title: Examining the Crux of Autonomic Dysfunction in Posttraumatic Stress Disorder: Whether Chronic or Situational Distress Underlies Elevated Heart Rate and Attenuated Heart Rate Variability.
abstract: Posttraumatic stress disorder (PTSD) has been linked to elevated heart rate (HR) and reduced heart rate variability (HRV) in cross-sectional research. Using ecological momentary assessment and minute-to-minute HRV/HR monitoring, we examined whether cross-sectional associations between PTSD symptom severity and HRV/HR were due to overall elevations in distress levels or to attenuated autonomic regulation during episodes of acute distress.
  
  
  
  Two hundred nineteen young adults (18-39 years old), 99 with PTSD, underwent 1 day of Holter monitoring and concurrently reported distress levels via ecological momentary assessment. Using multilevel modeling, we examined the associations between momentary distress and the 5-minute means for low-frequency (LF) and high-frequency (HF) HRV and HR immediately following distress ratings, and whether PTSD symptom severity moderated these associations.
  
  
  
  Compared with the controls, participants with PTSD recorded higher ambulatory distress (mean [standard deviation] = 1.7 [0.5] versus 1.2 [0.3], p < .001) and HR (87.2 [11.8] versus 82.9 [12.6] beats/min, p = .011), and lower ambulatory LF HRV (36.9 [14.7] versus 43.7 [16.9 ms, p = .002) and HF HRV (22.6 [12.3] versus 26.4 [14.6] milliseconds, p = .043). Overall distress level was not predictive of HR or HRV (p values > .27). However, baseline PTSD symptom severity was associated with elevated HR (t(1257) = 2.76, p = .006) and attenuated LF (t(1257) = -3.86, p < .001) and HF (t(1257) = -2.62, p = .009) in response to acute momentary distress.
  
  
  
  Results suggest that PTSD is associated with heightened arousal after situational distress and could explain prior findings associating PTSD with HR/HRV. Implications for treatment and cardiovascular risk are discussed.
authors.affiliation: From the Durham Veterans Affairs Medical Center (Dennis, Dedert, Van Voorhees, Calhoun, Dennis, Beckham), Durham, North Carolina; Department of Psychiatry and Behavioral Sciences (Dennis, Dedert, Van Voorhees, Watkins, Calhoun, Sherwood, Beckham), Duke University Medical Center, Durham, North Carolina; Department of Medical Education (Hayano), Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan; Veterans Affairs Mid-Atlantic Region Mental Illness Research (Calhoun, Beckham), Education, and Clinical Center, Durham, North Carolina; and Durham Veterans Affairs Center for Health Services Research in Primary Care (Calhoun), Durham, North Carolina.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Dennis
authors.forename: Eric A
authors.initials: EA
authors.lastname: Dedert
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Van Voorhees
authors.forename: Lana L
authors.initials: LL
authors.lastname: Watkins
authors.forename: Junichiro
authors.initials: J
authors.lastname: Hayano
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Calhoun
authors.forename: Andrew
authors.initials: A
authors.lastname: Sherwood
authors.forename: Michelle F
authors.initials: MF
authors.lastname: Dennis
authors.forename: Jean C
authors.initials: JC
authors.lastname: Beckham
mesh_terms: D000293:Adolescent; D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D000072860:Ecological Momentary Assessment; D015716:Electrocardiography, Ambulatory; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000503:physiopathology*; D013315:Stress, Psychological / Q000503:physiopathology*; D055815:Young Adult