Sleep 2009 23 rd AnnuAl Meeting Of the ASSOciAted prOfeSSiOnAl Sleep SOcietieS, llc. June 6 - 11, 2009WAShingtOn StAte cOnventiOn And trAde center • SeAttle, WAShingtOn
Conflict of Interest Disclosures Authors: to disclose, ORX 1. The authors do not have any potential conflicts of interest 2. The authors wish to disclose the following potential conflicts of interest: Type of Potential Conflict Details of Potential Conflict Grant/Research Support Consultant Speakers’ Bureaus Financial support Other 3. The material presented in this lecture has no relationship with any of these potential conflicts, OR 4. This talk presents material that is related to one or more of these potential conflicts, and the following objective references are provided as support for this lecture:1.2.3.
Waking qEEG in Veterans with PTSDCompared with Subjects with Insomnia and Good Sleepers.Jennifer Alman1, David Cashmere2, Robert Seres2, Jean Miewald2, Daniel J. Buysse2, MD., and Anne Germain2, Ph.D. 1 Washington & Jefferson University 2 Department of Psychiatry, University of Pittsburgh School of Medicine
Background• Veterans with Post-Traumatic Stress Disorder (PTSD) have many sleep disturbances. » e.g., Neylan et al., 1998• Sleep disturbances in PTSD relate to central arousal during wakefulness and sleep. » e.g., Woodward et al., 2000• Primary Insomnia (PI) is also associated with heightened central arousal during sleep. » e.g., Buysse et al., 2008
Study Aim1. To explore markers of central arousal during pre-sleep wakefulness in participants with PTSD, PI, and good sleepers (GS). – Primary focus on beta activity derived from qEEG – Other activity bands were also explored.2. To explore correlations between pre-sleep markers of central arousal and PTSD severity, depression, and anxiety.
Participants• 10 Military Veterans with PTSD – All combat exposed except for 1 – M age = 37.57 + 11.72 years old – 5 PTSD subjects were free of medication: 3 antidepressants, 1 hypnotic, 1 benzodiazepine.• 10 PI subjects – M age = 35.344 + 9.67 years old – Free of medication, medical conditions, psychiatric and other sleep disorders.• 9 GSC – M age = 40.12 + 22.78 years old – Free of medication, medical conditions, psychiatric and other sleep disorders
Procedures• Participants had one night of acclimation in the lab.• The second night a five-minute pre-sleep waking EEG was recorded. • Questionnaires to assess PTSD severity (PCL), depression (BDI), and anxiety (BAI).• Editing software was used to clear artifacts from records.
Data Analysis• Data were processed using an FFT model for power spectral analysis.• Kruskal-Wallis tests used for group differences on spectral data. – Distribution normalized when necessary for analysis• Spearman’s rho used for relationships between qEEG activity bands and self-reported symptom measures.
Results: Number of Epochs Rejected per Group• The number of epochs rejected in each group does not differ. Mean of Epochs Rejected• p > .05. 4 3.5 3• Mean Record Length 2.5 (good) 2 1.5 1 – PTSD: 2.72 minutes 0.5 0 – Insomnia: 2.44 PTSD Insomnia GSC minutes – GS: 2.15 minutes
Results: Beta 2 Power (16-32 Hz) andBeta 1 Power (12-16 Hz) Across Groups Mean Beta 2 Power Mean Beta 1 Power 9 20 18 8 16 7 14 6 12 5 10 4 8 Frequency Frequency 3 6 4 2 2 1 0 0 PTSD Insomnia GSC PTSD Insomnia GSC
Results: Correlations• Beta 2 (16-32 Hz) positively correlated to: – PTSD severity: rho: 0.78 p < 0.01 – Depression: rho: 0.72 p < 0.05 – Anxiety: rho: 0.84 p < 0.01• Beta 1 (12-16 Hz) positively correlated to: – Depression: rho: 0.72, p < 0.05• Theta power (4-8 Hz) positively correlated to: – PTSD severity: rho: 0.87, p < 0.01
Conclusions1. There was no significant group differences in beta activity during pre- sleep wakefulness. – Trend for PTSD > PI, GSC in Beta 2 – Trend for PI > PTSD, GSC in Beta 12. The neurobiological underpinnings of central arousal may differ pre- and post- sleep onset across diagnostic groups.
Conclusions1. Fast-frequency (Beta 2) activity during pre-sleep wakefulness is positively associated with clinical symptom severity in the subjects with PTSD.2. Increased theta power indicates sleepiness but patient cannot sleep because clinical symptoms prevent sleep onset.
Conclusions1. Larger samples are required to evaluate the robustness of these preliminary findings.2. Combining qEEG with neuroimaging techniques will clarify the source of heightened arousal in PTSD and PI.
Acknowledgements• Gina Pietrone• Research participants• N-CTRC staff US Department of Defense (PR054093: Germain) National Institute of Health (RR 0052, RR 024153, MH24652)