title: Sympathetic activity and hypothalamo-pituitary-adrenal axis activity during sleep in post-traumatic stress disorder: a study assessing polysomnography with simultaneous blood sampling.
abstract: BACKGROUND
  Nightmares and insomnia in PTSD are hallmark symptoms, yet poorly understood in comparison to the advances toward a biological framework for the disorder. According to polysomnography (PSG), only minor changes in sleep architecture were described. This warrants alternative methods for assessing sleep regulation in PTSD.
  
  
  METHODS
  After screening for obstructive sleep apnea and period limb movement disorder, veterans with PTSD (n=13), trauma controls (TCs, n=17) and healthy controls (HCs, n=15) slept in our sleep laboratory on two consecutive nights with an IV catheter out of which blood was sampled every 20min from 22:00h to 08:00h. Nocturnal levels of plasma adrenocorticotropic hormone (ACTH), cortisol, melatonin were assessed in conjunction with PSG registration, as well as subjective sleep parameters.
  
  
  RESULTS
  PTSD patients showed a significant increase in awakenings during sleep in comparison to both control groups. These awakenings were correlated with ACTH levels during the night, and with the subjective perception of sleep depth. Also, heart rate (HR) was significantly increased in PTSD patients as compared with both control groups. The diurnal regulation of ACTH, cortisol and melatonin appeared undisturbed. PTSD patients exhibited lower cortisol levels at borderline significance (p=0.056) during the first half of the night. ACTH levels and cortisol levels during the first half of the night were inversely related to slow wave sleep (SWS).
  
  
  CONCLUSIONS
  This study suggests that hypothalamo-pituitary-adrenal (HPA) axis activity is related to sleep fragmentation in PTSD. Also, activity of the sympathetic nervous system (SNS) is increased during sleep in PTSD. Further research is necessary to explore the potential causal relationship between sleep problems and the activity of the HPA-axis and SNS in PTSD.
authors: Research Center Military Mental Health Care, Utrecht, The Netherlands.
authors: Saskia
authors: S
authors: van Liempt
authors: Johan
authors: J
authors: Arends
authors: Pierre J M
authors: PJ
authors: Cluitmans
authors: Herman G M
authors: HG
authors: Westenberg
authors: René S
authors: RS
authors: Kahn
authors: Eric
authors: E
authors: Vermetten
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood*; D000328:Adult; D001800:Blood Specimen Collection; D002940:Circadian Rhythm; D004325:Dreams; D006339:Heart Rate; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D008297:Male; D008550:Melatonin / Q000097:blood*; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology; D010870:Pineal Gland / Q000378:metabolism / Q000503:physiopathology*; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D017286:Polysomnography; D012892:Sleep Deprivation / Q000097:blood / Q000209:etiology / Q000503:physiopathology*; D013313:Stress Disorders, Post-Traumatic / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D014728:Veterans / Q000523:psychology; D014857:Warfare; D014947:Wounds and Injuries / Q000097:blood / Q000150:complications / Q000503:physiopathology
chemical_list: D000324:Adrenocorticotropic Hormone; D008550:Melatonin; D006854:Hydrocortisone