Sleep characteristics and inflammatory markers in women with post-traumatic stress disorder

Mary Sau Ling Yeh; Dalva Poyares; Ana Teresa D D'Elia; Bruno M Coimbra; Andrea Feijo Mello; Sergio Tufik; Marcelo Feijo Mello

doi:10.1186/s12888-023-04765-1

Sleep characteristics and inflammatory markers in women with post-traumatic stress disorder

BMC Psychiatry. 2023 Apr 20;23(1):273. doi: 10.1186/s12888-023-04765-1.

Authors

Mary Sau Ling Yeh¹, Dalva Poyares², Ana Teresa D D'Elia³, Bruno M Coimbra³, Andrea Feijo Mello³, Sergio Tufik², Marcelo Feijo Mello³

Affiliations

¹ Department of Psychiatry, Universidade Federal de Sao Paulo (UNIFESP), Rua Major Maragliano, 241, São Paulo, 04017-030, SP, Brazil. mary.slyeh@gmail.com.
² Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
³ Department of Psychiatry, Universidade Federal de Sao Paulo (UNIFESP), Rua Major Maragliano, 241, São Paulo, 04017-030, SP, Brazil.

Abstract

Introduction: Sexual violence is one of the most severe traumatic events. It is associated with a higher risk for post-traumatic stress disorder (PTSD) development. Sleep disturbances such as insomnia are frequently reported by PTSD patients and play a key role in the development and course of the disorder. Sleep disturbances are associated with higher levels of pro-inflammatory cytokines emphasizing the importance of sleep studies in individuals with PTSD.

Objectives: To investigate the association between subjective and objective sleep measurements and PTSD symptoms with inflammatory markers in women with PTSD following sexual assault.

Methods: In this longitudinal study fifty-seven women with PTSD were evaluated for sleep measurements and inflammatory markers. Participants completed the Clinician-Administered PTSD Scale, the Beck Depression Inventory, the Pittsburgh Sleep Quality Index (PSQI), and the Insomnia Severity Index. In addition, patients underwent full in-lab polysomnography and serum levels of interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α, and C-reactive protein (CRP) measurement. All assessments were performed at baseline and after one year. Patients received pharmacological and/or psychological interventions between baseline and one-year follow-up.

Results: Despite improving PTSD symptoms severity and sleep quality (expressed in PSQI), we found an increase in the inflammatory markers IL-1β, TNF-α, IL-6 and CRP after one year of follow-up. These findings suggest that neurobiological processes may advance independently of PTSD symptoms. We found a significant increase in the levels of IL-1β and TNF-α associated with decreased slow-wave sleep (p = 0.019 and p = 0.018 respectively), IL-6 associated with arousal index (p = 0.024), and CRP associated with insomnia severity (p = 0.012), and sleep duration longer than 6 h per night (p < 0.001).

Conclusions: Sleep impairments in PTSD may be associated with a gradual and persistent alteration in the immune system, resulting in a progressive inflammatory process. Our results suggest that sleep mechanisms are involved in this incident inflammatory process in young women with PTSD.

Keywords: Cytokines; Inflammatory markers; Polysomnography; Post-traumatic stress disorder; Sleep.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Female
Humans
Interleukin-6
Longitudinal Studies
Sleep
Sleep Initiation and Maintenance Disorders* / complications
Sleep Wake Disorders* / complications
Stress Disorders, Post-Traumatic* / psychology
Tumor Necrosis Factor-alpha

Substances

Tumor Necrosis Factor-alpha
Interleukin-6