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Sleep, a Governor of Morbidity in PTSD: A Systematic Review of Biological Markers in PTSD-Related Sleep Disturbances

Authors Maguire DG, Ruddock MW, Milanak ME, Moore T, Cobice D, Armour C

Received 4 May 2020

Accepted for publication 6 July 2020

Published 31 July 2020 Volume 2020:12 Pages 545—562


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Sutapa Mukherjee

Daniel G Maguire,1 Mark W Ruddock,2 Melissa E Milanak,3 Tara Moore,1 Diego Cobice,1 Cherie Armour4

1Biomedical Sciences Research Institute, Ulster University, Coleraine BT52 1SA, Northern Ireland; 2Randox Laboratories Ltd, Clinical Studies, Crumlin, County Antrim BT29 4QY, Northern Ireland; 3Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; 4School of Psychology, David Keir Building, Queen’s University Belfast, Belfast BT9 5BN, Northern Ireland

Correspondence: Mark W Ruddock Tel +44 02894422413

Background: Sleep disturbances (SD) are the most impactful and commonly reported symptoms in post-traumatic stress disorder (PTSD). Yet, they are often resistant to primary PTSD therapies. Research has identified two distinct SDs highly prevalent in PTSD; insomnia and nightmares. Those who report SDs prior to a traumatic event are at greater risk for developing PTSD; highlighting that sleep potentially plays a role in PTSD’s pathology. To further understand the pathobiological mechanisms that lead to the development of PTSD, it is first imperative to understand the interplay which exists between sleep and PTSD on a biological level. The aim of this systematic review is to determine if biological or physiological markers are related to SD in PTSD.
Methods: A systematic literature search was conducted on the electronic databases; Medline, Embase, AMED and PsycINFO, using Medical Subject Headings and associated keywords.
Results: Sixteen studies were included in the final analyses. Physiological makers of autonomic function, and biochemical markers of HPA-axis activity; inflammatory processes; and trophic factor regulation were related to the severity of SDs in PTSD.
Conclusion: These findings add to the growing literature base supporting a central focus on sleep in research aiming to define the pathophysiological processes which result in PTSD, as well as emphasising the importance of specifically targeting sleep as part of a successful PTSD intervention strategy. Resolving SDs will not only reduce PTSD symptom severity and improve quality of life but will also reduce all-cause mortality, hospital admissions and lifetime healthcare costs for those with PTSD. Limitations of the current literature are discussed, and key recommendations future research must adhere to are made within.

Keywords: post-traumatic stress disorder, sleep disturbances, insomnia, nightmares, biomarkers

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