El Abric del Pastor en el poblamiento neandertal de los Valles de Alcoy: Alicante (España)

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. Downloaded from https://academic.oup.com/sleep/article-abstract/40/suppl_1/A404/3781127 by guest on 10 June 2020 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.