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Autonomic activity, posttraumatic and nontraumatic nightmares, and PTSD after trauma exposure

Published online by Cambridge University Press:  15 June 2021

Thomas Mäder Open the ORCID record for Thomas Mäder [Opens in a new window] ,
Katelyn I. Oliver ,
Carolina Daffre ,
Sophie Kim ,
Scott P. Orr ,
Natasha B. Lasko ,
Jeehye Seo ,
Birgit Kleim  and
Edward Franz Pace-Schott
Thomas Mäder
Affiliation:
Department of Psychology, University of Zurich, Zurich, Switzerland Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
Katelyn I. Oliver
Affiliation:
Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
Carolina Daffre
Affiliation:
Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
Sophie Kim
Affiliation:
Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
Scott P. Orr
Affiliation:
Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA Department of Psychiatry, Harvard Medical School, Charlestown, MA, USA
Natasha B. Lasko
Affiliation:
Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA Department of Psychiatry, Harvard Medical School, Charlestown, MA, USA
Jeehye Seo
Affiliation:
Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA Department of Psychiatry, Harvard Medical School, Charlestown, MA, USA Department of Psychological & Brain Sciences, University of Massachusetts, Amherst, MA, USA
Birgit Kleim
Affiliation:
Department of Psychology, University of Zurich, Zurich, Switzerland Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland Neuroscience Centre Zurich, University of Zurich, Zurich, Switzerland
Edward Franz Pace-Schott*
Affiliation:
Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA Department of Psychiatry, Harvard Medical School, Charlestown, MA, USA
*
Author for correspondence: Edward Franz Pace-Schott, E-mail: epace-schott@mgh.harvard.edu
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Abstract

Background

Nightmares are a hallmark symptom of posttraumatic stress disorder (PTSD). This strong association may reflect a shared pathophysiology in the form of altered autonomic activity and increased reactivity. Using an acoustic startle paradigm, we investigated the interrelationships of psychophysiological measures during wakefulness and PTSD diagnosis, posttraumatic nightmares, and nontraumatic nightmares.

Methods

A community sample of 122 trauma survivors were presented with a series of brief loud tones, while heart rate (HRR), skin conductance (SCR), and orbicularis oculi electromyogram (EMGR) responses were measured. Prior to the tone presentations, resting heart rate variability (HRV) was assessed. Nightmares were measured using nightmare logs. Three dichotomous groupings of participants were compared: (1) current PTSD diagnosis (n = 59), no PTSD diagnosis (n = 63), (2) those with (n = 26) or without (n = 96) frequent posttraumatic nightmares, and (3) those with (n = 22) or without (n = 100) frequent nontraumatic nightmares.

Results

PTSD diagnosis was associated with posttraumatic but not with nontraumatic nightmares. Both PTSD and posttraumatic nightmares were associated with a larger mean HRR to loud tones, whereas nontraumatic nightmare frequency was associated with a larger SCR. EMGR and resting HRV were not associated with PTSD diagnosis or nightmares.

Conclusions

Our findings suggest a shared pathophysiology between PTSD and posttraumatic nightmares in the form of increased HR reactivity to startling tones, which might reflect reduced parasympathetic tone. This shared pathophysiology could explain why PTSD is more strongly related to posttraumatic than nontraumatic nightmares, which could have important clinical implications.

Keywords

Acoustic startle procedureautonomic activityheart rateidiopathicnightmarespathophysiologyposttraumaticPTSD
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 3 , February 2023 , pp. 731 - 740
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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