Traumáticos/complicações , Vigília
7.
Physiol Behav ; 236: 113413, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33811909

RESUMO

PURPOSE: To study the impact of 48 h of simulated military operational stress (SMOS) on executive function, in addition to the role of trait resilience (RES) and aerobic fitness (FIT) on executive function performance. Associations between executive function and neuropeptide-Y (NPY), brain-derived neurotropic factor (BDNF), insulin-like growth factor-I (IGF-I), oxytocin, and α-klotho (klotho) were assessed to elucidate potential biomarkers that may contribute to cognitive performance during a multi-factorial stress scenario. METHODS: Fifty-four service members (SM) (26.4 ± 5.4 years, 178.0 ± 6.5 cm, 85.2 ± 14.0 kg) completed the 5-day protocol, including daily physical exertion and 48 h of restricted sleep and caloric intake. Each morning subjects completed a fasted blood draw followed by Cognition, a 10-part cognitive test battery assessing executive function. SMs were grouped into tertiles [low (L-), moderate (M-), high (H-)] based on Connor Davidson Resilience Score (RES) and V˙O2peak (FIT). Repeated measures ANOVA were run to analyze the effect of day on cognitive performance and biomarker concentration. Separate two-way mixed ANOVAs were run to determine the interaction of group by day on cognitive function. Friedman test with Bonferroni-corrected pairwise comparisons were used if assumptions for ANOVA were not met. Associations between changes in biomarkers and cognitive performance were analyzed using parametric and non-parametric correlation coefficients. RESULTS: SMOS reduced SM vigilance -11.3% (p < 0.001) and working memory -5.6% (p = 0.015), and increased risk propensity +9.5% (p = 0.005). H-RES and H-FIT SMs demonstrated stable vigilance across SMOS (p > 0.05). Vigilance was compromised during SMOS in L- and M-RES (p = 0.007 and p = 0.001, respectively) as well as L- and M-FIT (p = 0.001 and p = 0.031, respectively). SMOS reduced circulating concentrations of α-klotho -7.2% (p = 0.004), NPY -6.4% (p = 0.001), and IGF-I -8.1% (p < 0.001) from baseline through the end of the protocol. BDNF declined -19.2% after the onset of sleep and caloric restriction (p = 0.005) with subsequent recovery within 48 h. Oxytocin remained stable (p > 0.05). Several modest associations between neuroendocrine biomarkers and cognitive performance were identified. CONCLUSION: This study demonstrates H-FIT and H-RES may buffer the impact of SMOS on vigilance. SMOS negatively impacted circulating neuroendocrine biomarkers. While BDNF returned to baseline concentrations by the end of the 5 d protocol, NPY, IGF-I, and α-klotho may require a longer recovery period. These data suggest that the military may benefit by training and/or selection processes targeting at augmenting trait resilience and aerobic fitness for increased readiness.


Assuntos
Função Executiva , Militares , Biomarcadores , Cognição , Exercício Físico , Humanos , Memória de Curto Prazo , Aptidão Física
8.
Artigo em Inglês | MEDLINE | ID: mdl-33757792

RESUMO

BACKGROUND: Preliminary evidence indicates that non-rapid eye movement (NREM) sleep is implicated in enhancing working memory (WM) performance across days in healthy individuals. While REM sleep has been implicated in other forms of memory, its role in WM remains unclear. Further, the relationship between sleep changes and WM improvement is largely unknown in posttraumatic stress disorder (PTSD). Examining the relationship between changes in sleep and WM improvement in healthy participants and participants with PTSD may inform cognitive enhancement strategies and intervention targets. METHODS: Repeated assessments of WM and overnight measurement of NREM and REM sleep parameters were performed in 79 participants (participants with PTSD: n = 33) during a 48-hour laboratory stay. Relationships between sleep parameter changes, WM performance changes, and clinical characteristics were analyzed in PTSD and healthy groups. RESULTS: A between-night enhancement in both NREM and REM sleep parameters in frontoparietal areas predicted across-day better WM performance in healthy participants, particularly in those with improved performance. In contrast, in participants with PTSD, an enhancement of these sleep parameters predicted a worse WM performance and was also associated with more PTSD-related sleep disturbances. CONCLUSIONS: This study shows that higher sleep activity in frontoparietal areas leads to enhanced WM performance in healthy individuals, whereas in individuals with PTSD, it likely reflects the presence of sleep disturbances that interfere with WM improvement. Interventions focused on addressing sleep disturbances could therefore ameliorate cognitive impairments in individuals with PTSD.


Assuntos
Transtornos de Estresse Pós-Traumáticos , Voluntários Saudáveis , Humanos , Memória de Curto Prazo , Polissonografia , Sono
10.
Hum Brain Mapp ; 42(8): 2445-2460, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33739544

RESUMO

While stress may be a potential mechanism by which childhood threat and deprivation influence mental health, few studies have considered specific stress-related white matter pathways, such as the stria terminalis (ST) and medial forebrain bundle (MFB). Our goal was to examine the relationships between childhood adversity and ST and MFB structural integrity and whether these pathways may provide a link between childhood adversity and affective symptoms and disorders. Participants were young adults (n = 100) with a full distribution of maltreatment history and affective symptom severity. Threat was determined by measures of childhood abuse and repeated traumatic events. Socioeconomic deprivation (SED) was determined by a measure of childhood socioeconomic status (parental education). Participants underwent diffusion spectrum imaging. Human Connectome Project data was used to perform ST and MFB tractography; these tracts were used as ROIs to extract generalized fractional anisotropy (gFA) from each participant. Childhood threat was associated with ST gFA, such that greater threat was associated with less ST gFA. SED was also associated with ST gFA, however, conversely to threat, greater SED was associated with greater ST gFA. Additionally, threat was negatively associated with MFB gFA, and MFB gFA was negatively associated with post-traumatic stress symptoms. Our results suggest that childhood threat and deprivation have opposing influences on ST structural integrity, providing new evidence that the context of childhood adversity may have an important influence on its neurobiological effects, even on the same structure. Further, the MFB may provide a novel link between childhood threat and affective symptoms.

11.
Trials ; 22(1): 46, 2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33430955

RESUMO

BACKGROUND: Insomnia affects almost one in four military service members and veterans. The first-line recommended treatment for insomnia is cognitive-behavioral therapy for insomnia (CBTI). CBTI is typically delivered in-person or online over one-to-four sessions (brief versions) or five-to-eight sessions (standard versions) by a licensed doctoral or masters-level clinician with extensive training in behavioral sleep medicine. Despite its effectiveness, CBTI has limited scalability. Three main factors inhibit access to and delivery of CBTI including restricted availability of clinical expertise; rigid, resource-intensive treatment formats; and limited capacities for just-in-time monitoring and treatment personalization. Digital technologies offer a unique opportunity to overcome these challenges by providing scalable, personalized, resource-sensitive, adaptive, and cost-effective approaches for evidence-based insomnia treatment. METHODS: This is a hybrid type 3 implementation-effectiveness randomized trial using a scalable evidence-based digital health software platform, NOCTEM™'s Clinician-Operated Assistive Sleep Technology (COAST™). COAST includes a clinician portal and a patient app, and it utilizes algorithms that facilitate detection of sleep disordered patterns, support clinical decision-making, and personalize sleep interventions. The first aim is to compare three clinician- and system-centered implementation strategies on the reach, adoption, and sustainability of the COAST digital platform by offering (1) COAST only, (2) COAST plus external facilitation (EF: assistance and consultation to providers by NOCTEM's sleep experts), or (3) COAST plus EF and internal facilitation (EF/IF: assistance/consultation to providers by NOCTEM's sleep experts and local champions). The second aim is to quantify improvements in insomnia among patients who receive behavioral sleep care via the COAST platform. We hypothesize that reach, adoption, and sustainability and the magnitude of improvements in insomnia will be superior in the EF and EF/IF groups relative to the COAST-only group. DISCUSSION: Digital health technologies and machine learning-assisted clinical decision support tools have substantial potential for scaling access to insomnia treatment. This can augment the scalability and cost-effectiveness of CBTI without compromising patient outcomes. Engaging providers, stakeholders, patients, and decision-makers is key in identifying strategies to support the deployment of digital health technologies that can promote quality care and result in clinically meaningful sleep improvements, positive systemic change, and enhanced readiness and health among service members. TRIAL REGISTRATION: ClinicalTrials.gov NCT04366284 . Registered on 28 April 2020.


Assuntos
Terapia Cognitivo-Comportamental , Distúrbios do Início e da Manutenção do Sono , Veteranos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Sono , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/terapia , Resultado do Tratamento
12.
Artigo em Inglês | MEDLINE | ID: mdl-33279459

RESUMO

BACKGROUND: We assessed the impact of total and partial sleep loss on neural correlates of fear conditioning, extinction learning, and extinction recall in healthy young adults. METHODS: Participants (56.3% female, age 24.8 ± 3.4 years) were randomized to a night of normal sleep (NS) (n = 48), sleep restriction (SR) (n = 53), or sleep deprivation (SD) (n = 53). All completed fear conditioning and extinction learning phases the following morning. Extinction recall was tested in the evening of the same day. Task-based contrasts were modeled at the beginning of, at the end of, and across the fear conditioning and extinction learning phases, and at the beginning of extinction recall. These contrasts were compared among the 3 groups by means of analysis of variance. Nonparametric permutation corrected analyses using a cluster-determining threshold of p < .005 and a familywise error of p < .05. RESULTS: At the end of fear conditioning, NS activated medial prefrontal regions, SR activated motor areas, and participants in the SD group showed no significant activations. Across extinction learning, only NS activated both salience (fear) and extinction (regulatory) areas. For extinction recall, SD activated similar regions as NS across extinction learning, while SR activated salience and motor areas. During early fear conditioning, compared with NS, SD activated more medial prefrontal and SR activated more salience network areas. For extinction recall, NS activated more prefrontal areas and SD activated more of both salience- and extinction-related areas than SR. CONCLUSIONS: Relative to NS, SR may enhance fear-related and diminish extinction-related activity, whereas SD may delay engagement of extinction learning. Findings may have clinical implications for populations and occupations in which sleep loss is common.


Assuntos
Extinção Psicológica , Privação do Sono , Adulto , Condicionamento Clássico , Medo , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Adulto Jovem
13.
Front Psychiatry ; 11: 532623, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33329079

RESUMO

Background: Previously, we identified sleep-electroencephalography (EEG) spectral power and synchrony features that differed significantly at a population-average level between subjects with and without posttraumatic stress disorder (PTSD). Here, we aimed to examine the extent to which a combination of such features could objectively identify individual subjects with PTSD. Methods: We analyzed EEG data recorded from 78 combat-exposed Veteran men with (n = 31) and without (n = 47) PTSD during two consecutive nights of sleep. To obviate the need for manual assessment of sleep staging and facilitate extraction of features from the EEG data, for each subject, we computed 780 stage-independent, whole-night features from the 10 most commonly used EEG channels. We performed feature selection and trained a logistic regression model using a training set consisting of the first 47 consecutive subjects (18 with PTSD) of the study. Then, we evaluated the model on a testing set consisting of the remaining 31 subjects (13 with PTSD). Results: Feature selection yielded three uncorrelated features that were consistent across the two consecutive nights and discriminative of PTSD. One feature was from the spectral power in the delta band (2-4 Hz) and the other two were from phase synchronies in the alpha (10-12 Hz) and gamma (32-40 Hz) bands. When we combined these features into a logistic regression model to predict the subjects in the testing set, the trained model yielded areas under the receiver operating characteristic curve of at least 0.80. Importantly, the model yielded a testing-set sensitivity of 0.85 and a positive predictive value (PPV) of 0.31. Conclusions: We identified robust stage-independent, whole-night features from EEG signals and combined them into a logistic regression model to discriminate subjects with and without PTSD. On the testing set, the model yielded a high sensitivity and a PPV that was twice the prevalence rate of PTSD in the U.S. Veteran population. We conclude that, using EEG signals collected during sleep, such a model can potentially serve as a means to objectively identify U.S. Veteran men with PTSD.

14.
Artigo em Inglês | MEDLINE | ID: mdl-33010410

RESUMO

BACKGROUND/AIMS: Sleep disturbances and fatigue are common symptoms amongst patients with Crohn's disease (CD). The aim of this study was to test the feasibility and effects of a pragmatic, stepped-care intervention for the treatment of poor sleep quality and fatigue in adolescents and young adults with CD. METHODS: This study is a two-phase open trial exploring interventions for sleep and fatigue. After the initial comprehensive assessment which included quantitative measures and an interview to evaluate sleep and physical and mental health, the 12-week intervention consisted of two sequential steps: 1) a brief behavioral therapy for sleep in inflammatory bowel disease (IBD) (BBTS-I; 4 weeks) and 2) adding the psychotropic medication, bupropion sustained release (BUP-SR; 8 weeks), for the subset of subjects continuing to experience fatigue. RESULTS: 232 CD patients (median age=24, median sex=female) were approached over 18 months, of whom 112 screened positive on the Pittsburgh Sleep Quality Index (PSQI) and multi-dimensional fatigue inventory (MFI), with 68 CD patients completing the more comprehensive baseline assessment. Of the 68 patients, 52 participated in Phase I of the BBTS-I intervention. Following 4-weeks of the BBTS-I, there were significant improvements in sleep quality (p < .001) and fatigue (p < .001). As part of Phase II, of the 52 patients who met fatigue threshold criteria, 33 patients participated in the BUP-SR+BBTS-I arm while 19 participated in the BBTS-I only intervention group. After 8 weeks of Phase II, both intervention groups saw significant further improvement in sleep, fatigue, anxiety and depressive symptoms, but without significant differences between the two intervention groups. CONCLUSIONS: A stepped-care approach shows that we can improve sleep disturbance with BBTS-I in CD patients, but fatigue only partially improves. For a subset of patients who chose to add BUP-SR to their behavioral therapy, fatigue improves further but not to a statistically significant effect compared to behavioral therapy alone.

15.
Neuroimage Clin ; 28: 102390, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32882644

RESUMO

Sleep disturbances are common complaints in patients with post-traumatic stress disorder (PTSD). To date, however, objective markers of PTSD during sleep remain elusive. Sleep spindles are distinctive bursts of brain oscillatory activity during non-rapid eye movement (NREM) sleep and have been implicated in sleep protection and sleep-dependent memory processes. In healthy sleep, spindles observed in electroencephalogram (EEG) data are highly synchronized across different regions of the scalp. Here, we aimed to investigate whether the spatiotemporal synchronization patterns between EEG channels during sleep spindles, as quantified by the phase-locking value (PLV) and the mean phase difference (MPD), are altered in PTSD. Using high-density (64-channel) EEG data recorded from 78 combat-exposed Veteran men (31 with PTSD and 47 without PTSD) during two consecutive nights of sleep, we examined group differences in the PLV and MPD for slow (10-13 Hz) and fast (13-16 Hz) spindles separately. To evaluate the reproducibility of our findings, we set apart the first 47 consecutive participants (18 with PTSD) for the initial discovery and reserved the remaining 31 participants (13 with PTSD) for replication analysis. In the discovery analysis, compared to the non-PTSD group, the PTSD group showed smaller MPDs during slow spindles between the frontal and centro-parietal channel pairs on both nights. We obtained reproducible results in the replication analysis in terms of statistical significance and effect size. The PLVs during slow or fast spindles did not significantly differ between groups. The reduced inter-channel phase difference during slow spindles in PTSD may reflect pathological changes in the underlying thalamocortical circuits. This novel finding, if independently validated, may prove useful in developing sleep-focused PTSD diagnostics and interventions.


Assuntos
Transtornos de Estresse Pós-Traumáticos , Veteranos , Eletroencefalografia , Humanos , Masculino , Polissonografia , Reprodutibilidade dos Testes , Sono , Fases do Sono
16.
Behav Ther ; 51(4): 535-547, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32586428

RESUMO

The goal of this study was to compare a brief behavioral treatment for insomnia (BBTI), which has fewer sessions (4), shorter duration (<30-45 minutes), and delivers treatment in-person plus phone calls to cognitive behavioral therapy for insomnia (CBTI), which has 5 in-person sessions. The hypothesis was BBTI would be noninferior to CBTI. The Reliable Change Index was used to establish a noninferiority margin (NIM) of 3.43, representing the maximum allowable difference between groups on the pre-post Insomnia Severity Index change (ΔISI). Sixty-three veterans with chronic insomnia were randomized to either BBTI or CBTI and veterans in both groups had significant reductions of their insomnia severity per the ISI and improved their sleep onset latency, total wake time, sleep efficiency, and sleep quality per sleep diaries. While CBTI had a larger pre-post ΔISI, this was not significantly different than ΔISI BBTI and was less than the NIM. However, the 95% confidence interval of the between group pre-post ΔISI extended beyond the NIM, and thus BBTI was inconclusively noninferior to CBTI. Limitations, such as small sample size and high rate of dropout, indicate further study is needed to compare brief, alternative yet complementary behavioral insomnia interventions to CBTI. Still, evidence-based brief and flexible treatment options will help to further enhance access to care for veterans with chronic insomnia, especially in non-mental-health settings like primary care.


Assuntos
Terapia Cognitivo-Comportamental , Distúrbios do Início e da Manutenção do Sono , Veteranos , Terapia Comportamental , Humanos , Distúrbios do Início e da Manutenção do Sono/terapia , Fatores de Tempo , Resultado do Tratamento
17.
J Clin Sleep Med ; 16(9): 1445-1454, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32406371

RESUMO

STUDY OBJECTIVES: High-frequency electroencephalographic activity (> 16 Hz activity) is often elevated during nonrapid eye movement sleep among individuals with insomnia, in line with the hyperarousal theory of insomnia. Evidence regarding sleep depth marked by slow-wave activity (< 4 Hz) is more mixed. Distinguishing subcomponents of slow-wave activity (slow-oscillation [< 1 Hz] or delta activity [1-4 Hz)]) may be critical in understanding these discrepancies, given that these oscillations have different neural generators and are functionally distinct. Here we tested the effects of insomnia diagnosis and insomnia treatment on nonrapid eye movement electroencephalography in older adults, distinguishing slow-oscillation and delta power. METHODS: In 93 older adults with insomnia and 71 good sleeper control participants (mean ages 68 years), effects of insomnia and cognitive behavioral therapy for insomnia (insomnia group only) on electroencephalographic spectral power were analyzed. Main effects and interactions with nonrapid eye movement period were assessed for the following frequency bands: slow-oscillation (0.5-1 Hz), delta (1-4 Hz), theta (4-8 Hz), alpha (8-12 Hz), sigma (12-16 Hz), and beta (16-32 Hz). RESULTS: Slow-oscillation absolute and relative power were lower in the insomnia group compared with controls. There were no group differences in delta power. Insomnia was also associated with elevated 4-32 Hz absolute and relative power. After cognitive behavioral therapy for insomnia, absolute sigma and beta activity decreased. CONCLUSIONS: Deficits in slow-wave activity in insomnia are specific to the slow-oscillation. Elevated high frequency activity is reduced for sigma and beta power following cognitive behavioral therapy for insomnia . These findings inform the pathophysiology of insomnia, including the mechanisms underlying cognitive behavioral therapy for insomnia in older adults.


Assuntos
Distúrbios do Início e da Manutenção do Sono , Sono de Ondas Lentas , Idoso , Eletroencefalografia , Humanos , Polissonografia , Sono , Distúrbios do Início e da Manutenção do Sono/complicações , Distúrbios do Início e da Manutenção do Sono/terapia
18.
Sleep ; 43(10)2020 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-32239159

RESUMO

STUDY OBJECTIVES: Sleep disturbances are core symptoms of post-traumatic stress disorder (PTSD), but reliable sleep markers of PTSD have yet to be identified. Sleep spindles are important brain waves associated with sleep protection and sleep-dependent memory consolidation. The present study tested whether sleep spindles are altered in individuals with PTSD and whether the findings are reproducible across nights and subsamples of the study. METHODS: Seventy-eight combat-exposed veteran men with (n = 31) and without (n = 47) PTSD completed two consecutive nights of high-density EEG recordings in a laboratory. We identified slow (10-13 Hz) and fast (13-16 Hz) sleep spindles during N2 and N3 sleep stages 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 non-PTSD participants, PTSD participants exhibited (1) higher slow-spindle oscillatory frequency over the antero-frontal regions on both nights and (2) higher fast-spindle oscillatory frequency over the centro-parietal regions on the second night. The first finding was preserved in the replication analysis. We found no significant group differences in the amplitude, duration, or density of slow or fast spindles. CONCLUSIONS: The elevated spindle oscillatory frequency in PTSD may indicate a deficient sensory-gating mechanism responsible for preserving sleep continuity. Our findings, if independently validated, may assist in the development of sleep-focused PTSD diagnostics and interventions.


Assuntos
Transtornos de Estresse Pós-Traumáticos , Veteranos , Eletroencefalografia , Humanos , Masculino , Polissonografia , Reprodutibilidade dos Testes , Sono , Fases do Sono
19.
Acad Emerg Med ; 27(11): 1126-1139, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32339359

RESUMO

OBJECTIVE: Posttraumatic stress disorder (PTSD) symptoms (PTSS) are common after minor injuries and can impair recovery. We sought to understand whether an evidence-based mobile phone application with self-help tools (PTSD Coach) could be useful to improve recovery after acute trauma among injured emergency department (ED) patients. This pilot study examined the feasibility, acceptability, and potential benefit of using PTSD Coach among acutely injured motor vehicle crash (MVC) patients. METHODS: From September 2017 to September 2018, we recruited adult patients within 24 hours post-MVC from the EDs of two Level I trauma centers in the United States. We randomly assigned 64 injured adults to either the PTSD Coach (n = 33) or treatment as usual (TAU; n = 31) condition. We assessed PTSS and associated symptoms at 1 month (83% retained) and 3 months (73% retained) postenrollment. RESULTS: Enrollment was feasible (74% of eligible subjects participated) but usability and engagement were low (67% used PTSD Coach at least once, primarily in week 1); 76% of those who used it rated the app as moderately to extremely helpful. No differences emerged between groups in PTSS outcomes. Exploratory analyses among black subjects (n = 21) indicated that those in the PTSD Coach condition (vs. TAU) reported marginally lower PTSS (95% CI = -0.30 to 37.77) and higher PTSS coping self-efficacy (95% CI = -58.20 to -3.61) at 3 months. CONCLUSIONS: We demonstrated feasibility to recruit acutely injured ED patients into an app-based intervention study, yet mixed evidence emerged for the usability and benefit of PTSD Coach. Most patients used the app once and rated it favorably in regard to satisfaction with and helpfulness, but longitudinal engagement was low. This latter finding may explain the lack of overall effects on PTSS. Additional research is warranted regarding whether targeting more symptomatic patients and the addition of engagement and support features can improve efficacy.


Assuntos
Acidentes de Trânsito/psicologia , Aplicativos Móveis , Transtornos de Estresse Pós-Traumáticos , Telefone , Adulto , Humanos , Tutoria , Veículos Automotores , Projetos Piloto , Transtornos de Estresse Pós-Traumáticos/terapia
20.
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