Overview In Brief: Why is sleep important? · 2018/09/22 1 Gosia Lipinska Sleep quality in PTSD-diagnosed women in South Africa: cognitive-affective associations Overview •In Brief:

2018/09/22

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Gosia Lipinska

Sleep quality in PTSD-diagnosed women in

South Africa: cognitive-affective associations

Overview

• In Brief: Why is sleep important?

– Sleep, memory and emotional processing in PTSD

– Why study sleep in PTSD?

• Study Methodology

• Results

– Sleep in PTSD

– Neutral Declarative Memory and Sleep in PTSD

– Emotional Memory and Sleep in PTSD

– Emotional Reactivity and Sleep in PTSD

• Discussion

UNIVERSITY OF CAPE TOWN

In Brief: Why is sleep important?

• Sleep and neutral declarative memory

consolidation


Diekelmann & Born, 2010


• Sleep and emotional memory consolidation

– Positive + negative > neutral

– Healthy sleep = balanced consolidation

– Sleep deprivation = negative > positive or neutral

– Role of REM sleep


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• Sleep and emotional reactivity

– Autonomic arousal

– REM sleep attenuates emotional reactivity


Walker, 2009

• Characteristics of sleep in PTSD

– Diagnostic criteria: insomnia and nightmares

• Subjective reports of very poor sleep

– Less SWS

–More stage 1 NREM

– REM sleep abnormalities

• REM density

• REM fragmentation in the aftermath of a trauma

predicts the development of PTSD


In Brief: Sleep in PTSD

• Neutral declarative memory

– Poor free recall in comparison to TE and HC

– No difference in retention

– Hippocampus??

• Emotion memory and reactivity

– Biased memory for negative stimuli

– Elevated emotional reactivity in response to

negative and arousing stimuli


In Brief: Memory and Emotion

Processing in PTSD

• PTSD sleep disturbances

• PTSD memory and emotional disturbances

• Perhaps not an accident


In Brief: Why study sleep

in PTSD

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In Brief: Why is study sleep

in PTSD?

• PTSD

– Prevalence in South Africa is 2.3% and conditional

prevalence is 3.5%

• Experiencing trauma places demands on

public health system

• In LMIC there are few resources

– A place for sleep therapies?


Walker, 2009

Overview





• Results

– Sleep in PTSD




• Discussion


• Participants: women 18-40 years old


MethodsParticipants

TE*PTSD

n = 21 n = 19

HC**

n = 20

*TE = Trauma-Exposed non-PTSD; **HC = healthy control

Trauma < 6 months

Trauma > 5 years

• Subjective sleep report – PSQI

• Nihon Khoden polysomnograph (PSG)

• Noradrenergic activity

– Urine metabolites


MethodsMaterials

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• Logical Memory; Word List;

Story Memory


MethodsMaterials

• Vrije Universiteit Ambulatory Monitoring

System (VU-AMS)

• International Affective Picture System (IAPS)


MethodsMaterials


MethodsProcedure

Overview





• Results

– Sleep in PTSD




• Discussion


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• Subjective reports


**

***

* p < .05, ** p < .01

Sleep in PTSD

• Objective

polysomnograph

– No between-group

differences in gross

architecture

– Sleep stage differences

– REM arousals

• PTSD > TE and HC, n.s.

UNIVERSITY OF CAPE TOWNSleep in PTSD

0

10

20

30

40

50

60

70

80

90

100

PTSD TE HC

REM%

SWS%

NREM2%

NREM1%

TE = trauma-exposed; HC = healthy control

GL1

Overview





• Results

– Sleep in PTSD




• Discussion



Neutral Declarative Memory

and Sleep in PTSD

• PTSD < healthy controls

– delayed recall and retention after sleep

– immediate and delayed recall but not

retention across waking.

• N.s. between TE participants and

participants in the other groups

Slide 18

GL1 bring in findings from other studiesGosia Lipinska, 2018/03/25

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and Sleep in PTSD

Across Sleep Across Waking

* * * *

PTSD Trauma-Exposed Healthy Control



and Sleep in PTSD

• Predicting Night-time Neutral Declarative Retention

Note. For the overall model, R2 = .41, adjusted R2 = .35.

Retention REM fragmentation

PTSD: r = -.50, p = .03; TE: r = -.13, p = .60; HC: r = .17, p = .47

Overview





• Results

– Sleep in PTSD




• Discussion


• Emotion Memory

– : all participants ≈ ≈

• i.e. balanced accuracy

– : all participants > ≈

• i.e. biased accuracy


Emotional Memory and

Sleep in PTSD

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Recognition accuracy: Comparing picture type after sleep and waking

0

0.5

1

1.5

2

2.5

3

High Arousing Negative High Arousing Positive Low Arousing Neutral

Me

an

Re

cog

nit

ion

Acc

ura

cy

Valence and Arousal

Condition

Sleep

Waking

Sleep

Waking

High Arousing

Negative

High Arousing

Positive

Low Arousing

Neutral


Sleep in PTSD

Overview





• Results

– Sleep in PTSD




• Discussion


• Emotion Reactivity

– : all participants, all pictures

• i.e. sleep attenuated emotion reactivity

– : all participants, all pictures

• i.e. waking increased emotion reactivity

– No relationship: REM and (i) emotion memory & (ii) emotion reactivity


Emotional Reactivity and

Sleep in PTSD


Pre-Ejection Period and Left Ventricular Ejection Time Change: Comparing emotion

reactivity to the initial presentation of a picture (pre-delay) to the repeat presentation of

that picture (post-delay), within each of the Sleep and Waking conditions

PE

P

LVE

T

Sleep Waking Sleep Waking

pre-delay

post-delay


Sleep in PTSD

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Overview





• Results

– Sleep in PTSD




• Discussion


• Some evidence of objective sleep disturbance

in PTSD

– Fairly minimal, subjective reports suggest

improved sleep quality in PTSD in the lab


Discussion

• : PTSD retention

• : PTSD retention ≈ other groups

• Pattern of memory performance

– Hippocampal functioning

– Saturated networks?

• REM fragmentation, not SWS


Discussion

• Sleep regulates emotion memory & reactivity

– Not in predicted direction for emotion memory

• Context specific?

– General effect of sleep on emotional reactivity


Discussion

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• Neutral declarative memory vs. emotional

memory and reactivity

– Totally different results

– Possible sensitivity of the hippocampus


Discussion

vs

Conclusion

• Good quality sleep is important for memory and

emotional reactivity

• Sleep research in the context of psychiatric

disorders helps us understand that symptoms

are related


• National Research Foundation

• A.W. Mellon Foundation

• A/Professor Kevin Thomas

• UCT Sleep Sciences Team


Thanks!

Documents

Overview In Brief: Why is sleep important? · 2018/09/22 1 Gosia Lipinska Sleep quality in PTSD-diagnosed women in South Africa: cognitive-affective associations Overview •In Brief: