Sleep Disturbance as a Mechanism for Ischemic Heart Disease in PTSD

睡眠障碍是创伤后应激障碍 (PTSD) 患者缺血性心脏病的机制

• 批准号: 9263431
• 负责人: Viola Vaccarino
• 金额: $ 77.4万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-03-17 至 2021-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9263431
• 关键词: Address; Affect; Ancillary Study; Autonomic nervous system; Behavior; Brothers; Cardiac; Cardioscopes; Cardiovascular system; Cessation of life; Chronic; Clinical; Collection; Comorbidity; Controlled Environment; Controlled Study; Coronary; Data; Dimensions; Dizygotic Twins; Dysautonomias; Electrocardiogram; Environment; Etiology; Evaluation; Exhibits; Follow-Up Studies; Frequencies; Functional disorder; Funding; General Population; Genes; Goals; Health Expenditures; Home environment; Hospitalization; Hour; Image; Individual; Intervention; Link; Measures; Military Personnel; Monitor; Monozygotic twins; Morbidity - disease rate; Myocardial Ischemia; Myocardial perfusion; National Heart, Lung, and Blood Institute; Nightmare; Participant; Pathway interactions; Patient Self-Report; Patients; Perfusion; Phenotype; Play; Polysomnography; Positron-Emission Tomography; Post-Traumatic Stress Disorders; Psychophysiology; Recurrence; Registries; Reporting; Risk; Role; Sampling; Site; Sleep; Sleep Apnea Syndromes; Sleep Disorders; Sleep Fragmentations; Sleep disturbances; Symptoms; Testing; Trauma; Twin Multiple Birth; Twin Studies; United States; Veterans; Vietnam; Visit; actigraphy; base; biobehavior; cardiovascular risk factor; combat; design; disability; disorder control; disorder risk; effective intervention; falls; heart rate variability; high dimensionality; mortality; novel; perfusion imaging; sleep abnormalities

Growing evidence links posttraumatic stress disorder (PTSD) to cardiovascular morbidity and mortality, but the mechanisms are incompletely understood. Abnormal sleep is a modifiable behavior that is a known contributor to cardiovascular risk and a hallmark symptom of PTSD. Our preliminary data and data from other labs show that PTSD is associated with profound sleep disturbance and with abnormal autonomic function (dysautonomia) especially at night. We propose a rigorous twin study to test the new paradigm that abnormal sleep is linked in a bidirectional way with nighttime dysautonomia to increase cardiovascular risk in PTSD. We will add comprehensive autonomic and sleep assessments to an ongoing NHLBI-funded twin study of PTSD and ischemic heart disease (IHD), the Emory Twin Study Follow-up (ETSF). The ETSF will re-examine 180 monozygotic and dizygotic twin pairs (360 individuals) from the Vietnam Era Twin Registry to reassess PTSD status and cardiac status using positron emission tomography (PET) myocardial perfusion imaging. In a previous examination of this sample, we found that twins with PTSD had worse myocardial perfusion and coronary microvascular function compared with twins without PTSD. As part of the proposed ancillary study, we will add both at home and in-lab objective sleep and autonomic monitoring, which will allow for both “real- world” and controlled psychophysiological assessments. Twins will undergo in-lab polysomnography when on site and will be equipped patches for electrocardiogram monitoring and actigraphy wristbands for sleep monitoring to use at home for 14 days. During their visit, they will be examined in a controlled environment which matches their brothers' and allows for the most controlled analyses of within-pair difference. We will address the following hypotheses: (1) Twins with PTSD will exhibit more disturbed sleep (shorter sleep duration, more sleep fragmentation, and more sleep-disordered breathing) compared with twins without PTSD. (2) Twins with PTSD will exhibit more nocturnal dysautonomia (lower nighttime HRV) compared with twins without PTSD. (3) Disturbed sleep and nighttime dysautonomia will be positively related to quantitative indicators of IHD using PET imaging, including perfusion deficits and lower coronary flow reserve. We will also explore dynamic associations among PTSD, sleep disturbance and dysautonomia in the lab and at home. Our proposed twin study should fill a significant gap in evidence regarding the mechanisms of cardiovascular risk in PTSD. If our hypotheses are met, this study will place abnormal sleep and nighttime altered autonomic function at the forefront as interrelated biobehavioral pathways linking PTSD to IHD. The long-term goal is to provide targets for novel interventions that collectively help reduce IHD risk, sleep disturbance, and PTSD symptom burden.

越来越多的证据将创伤后应激障碍（PTSD）与心血管发病率和死亡率联系起来，但 机制尚不完全理解。异常睡眠是一种可修改的行为，是已知的贡献者 心血管风险和PTSD的标志性症状。我们的初步数据和其他实验室的数据显示 PTSD与深刻的睡眠障碍和异常自主功能有关 （功能障碍），尤其是晚上。我们提出了一项严格的双胞胎研究，以测试异常的新范式 睡眠以双向方式与夜间功能障碍联系起来，以增加PTSD的心血管风险。 我们将在正在进行的NHLBI资助的双胞胎研究中添加全面的自主和睡眠评估 PTSD和缺血性心脏病（IHD），Emory Twin研究随访（ETSF）。 ETSF将重新检查 从越南时代双注册表到恢复 PTSD状态和心脏状态使用正电子发射断层扫描（PET）心肌灌注成像。在 先前检查了该样品，我们发现患有PTSD的双胞胎的心肌灌注较差和 与没有PTSD的双胞胎相比，冠状动脉微血管功能。作为拟议的辅助研究的一部分， 我们将在家里增加和单位客观的睡眠和自主神经监控，这将允许“实现” 世界和受控的心理生理评估。双胞胎将在上 站点，将配备用于心电图监测和行为腕带的配备贴片 监视在家中使用14天。在他们访问期间，将在受控环境中进行检查 这与他们兄弟的相匹配，并允许对内对内部差异进行最控制的分析。 我们将解决以下假设：（1）具有PTSD的双胞胎将暴露更多不安的睡眠（睡眠较短） 与没有PTSD的双胞胎相比，持续时间，更多的睡眠破碎和更多的睡眠呼吸）。 （2）与双胞胎相比 没有PTSD。 （3）睡眠和夜间动作障碍将与定量呈正相关 使用PET成像的IHD的指标，包括灌注定义和较低的冠状动脉流量。我们也会 探索实验室和家里的PTSD，睡眠障碍和功能障碍的动态关联。 我们提出的双胞胎研究应填补有关心血管机制的证据的重大空白 PTSD的风险。如果我们的假设得到满足，这项研究将使睡眠异常和夜间改变自主神经。 将PTSD与IHD联系起来的相互关联的生物行为途径处于最前沿的功能。长期目标是 为新颖的干预措施提供目标，以共同有助于降低IHD风险，睡眠障碍和PTSD 症状伯恩。