In-Home Sleep Recordings in Military Veterans With Posttraumatic Stress Disorder Reveal Less REM and Deep Sleep <1 Hz - PubMed (original) (raw)

In-Home Sleep Recordings in Military Veterans With Posttraumatic Stress Disorder Reveal Less REM and Deep Sleep <1 Hz

Julie A Onton et al. Front Hum Neurosci. 2018.

Abstract

Veterans with posttraumatic stress disorder (PTSD) often report suboptimal sleep quality, often described as lack of restfulness for unknown reasons. These experiences are sometimes difficult to objectively quantify in sleep lab assessments. Here, we used a streamlined sleep assessment tool to record in-home 2-channel electroencephalogram (EEG) with concurrent collection of electrodermal activity (EDA) and acceleration. Data from a single forehead channel were transformed into a whole-night spectrogram, and sleep stages were classified using a fully automated algorithm. For this study, 71 control subjects and 60 military-related PTSD subjects were analyzed for percentage of time spent in Light, Hi Deep (1-3 Hz), Lo Deep (<1 Hz), and rapid eye movement (REM) sleep stages, as well as sleep efficiency and fragmentation. The results showed a significant tendency for PTSD sleepers to spend a smaller percentage of the night in REM (p < 0.0001) and Lo Deep (p = 0.001) sleep, while spending a larger percentage of the night in Hi Deep (p < 0.0001) sleep. The percentage of combined Hi+Lo Deep sleep did not differ between groups. All sleepers usually showed EDA peaks during Lo, but not Hi, Deep sleep; however, PTSD sleepers were more likely to lack EDA peaks altogether, which usually coincided with a lack of Lo Deep sleep. Linear regressions with all subjects showed that a decreased percentage of REM sleep in PTSD sleepers was accounted for by age, prazosin, SSRIs and SNRIs (p < 0.02), while decreased Lo Deep and increased Hi Deep in the PTSD group could not be accounted for by any factor in this study (p < 0.005). Linear regression models with only the PTSD group showed that decreased REM correlated with self-reported depression, as measured with the Depression, Anxiety, and Stress Scales (DASS; p < 0.00001). DASS anxiety was associated with increased REM time (p < 0.0001). This study shows altered sleep patterns in sleepers with PTSD that can be partially accounted for by age and medication use; however, differences in deep sleep related to PTSD could not be linked to any known factor. With several medications [prazosin, selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs); p < 0.03], as well as SSRIs were associated with less sleep efficiency (b = -3.3 ± 0.95; p = 0.0005) and more sleep fragmentation (b = -1.7 ± 0.51; p = 0.0009). Anti-psychotics were associated with less sleep efficiency (b = -4.9 ± 1.4; p = 0.0004). Sleep efficiency was negatively impacted by SSRIs, antipsychotic medications, and depression (p < 0.008). Increased sleep fragmentation was associated with SSRIs, SNRIs, and anxiety (p < 0.009), while prazosin and antipsychotic medications correlated with decreased sleep fragmentation (p < 0.05).

Keywords: EEG; Lo Deep; PTSD; REM; electrodermal activity; sleep; sleep scoring algorithm; slow wave sleep.

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Figures

FIGURE 1

FIGURE 1

Maximum EDA magnitudes were most common during Lo Deep sleep in both groups. However, relatively more PTSD-sleeper nights had maximum EDA magnitude during REM sleep or no appreciable changes in EDA level. EDA, electrodermal activity; Negl., negligible; PTSD, posttraumatic stress disorder; REM, rapid eye movement.

FIGURE 2

FIGURE 2

Sleep report examples from two control (A,B) and two PTSD (C,D) sleepers. These control sleepers showed Lo Deep sleep with associated EDA, while the PTSD sleepers showed a lack of Lo Deep and associated EDA. (A) Hi Deep was not associated with EDA peaks. (B) EDA can have variable magnitude during different cycles of Lo Deep sleep. (C) PTSD sleepers more often showed no substantial changes at all, or (D) increases during REM. Inset in (D) shows the EDA activity at higher magnification to highlight the signal characteristics. Red asterisks on hypnogram indicate post-algorithm adjustment from Lo Deep to REM when 25 Hz band is higher power than spindle band. Cyan lines on the Dominant Frequency panel indicate moments of large EEG deflections likely due to movement. Red lines on the Dominant Frequency panel indicate the estimated time of sleep onset. EDA, electrodermal activity; EEG, electroencephalography; PTSD, posttraumatic stress disorder, REM, rapid eye movement.

FIGURE 3

FIGURE 3

Mean power spectra during each sleep stage across each group. Solid traces = controls, dashed traces = posttraumatic stress disorder (PTSD) sleepers. The only significant differences between controls and PTSD sleepers ranged between 1.3–5.4 Hz and 12.2–13.8 Hz in Hi Deep sleep, where PTSD sleepers showed significantly lower relative power than control sleepers (p < 0.003).

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