B. Clinical Sleep Science
IX. Sleep and Psychiatric Disorders
1084
TRAUMA EXPOSURE POTENTIATES THE RELATIONSHIP
BETWEEN SLEEP AND CHRONIC PAIN IN VETERANS
WITH TBI AND PTSD
Elliott JE1,2, Weymann KB3,2, Barsalou Y3,2, Opel RA2, Geiger MR2,
Teutsch P2, Chau AQ2, Oken BS1, Heinricher MM4, Lim MM2,1
1
Department of Neurology, Oregon Health & Science University,
Portland, OR, USA, Portland, OR, 2VA Portland Health Care System,
Portland, OR, USA, Portland, OR, 3School of Nursing, Oregon Health
& Science University, Portland, OR, USA, Portland, OR, 4Department
of Behavioral Neuroscience, Oregon Health & Science University,
Portland, OR, USA, Portland, OR, 5VA Portland Health Care System,
Portland, OR, USA, Portland, OR
Introduction: One of the main sequelae of mild traumatic brain injury
(mTBI) is sleep-wake disturbances (e.g., excessive daytime sleepiness,
insomnia and circadian rhythm disorders), which is present in 50–70%
of civilians and Veterans with mTBI. In addition to sleep-wake disturbances, mTBI is commonly associated with headache and chronic
pain. As the relationship between sleep-wake disturbances and chronic
pain/headache may be potentiated by the co-existence of trauma, the
purpose of this study is to describe the association between sleep-wake
disturbances and pain in a large sample of Veterans without trauma
exposure, with mTBI, with post-traumatic stress disorder (PTSD), and
with co-morbid mTBI+PTSD.
Methods: Veterans without trauma exposure (Control; n=309), with
mTBI (n=117), with PTSD (n=130), and with comorbid mTBI and
PTSD (mTBI+PTSD; n=96) were consented and enrolled from the
VA Portland Health Care System Sleep Disorders Laboratory. Data
collected included overnight in-lab polysomnography, self-reported
sleep-wake disturbances assessed via the insomnia severity index
(ISI), and the presence/severity of headache/pain as assessed via the
NIH PROMIS Global Health scale. TBI and PTSD symptom severity was assessed using the Rivermead Post-Concussive Questionnaire
(RPQ) and the PTSD Checklist (PCL-5), respectively.
SLEEP, Volume 40, Abstract Supplement, 2017
A404
Results: Trauma exposure was associated with worse ISI
scores (Control=13 ± 0.3, mTBI=15 ± 0.6, PTSD=18 ± 0.5, and
mTBI+PTSD=19 ± 0.5; max=26). ISI was positively correlated with
RPQ scores in mTBI Veterans (r=0.65, P<0.0001), and with PCL-5
scores in PTSD Veterans (r=0.31, P<0.0007). The prevalence of headaches increased with trauma exposure (Control=35%, mTBI=50%,
PTSD=63%, mTBI+PTSD=72%). Additionally, the frequency of experiencing a headache >25% of days/month increased with trauma exposure (Control=35%, mTBI=69%, PTSD=67%, mTBI+PTSD=73%).
Finally, self-reported global pain also increased with trauma exposure (Control=3.3 ± 0.1, mTBI=4.1 ± 0.2, PTSD=4.7 ± 0.2, and
mTBI+PTSD=5.4 ± 0.2; max=6).
Conclusion: The present study highlights how trauma exposure potentiates the association between sleep-wake disturbances and headache/
pain in a large sample of Veterans with mTBI, PTSD, and co-morbid
mTBI+PTSD. Future work will explore novel biomarkers using these
subjects’ in-lab polysomnography data in association with measures of
self-reported and quantitative pain.
Support (If Any): NIH T32 AT002688 to JEE; VA OAA Nursing
Postdoctoral Fellowship to KBW; VA Career Development Award
#IK2 BX002712 and the Portland VA Research Foundation to MML.
1085
EARLY VS. LATE WAKE THERAPY IMPROVES MOOD
IN ANTEPARTUM VS. POSTPARTUM DEPRESSION BY
DIFFERENTIALLY ALTERING MELATONIN AND SLEEP
TIMING.
Parry BL1, Meliska C1, Lopez A1, Sorenson D1, Martinez F1, Orff H1,
Hauger R1, Kripke D1
1
University of California, San Diego, La Jolla, CA, 2University of
California, San Diego, La Jolla, CA
Introduction: Critically-timed wake therapy improves mood in one
day in most depressed patients (DP). We tested the hypothesis that early-night wake therapy (EWT: sleep 3:00 - 7:00 am) vs. late-night wake
therapy (LWT: sleep 9:00 pm - 01:00 am) improves mood more in
antepartum vs. postpartum depression by differentially altering melatonin and sleep timing relationships.
Methods: In 50 women: 26 antepartum (17 healthy comparison (HC)
subjects, 9 DP, by DSM-IV criteria) and 24 postpartum (8 HC, 16 DP)
initially randomized to a cross-over trial of one night of either EWT
or LWT, we measured, pre- and post-treatment, interview-based mood
assessments; plasma melatonin (sampled at 30-min intervals from
6:00 pm - 11:00 am); polysomnography (PSG); and melatonin-sleep
phase-angle differences (PADs) in relation to ambient day length.
Results: After EWT, mood improved significantly more in antepartum vs. postpartum DP; after LWT, mood improved more in postpartum than in antepartum DP. In antepartum DP after EWT, mood
improvement correlated with a normalized later melatonin onset time,
an earlier sleep onset and a reduced PAD between melatonin and sleep
onset time. In contrast, in postpartum DP after LWT, mood improvement correlated with normalization and increase in total sleep time.
Longer day length was associated with later melatonin onset time and
enhanced mood improvement in antepartum DP after EWT.
Conclusion: In peripartum depression, one night of non-pharmacological behavioral sleep/wake intervention, targeted to specific
underlying circadian rhythm abnormalities, improves mood, offering
a treatment strategy to women with a potentially severe illness, consistent with the aims of “precision medicine.”
Support (If Any): Supported by NIH grants 1 RO1 HD076476-01,
R01 MH-070788, 1 RO1 AT007169-01A1 to Barbara Parry (PI) and
NIH Clinical Research Center (CRC) grant M01-RR-00827.
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Results: The PTSD+ group demonstrated less SWA [F1, 113=5.11,
p=.03] than the PTSD- group, but no group differences were observed
in sigma. In the PTSD+ group, SWA positively correlated with overall PTSD severity determined by the CAPS (r=.21, p=.05) and sigma
negatively correlated with CAPS cognitive items (r=-.21, p=.05).
Adjusting for age did not impact the significance of relationships
tested. However, age correlated with overall PTSD severity (r=-.50,
p< .001) CAPS cognitive items (r=-.26, p=.01) and SWA (r=-.48, p<
.001), but not with sigma.
Conclusion: SWA is associated with overall PTSD severity and age,
while sigma is related to CAPS cognitive items. Although sigma did
not differ between groups, other related features, such as sleep spindles, may be related to cognitive functioning in PTSD, and age may
uniquely contribute to relationships involving SWA. More precise
and objective measures are necessary to fully assess the relationships
between SWA, sigma, PTSD, and cognitive functioning in military
veterans.
Support (If Any): Department of Defense Congressionally Directed
Medical Research Programs (Germain-W81XWH-06-1-0257,
W81XWH-08-1-0637, W81XWH-12-2-0024; Reifman-W81XWH14-2-0145) National Institutes of Health (Germain-MH083035; PI:
Buysse- 4T32HL082610-10). Disclaimer: The opinions and assertions
contained herein are the private views of the authors and are not to be
construed as official or as reflecting the views of the US Army or of the
US Department of Defense. This abstract has been approved for public
release with unlimited distribution.