Neurobiology of Sleep Disturbances in PTSD Patients and Traumatized Controls: MRI and SPECT Findings

Abstract

ObjectiveSleep disturbances such as insomnia and nightmares are core components of post-traumatic stress disorder (PTSD), yet their neurobiological relationship is still largely unknown. We investigated brain alterations related to sleep disturbances in PTSD patients and controls by using both structural and functional neuroimaging techniques.MethodThirty-nine subjects either developing (n = 21) or not developing (n = 18) PTSD underwent magnetic resonance imaging and a symptom-provocation protocol followed by the injection of 99mTc-hexamethylpropyleneamineoxime. Subjects were also tested with diagnostic and self-rating scales on the basis of which a Sleep Disturbances Score (SDS; i.e., amount of insomnia/nightmares) was computed.ResultsCorrelations between SDS and gray matter volume (GMV)/regional cerebral blood flow (rCBF) were computed in the whole sample and separately in the PTSD and control groups. In the whole sample, higher sleep disturbances were associated with significantly reduced GMV in amygdala, hippocampus, anterior cingulate, and insula; increased rCBF in midbrain, precuneus, and insula; and decreased rCBF in anterior cingulate. This pattern was substantially confirmed in the PTSD group, but not in controls.ConclusionSleep disturbances are associated with GMV loss in anterior limbic/paralimbic, PTSD-sensitive structures and with functional alterations in regions implicated in rapid eye movement-sleep control, supporting the existence of a link between PTSD and sleep disturbance.

Increased interhemispheric resting-state functional connectivity in healthy participants with insomnia symptoms

“…Importantly, our VMHC results largely overlap with regions reported in Nardo et al [52] This indicates that PTSD and insomnia share a substantial neurobiological substrate. [53] A noticeable difference between our current findings and those reported by Nardo et al [52] concerns the insular subregion.…”

Understanding Recent Insights in Sleep and Posttraumatic Stress Disorder from a Research Domain Criteria (RDoC) Framework

“…Structural changes in the brain are also present in individuals with both sleep and trauma-related symptom complaints. Insomnia and nightmares were associated with reduced gray matter volume in the amygdala, hippocampus, anterior cingulate cortex, and insula in traumaexposed Stockholm transportation workers who developed PTSD relative to workers who did not develop PTSD [24]. Reduced frontal lobe volume was associated with worse subjective sleep quality in combat-exposed Gulf War Veterans, regardless of PTSD diagnosis [25].…”

Trends and factors associated with insomnia and sleep apnea in all United States military service members from 2005 to 2014

“…In addition, an investigation of soldiers returning from combat with mild to moderate TBI found that 97.4% complained of sleep disorders and that blunt trauma was a significant predictor of OSA (Collen et al ., ). It is clear that long‐lasting sleep disturbances are a central feature of PTSD, and structural and functional neuroimaging techniques suggest a neurobiological link between PTSD and non‐restorative sleep (Nardo et al ., ). Perhaps this will also be the case for other comorbid disorders.…”