Sex differences in the effect of subjective sleep on fear conditioning, extinction learning, and extinction recall in individuals with a range of PTSD symptom severity

Schenker, Maya T.; Ince, Sevil; Ney, Luke J.; Hsu, Chih‐Chin; Zuj, Daniel V.; Jordan, Amy S.; Nicholas, Christian L.; Felmingham, Kim L.

doi:10.1016/j.brat.2022.104222

Cited by 7 publications

(4 citation statements)

References 96 publications

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“…Exploratory moderator analyses found significant differences in the association between sleep and daytime PTSD symptoms between men and women, suggesting potential differences in those associations between sexes. This is consistent with our previous work which found sex differences in sleep to be related with extinction memories (Schenker et al, 2021 ; Schenker et al, 2022 ) and other studies investigating sex differences in PTSD (Gibson et al, 2017 ; Kobayashi & Delahanty, 2013 ; Richards et al, 2022 ; Zhang et al, 2019 ). Here, greater disruptions in sleep were directly related to worse PTSD symptoms the next day in women only, but no effect was found in men.…”

Section: Discussionsupporting

confidence: 92%

“…Over the recent years, biological sex has been found to be an important factor influencing both PTSD and sleep, as well as their relationship (e.g. Kobayashi et al, 2007 ; Richards et al, 2022 ; Schenker et al, 2021 ; Schenker et al, 2022 ; Zhang et al, 2019 ). Women are at greater risk of developing PTSD after trauma exposure (Blanco et al, 2018 ; Felmingham et al, 2010 ), and are also more likely to report subjective sleep disturbances (Suh et al, 2018 ), despite lacking objective evidence of disrupted sleep (Mong & Cusmano, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

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Sleep and day-to-day PTSD symptom variability: an ecological momentary assessment and actigraphy monitored study in trauma-exposed young adults

Schenker

Theoswin

Qian

et al. 2023

European Journal of Psychotraumatology

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Background: Disrupted sleep and post-traumatic stress disorder (PTSD) are bi-directionally linked and have been found to mutually reinforce each other on a day-to-day basis. However, most of the previous research has focused on subjective measures of sleep only. Objective: Here, we investigated the temporal relationship between sleep and PTSD symptoms using both subjective (sleep diary) and objective measures of sleep (actigraphy). Methods: Forty-one non-treatment seeking, trauma exposed young adults (age M = 24.68, SD = 8.15) with a range of PTSD symptom severities (PTSS, 0–53 on PCL-5) were recruited. Participants completed two surveys per day over four weeks to measure day-time PTSD symptoms (i.e. PTSS and number of intrusions) and night-time sleep subjectively, while wearing an actigraphy watch to measure sleep objectively. Results: Linear mixed models revealed that subjectively reported sleep disruptions were associated with elevated next-day PTSS and increasing number of intrusive memories both within and between participants. Similar results were found for daytime PTSD symptoms on night-time sleep. However, these associations were not found using objective sleep data. Exploratory moderator analyses including sex (male vs. female) found that these associations differed in strength between sexes but were generally in the same direction. Discussion: These results were in line with our hypothesis with regards to the sleep diary (subjective sleep), but not actigraphy (objective sleep). Several factors which have implications on both PTSD and sleep, such as the COVID-19 pandemic and/ or sleep-state misperception, may be potential reasons behind those discrepancies. However, this study had limited power and needs to be replicated in larger samples. Nonetheless, these results add to the current literature about the bi-directional relationship between sleep and PTSD and have clinical implications for treatment strategies.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Sleep and day-to-day PTSD symptom variability: an ecological momentary assessment and actigraphy monitored study in trauma-exposed young adults

Schenker

Theoswin

Qian

et al. 2023

European Journal of Psychotraumatology

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“…The association of HRV with physiological extinction recall in males should be treated as a preliminary finding, because of the small number of male participants in our sample (N=34). Nevertheless, if replicated, it would be in line with prior research suggesting that sex modulates fear extinction (Milad et al 2006; Milad et al 2010; Shvil et al 2014; Velasco et al 2019) and its processing during sleep (Schenker et al 2022).…”

Section: Discussionsupporting

confidence: 82%

REM disruption and REM Vagal Activity Predict Extinction Recall in Trauma-Exposed Individuals

Yuksel,

Watford,

Muranaka

et al. 2023

Preprint

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Accumulating evidence suggests that rapid eye movement sleep (REM) supports the consolidation of extinction memory. REM is disrupted in PTSD, and REM abnormalities after traumatic events increase the risk of developing PTSD. Therefore, it was hypothesized that abnormal REM in trauma-exposed individuals may pave the way for PTSD by interfering with the processing of extinction memory. In addition, PTSD patients display reduced vagal activity. Vagal activity contributes to the strengthening of memories, including fear extinction memory, and recent studies show that the role of vagus in memory processing extends to memory consolidation during sleep. Therefore, it is plausible that reduced vagal activity during sleep in trauma-exposed individuals may be an additional mechanism that impairs extinction memory consolidation. However, to date, the contribution of sleep vagal activity to the consolidation of extinction memory or any emotional memory has not been investigated. To test these hypotheses, we examined the association of extinction memory with REM characteristics and REM vagal activity (indexed as high-frequency heart rate variability; HF-HRV) in a large sample of trauma-exposed individuals (n=113). Consistent with our hypotheses, REM sleep characteristics (increased REM density and shortened REM latency) were associated with poorer physiological and explicit extinction memory. Furthermore, higher HF-HRV during REM was associated with better explicit extinction memory. These findings support the notion that disrupted REM may contribute to PTSD by impairing the consolidation of extinction memory and indicate the potential utility of interventions that target REM sleep characteristics and REM vagal activity in fear-related disorders.

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“…Prior evidence has suggested that individual differences in demographic, self-reported, clinical, and psychophysiological characteristics may predict fear extinction, but specific robust predictors have yet to be identified (for reviews, see [ 4 , 6 , 24 ]). Each of the following variables has been associated with fear extinction, albeit inconsistently across studies: sleep (for reviews, see [ 25 , 26 , 27 ]), sex [ 6 , 8 , 17 , 28 ], level and type of childhood trauma exposure [ 29 , 30 ], level of adulthood trauma exposure [ 19 , 31 ], severity of depression symptoms [ 32 , 33 ], trait anxiety (reviewed by [ 6 ]), state anxiety (reviewed by [ 6 ]), and resting heart rate variability (HRV) [ 24 , 34 , 35 ]. Although the literature thus far is inconclusive, each of these patient characteristics is relevant to PTSD treatment and they warrant further study as predictors of fear extinction.…”

Section: Introductionmentioning

confidence: 99%

Predicting Fear Extinction in Posttraumatic Stress Disorder

Lewis,

Webb,

Kuhn

et al. 2023

Brain Sciences

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Fear extinction is the basis of exposure therapies for posttraumatic stress disorder (PTSD), but half of patients do not improve. Predicting fear extinction in individuals with PTSD may inform personalized exposure therapy development. The participants were 125 trauma-exposed adults (96 female) with a range of PTSD symptoms. Electromyography, electrocardiogram, and skin conductance were recorded at baseline, during dark-enhanced startle, and during fear conditioning and extinction. Using a cross-validated, hold-out sample prediction approach, three penalized regressions and conventional ordinary least squares were trained to predict fear-potentiated startle during extinction using 50 predictor variables (5 clinical, 24 self-reported, and 21 physiological). The predictors, selected by penalized regression algorithms, were included in multivariable regression analyses, while univariate regressions assessed individual predictors. All the penalized regressions outperformed OLS in prediction accuracy and generalizability, as indexed by the lower mean squared error in the training and holdout subsamples. During early extinction, the consistent predictors across all the modeling approaches included dark-enhanced startle, the depersonalization and derealization subscale of the dissociative experiences scale, and the PTSD hyperarousal symptom score. These findings offer novel insights into the modeling approaches and patient characteristics that may reliably predict fear extinction in PTSD. Penalized regression shows promise for identifying symptom-related variables to enhance the predictive modeling accuracy in clinical research.

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Sex differences in the effect of subjective sleep on fear conditioning, extinction learning, and extinction recall in individuals with a range of PTSD symptom severity

Cited by 7 publications

References 96 publications

Sleep and day-to-day PTSD symptom variability: an ecological momentary assessment and actigraphy monitored study in trauma-exposed young adults

Sleep and day-to-day PTSD symptom variability: an ecological momentary assessment and actigraphy monitored study in trauma-exposed young adults

REM disruption and REM Vagal Activity Predict Extinction Recall in Trauma-Exposed Individuals

Predicting Fear Extinction in Posttraumatic Stress Disorder

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