Sleep disturbance and baroreceptor sensitivity in women with posttraumatic stress disorder

Ulmer, Christi S.; Calhoun, Patrick S.; Edinger, Jack D.; Wagner, H. Ryan; Beckham, Jean C.

doi:10.1002/jts.20464

Cited by 19 publications

(9 citation statements)

References 17 publications

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“…A PTSD diagnosis involves hyperarousal, re-experiencing of stress and sleep difficulties 25 , and having a diagnosis of PTSD places one at greater risk of hypertension 26 and death due to early onset of coronary heart disease 27 . In a sample of women, we found evidence of these shared associations across several previous studies, including one study focused on baroreceptor sensitivity 28 . Baroreceptors are sensors located in the wall of blood vessels which detect blood pressure changes and relay this information to the central nervous system.…”

Section: Introductionsupporting

confidence: 64%

Nocturnal Blood Pressure Non-Dipping, Posttraumatic Stress Disorder, and Sleep Quality in Women

Ulmer

Calhoun

Bosworth

et al. 2013

Behavioral Medicine

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Background Women with posttraumatic stress disorder (PTSD) have poor sleep quality and increased risk of cardiovascular disease (CVD). Non-dipping of nocturnal blood pressure may be an explanatory factor for the relationship between sleep and CVD found in previous research. Purpose The current study was designed to determine if non-dipping nocturnal blood pressure was associated with trauma exposure, PTSD diagnosis, PTSD symptoms, and sleep quality in a sample of women. Methods Participants completed 24 hours of ABPM and self-report questionnaires. Non-dipping was defined as less than 10% reduction in blood pressure during sleep. Results The frequency of non-dippers did not differ by diagnostic status (d=.15). However, non-dippers endorsed more traumatic event categories (d=.53), more PTSD hyperarousal symptoms (d=.53), poorer overall sleep quality (d=.59), more frequent use of sleep medication (d=.62), greater sleep-related daytime dysfunction (d=.58), and longer sleep onset latencies (d=.55) than dippers. Conclusions Increased attention to nocturnal blood pressure variation may be needed to improve blood pressure control in trauma-exposed women.

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Section: Introductionsupporting

confidence: 64%

Nocturnal Blood Pressure Non-Dipping, Posttraumatic Stress Disorder, and Sleep Quality in Women

Ulmer

Calhoun

Bosworth

et al. 2013

Behavioral Medicine

Self Cite

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“…Furthermore, while baroreceptor sensitivity decreased for all participants during an anger recall task, the change was less dramatic for women with PTSD, possibly due to their lower resting values (76). More recently, in a study of women with and without PTSD, an interaction was detected between baroreceptor sensitivity and objective sleep parameters (79). Lower baroreceptor sensitivity was associated with poorer sleep in women with PTSD, but not in those without PTSD (79).…”

Section: Biomarkers Of Cardiovascular and Metabolic Disease In Ptsdmentioning

confidence: 99%

“…More recently, in a study of women with and without PTSD, an interaction was detected between baroreceptor sensitivity and objective sleep parameters (79). Lower baroreceptor sensitivity was associated with poorer sleep in women with PTSD, but not in those without PTSD (79). …”

Section: Biomarkers Of Cardiovascular and Metabolic Disease In Ptsdmentioning

confidence: 99%

Posttraumatic Stress Disorder, Cardiovascular, and Metabolic Disease: A Review of the Evidence

et al. 2010

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Background Posttraumatic stress disorder (PTSD) is a significant risk factor for cardiovascular and metabolic disease. Purpose The purpose of the current review is to evaluate the evidence suggesting that PTSD increases cardiovascular and metabolic risk factors, and to identify possible biomarkers and psychosocial characteristics and behavioral variables that are associated with these outcomes. Methods A systematic literature search in the period of 2002–2009 for PTSD, cardiovascular disease, and metabolic disease was conducted. Results The literature search yielded 78 studies on PTSD and cardiovascular/metabolic disease and biomarkers. Conclusions Although the available literature suggests an association of PTSD with cardiovascular disease and biomarkers, further research must consider potential confounds, incorporate longitudinal designs, and conduct careful PTSD assessments in diverse samples to address gaps in the research literature. Research on metabolic disease and biomarkers suggests an association with PTSD, but has not progressed as far as the cardiovascular research.

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“…For example, individuals with PTSD have increased prevalence of blood pressure dysregulation (6-8). Although results from previous studies have been mixed, meta-analyses have demonstrated that PTSD is associated with elevations in resting systolic and diastolic blood pressure (9, 10).…”

Section: Introductionmentioning

confidence: 99%

The Renin-Angiotensin Pathway in Posttraumatic Stress Disorder

Khoury¹,

Marvar²,

Gillespie³

et al. 2012

J. Clin. Psychiatry

121

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Objective PTSD is a debilitating stress-related illness associated with trauma exposure. The peripheral and central mechanisms mediating stress response in PTSD are incompletely understood. Recent data suggest that the renin-angiotensin pathway, essential to cardiovascular regulation, is also involved in mediating stress and anxiety. In this study, the authors examined the relationship between active treatment with blood pressure medication, including angiotensin converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARBs), and PTSD symptom severity within a highly traumatized civilian medical population. Method Cross-sectional, observational data was analyzed from a larger study, recruiting patients from Grady Memorial Hospital's outpatient population from 2006 to November 2010. Multi-variable linear regression models were fit to statistically evaluate the independent association of being prescribed an ACE-I or ARB with PTSD symptoms, using a sub-set of patients for whom medical information was available (n=505). PTSD diagnosis was assessed using the modified PTSD Symptom Scale (PSS) based on DSM-IV criteria with PTSD symptoms based on PSS and Clinician Administered PTSD Scale (CAPS). Results A significant association was determined between presence of ACE-I / ARB medication and decreased PTSD symptoms (mean PSS score 11.4 vs 14.9 for individuals prescribed vs not prescribed ACE-I/ARBs, respectively (p = 0.014)). After adjustment for covariates, ACE-I/ARB treatment remained significantly associated with decreased PTSD symptoms (p = 0.044). Notably, other blood pressure medications, including beta-blockers, calcium channel blockers, and diuretics, were not significantly associated with reduced PTSD symptoms. Conclusions These data provide the first clinical evidence supporting a role for the reninangiotensin system in the regulation of stress response in patients diagnosed with PTSD. Further studies should examine whether available medications targeting this pathway should be considered for future treatment and potential protection against PTSD symptoms.

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Sleep disturbance and baroreceptor sensitivity in women with posttraumatic stress disorder

Cited by 19 publications

References 17 publications

Nocturnal Blood Pressure Non-Dipping, Posttraumatic Stress Disorder, and Sleep Quality in Women

Nocturnal Blood Pressure Non-Dipping, Posttraumatic Stress Disorder, and Sleep Quality in Women

Posttraumatic Stress Disorder, Cardiovascular, and Metabolic Disease: A Review of the Evidence

The Renin-Angiotensin Pathway in Posttraumatic Stress Disorder

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