An analysis of fear inhibition and fear extinction in a sample of veterans with obstructive sleep apnea (OSA): Implications for co-morbidity with post-traumatic stress disorder (PTSD)

Reist, Christopher; Jovanović, Tanja; Kantarovich, Diana; Weingast, Leah T.; Hollifield, Michael; Novin, Mahmood; Khalaghizadeh, Sakineh; Jafari, Behrouz; George, Renie; Riser, Manessa; Woodford, Jessica; Norrholm, Seth D.

doi:10.1016/j.bbr.2021.113172

Cited by 9 publications

(6 citation statements)

References 44 publications

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“…For example, in a prospective cohort of veterans with PTSD and OSA, CPAP usage was associated with PTSD symptom improvement, including the frequency of nightmares (El-Solh et al, 2017). A recent study also found that CPAP treatment enhanced generalization of fear extinction learning in veterans with OSA, yet dysregulation of fear extinction and inhibition processes were still observed in veterans with PTSD when compared with veterans without PTSD (Reist et al, 2021).…”

Section: Manifestations Of Sleep Disturbance In Ptsdmentioning

confidence: 95%

Posttraumatic stress disorder (PTSD), sleep, and cardiovascular disease risk: A mechanism-focused narrative review.

Meinhausen¹,

Prather²,

Sumner³

2022

Health Psychology

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Objective: Growing longitudinal research has demonstrated that posttraumatic stress disorder (PTSD) precedes and predicts the onset of cardiovascular disease (CVD), and a number of physiological (e.g., dysregulation of the hypothalamic-pituitary-adrenal axis and autonomic nervous system, chronic systemic inflammation) and behavioral (e.g., physical inactivity, smoking, poor diet) factors might underlie this association. In this narrative review, we focus on sleep as a modifiable risk factor linking PTSD with CVD. Method: We summarize the evidence for sleep disturbance after trauma exposure and the potential cardiotoxic effects of poor sleep, with an emphasis on mechanisms. In addition, we review the literature that has examined sleep in the context of the PTSD-CVD risk relation. Results: Although sleep disturbance is a hallmark symptom of PTSD and a well-established risk factor for the development of CVD, the role of sleep in the association between PTSD and CVD has been largely unexamined in the extant literature. However, such work has the potential to improve our understanding of mechanisms of risk and inform intervention efforts to offset elevated CVD risk after trauma. Conclusions: We outline several recommendations for future research and behavioral medicine models in order to help define and address the role of sleep behavior in the development of CVD among trauma-exposed individuals with PTSD.

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Section: Manifestations Of Sleep Disturbance In Ptsdmentioning

confidence: 95%

Posttraumatic stress disorder (PTSD), sleep, and cardiovascular disease risk: A mechanism-focused narrative review.

Meinhausen¹,

Prather²,

Sumner³

2022

Health Psychology

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“…The association between PTSD and OSA is additionally supported by studies finding that OSA diagnosis prior to trauma exposure also predicts the development of PTSD [2,28]. Furthermore, individuals with comorbid PTSD and OSA show impairments in fear discrimination, inhibition, and extinction that improve with OSA treatment [70]. OSA occurring during REM sleep could thus be implicated as a potential cause of REM sleep fragmentation and contribute to PTSD pathology.…”

Section: The Osa and Ptsd Overlapmentioning

confidence: 87%

A Narrative Review of the Association between Post-Traumatic Stress Disorder and Obstructive Sleep Apnea

McCall

Watson

2022

JCM

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Obstructive sleep apnea (OSA) and post-traumatic stress disorder (PTSD) are often co-morbid with implications for disease severity and treatment outcomes. OSA prevalence is higher in PTSD sufferers than in the general population, with a likely bidirectional effect of the two illnesses. There is substantial evidence to support the role that disturbed sleep may play in the pathophysiology of PTSD. Sleep disturbance associated with OSA may interfere with normal rapid eye movement (REM) functioning and thus worsen nightmares and sleep-related movements. Conversely, hyperarousal and hypervigilance symptoms of PTSD may lower the arousal threshold and thus increase the frequency of sleep fragmentation related to obstructive events. Treating OSA not only improves OSA symptoms, but also nightmares and daytime symptoms of PTSD. Evidence suggests that positive airway pressure (PAP) therapy reduces PTSD symptoms in a dose-dependent fashion, but also presents challenges to tolerance in the PTSD population. Alternative OSA treatments may be better tolerated and effective for improving both OSA and PTSD. Further research avenues will be introduced as we seek a better understanding of this complex relationship.

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“…This can initially feel overwhelming but eventually leads to recovery from PTSD (Hundt et al, 2015). It is possible that sleep apnea can contribute to dropout from EBP as sleep is needed to recover from PTSD and process the associated emotions (Djonlagic et al, 2020; Gilbert et al, 2015; Reist et al, 2021). Providers can assist their patients by assessing for sleep apnea and knowing established predictors of dropout from PTSD treatment including African American ethnicity, comorbid diagnosis of substance use disorder, schizophrenia, or bipolar disorder (Harpaz-Rotem & Rosenheck, 2011); PTSD severity (Zayfert et al, 2005); and uncontrolled anger (female sample; Rizvi et al, 2009).…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, veterans in psychotherapy for PTSD demonstrate less PTSD symptom reduction when they have untreated sleep apnea (Mesa et al, 2017). Sleep apnea decreases sleep duration and quality that are needed to process traumatic memories (Gilbert et al, 2015), extinguish fear responses (Djonlagic et al, 2020; Reist et al, 2021), and recover from PTSD. Additionally, sleep apnea’s hypoxemia affects the fiber integrity of white matter tracts that connect the prefrontal cortex to the limbic structures, making it more difficult to regulate emotions (Kelly et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Sleep apnea and posttraumatic stress after traumatic brain injury (TBI): A Veterans Affairs TBI Model Systems study.

Miles

Silva

Lang

et al. 2021

Rehabilitation Psychology

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Objective: Traumatic brain injury (TBI) is a complex health problem in military veterans and service members (V/SM) that often co-occurs with psychological and medical conditions such as posttraumatic stress disorder (PTSD) and sleep apnea. We aimed to examine if sleep apnea is associated with the presence and severity of PTSD in V/SM with TBI of all severities. Research Method: The study examined participants at varying times since their TBI (N = 602) enrolled in the Veterans Affairs TBI Model Systems database. Frequency of selfreported sleep apnea diagnosis was calculated in a cross-sectional sample. Prevalence of co-occurring sleep apnea and probable PTSD was tested with a chi-square analysis. A multivariable regression model evaluated the association between sleep apnea and PTSD symptom severity while controlling for relevant covariates. Results: Almost 32% of the sample stated they had been diagnosed with sleep apnea. In those reporting sleep apnea, 32% also had probable PTSD; 19% of those without sleep apnea had probable PTSD. The regression demonstrated sleep apnea was significantly associated with PTSD symptom severity (p , .001). Greater number of TBIs, recent mental health treatment, being deployed to a combat zone, and greater years since TBI were also significant predictors of PTSD symptom severity (all p , .05). Conclusions: TBI, PTSD, and sleep apnea are often comorbid in V/SM. We expand the literature by demonstrating that sleep apnea was associated with PTSD severity. A multipronged approach to TBI rehabilitation that addresses sleep and psychological distress is recommended for enhancing health outcomes in this population.

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An analysis of fear inhibition and fear extinction in a sample of veterans with obstructive sleep apnea (OSA): Implications for co-morbidity with post-traumatic stress disorder (PTSD)

Cited by 9 publications

References 44 publications

Posttraumatic stress disorder (PTSD), sleep, and cardiovascular disease risk: A mechanism-focused narrative review.

Posttraumatic stress disorder (PTSD), sleep, and cardiovascular disease risk: A mechanism-focused narrative review.

A Narrative Review of the Association between Post-Traumatic Stress Disorder and Obstructive Sleep Apnea

Sleep apnea and posttraumatic stress after traumatic brain injury (TBI): A Veterans Affairs TBI Model Systems study.

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