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

Abstract

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.

Insomnia and early incident atrial fibrillation: A 16-year cohort study of younger men and women Veterans

“…51 In a recent study of young adults, individuals with insomnia, including frequent nighttime waking, displayed a lower wake-to-sleep reduction in heart rate than those without insomnia. 52 Insomnia-associated alterations in the renin-aldosterone-angiotensin system, which is promotes atrial remodeling, have also been proposed, 53,54 along with inflammation, endocrinological and/or adrenergic dysfunction, 55 all of which are well-described potential mediators of AF risk. [56][57][58] Other data from the UK Biobank showed that genetically-predicted insomnia is associated with a 13% higher risk of AF, and risk for eight other cardiovascular diseases.…”

Parallel processes of posttraumatic stress and cardiometabolic dysfunction: A systemic illness of traumatic stress.

“…Disrupted sleep may also be a key hyperarousal PTSD symptom and potential moderator of the development and growth of MetC. Sleep quality has been associated with many MetC and is a common outcome of social isolation (see Meinhausen et al, 2022 for a review). Therefore, poor sleep quality and quantity may also be a key mechanism through which hyperarousal symptoms overactivate physiological stress responses through the HPA axis and sympathetic adrenal medullary system, leading to poorer mental and physical health symptoms and, potentially, systemic illness following psychological trauma.…”

If not us, who? If not now, when? Paths forward in science, patient care, and training to maximize the impact of cardiovascular behavioral medicine.

“…Our field has identified novel behavioral and psychosocial risk and prognostic factors for multiple CVD presentations and plausible mechanisms through which these factors could influence the development and course of CVD. Examples that reflect the ongoing evolution and expansion of the field’s focus are the articles in this issue on posttraumatic stress disorder and symptoms (Eisenberg et al, 2022; Krantz et al, 2022; Meinhausen et al, 2022), poor sleep quality and quantity (Meinhausen et al, 2022; Park & Kim, 2022), attention-deficit/hyperactivity disorder (Xu et al, 2022), and behavioral flexibility (Habibović et al, 2022)—all of which identify candidate treatment targets for future intervention studies.…”