Examining the Effect of Sleep Disruption on Emotion Regulation and Trauma-Related Symptoms in Veterans

创伤后应激障碍(PTSD)在退伍军人中很常见，并与许多负面的 对身心健康的影响。而循证药理学和心理社会学 创伤后应激障碍的干预措施已经制定，但并不是所有的患者对治疗都有完全的反应。调查 参与创伤后应激障碍发展和维持的生物学过程将增加对创伤后应激障碍的理解 无序和帮助制定更有效的干预措施。睡眠障碍，尤其是快眼 运动(REM)睡眠中断是导致创伤后应激障碍的一个潜在的、可改变的危险因素。例如, 纵向研究表明创伤后急性期快速眼动睡眠碎裂预示着创伤后应激障碍 在稍后的时间点出现症状，强调睡眠作为创伤后应激障碍的一种机制的潜在重要性。 最近的研究还表明，睡眠不佳与情绪调节受损之间存在关联。 具体地说，研究表明，睡眠障碍会损害有效的情绪调节策略，例如 认知重新评估，同时增加对更多不适应情绪调节策略的依赖，例如 表现力压抑。例如，以前的研究已经表明，基线睡眠不足预示着身体受损 在涉及情绪刺激的实验室任务中的认知再评估。我们的课题组还 证明了自我报告的全球睡眠质量差与认知重新评估减少和 在一大群退伍军人中测量一个时间点时，对表情抑制的依赖增加 有无创伤后应激障碍。这一发现对创伤后应激障碍患者的影响尤为显著，因为 情绪调节不良会导致创伤相关症状的严重程度，增加痛苦，以及 干扰创伤后应激障碍的黄金标准干预。然而，大多数研究将睡眠中断与 在健康对照组中曾进行过受损情绪调节，或在临床上只在一个时间点进行过 样本。因此，有必要进行更多的研究，以支持假设的模型 睡眠中断会导致情绪调节不良，从而维持与创伤相关的情绪 症状。这项研究通过使用两种自我报告的纵向测量来回应文献中的这些差距 以及一项实验性的睡眠操作，以检验睡眠中断导致适应不良的假设 有无创伤后应激障碍退伍军人的情绪调节。这项研究的第一个目标将是检查 在某个时间点睡眠不佳预示着情绪调节不良和创伤相关症状 一大群患有和不患有创伤后应激障碍的退伍军人中的后续时间点。失眠严重指数(ISI)， 情绪调节问卷(ERQ)和创伤后应激障碍检查表(PCL)将在三点进行测量 在这个队列中的时间点。我们假设，在第一个时间点睡眠不佳会导致重新评估的减少， 表达抑制增强，并在随后的创伤相关症状的严重性增加 时间点。拟议项目的第二部分将以这些发现为基础，通过实验测试 打乱睡眠会导致情绪调节受损，这也将直接检验这一假说 快速眼动睡眠与情绪调节过程密切相关。退伍军人样本(n=60) 没有创伤后应激障碍的人将被招募并随机接受以下三种睡眠条件之一：1)一晚的快速眼动 睡眠剥夺(REMD)，2)一晚慢波睡眠剥夺(SWSD，一种主动控制条件)，或 3)一晚正常睡眠。然后，参与者将参与两个实验室情绪重新评估任务，使用 来自国际情感图片系统(IAPS)的图像。我们假设REMD的参与者 与SWSD组或正常组相比，在认知重评估任务中，组对图像的评价更负面 睡眠群体，也更有可能选择表达压抑而不是重新评估一种情绪 规则选择任务。探索性分析将确定这种影响是否因诊断组状态而不同。

Posttraumatic Stress Disorder (PTSD) is common in Veterans and associated with a number of negative physical and mental health consequences. While evidence-based pharmacological and psychosocial interventions for PTSD have been developed, not all patients respond fully to treatment. Investigating the biological processes involved in the development and maintenance of PTSD will increase understanding of the disorder and aid in the development of more effective interventions. Sleep disruption, particularly Rapid Eye Movement (REM) sleep disruption, is a potent and modifiable risk factor contributing to PTSD. For example, longitudinal studies have shown REM sleep fragmentation in the acute aftermath of trauma predicts PTSD symptoms at a later timepoint, underscoring the potential importance of sleep as a mechanism in PTSD. Recent research has also demonstrated an association between poor sleep and impaired emotion regulation. Specifically, research suggests disrupted sleep impairs effective emotion regulation strategies, such as cognitive reappraisal, while increasing reliance on more maladaptive emotion regulation strategies, such as expressive suppression. For example, previous studies have shown poor sleep at baseline predicts impaired cognitive reappraisal in lab-based tasks involving emotionally provocative stimuli. Our research group has also demonstrated that poor self-reported global sleep quality is associated with reduced cognitive reappraisal and increased reliance on expressive suppression when measured at one timepoint in a large group of Veterans with and without PTSD. The implications of this finding are particularly salient for patients with PTSD, because maladaptive emotion regulation contributes to severity of trauma-related symptoms, increases distress, and interferes with gold-standard interventions for PTSD. However, most research linking disrupted sleep to impaired emotion regulation has been conducted in healthy controls, or at only one time-point in clinical samples. Therefore, additional research is necessary to provide support for a hypothesized model whereby disrupted sleep contributes to maladaptive emotion regulation, thus in turn maintaining trauma-related symptoms. This study responds to these gaps in the literature by using both self-report longitudinal measures and an experimental sleep manipulation to test the hypothesis that disrupted sleep contributes to maladaptive emotion regulation in Veterans with and without PTSD. The first aim of the study will be to examine whether poor sleep at one timepoint predicts maladaptive emotion regulation and trauma-related symptoms at subsequent timepoints in a large cohort of Veterans with and without PTSD. The Insomnia Severity Index (ISI), the Emotion Regulation Questionnaire (ERQ), and the PTSD Checklist (PCL) will be measured at three timepoints in this cohort. We hypothesize that poor sleep at the first timepoint will predict reduced reappraisal, increased expressive suppression, and increased severity of trauma-related symptoms at the subsequent timepoints. The second portion of the proposed project will build upon these findings by experimentally testing the notion that disrupted sleep results in impaired emotion regulation, and will also directly test the hypothesis that REM sleep specifically is tied to emotion regulation processes. A sample of Veterans (n = 60) with and without PTSD will be recruited and randomized to undergo one of three sleep conditions: 1) one night of REM sleep deprivation (REMD), 2) one night of slow-wave sleep deprivation (SWSD, an active control condition), or 3) one night of normal sleep. Participants will then participate in two laboratory emotion reappraisal tasks using images from the International Affective Picture System (IAPS). We hypothesize that participants in the REMD group will rate the images more negatively during a cognitive reappraisal task than SWSD group or the normal sleep group, and will also be more likely to choose expressive suppression than reappraisal on an emotion regulation choice task. Exploratory analyses will determine if this effect differs by diagnostic group status.