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Chronic insufficient sleep is linked to a variety of adverse health outcomes, and African Americans have been found to have poorer sleep than their non-Hispanic White counterparts. African Americans disproportionately live in low-income disordered neighborhoods which increases their risk of trauma exposure and adversely affects their sleep. Fear of sleep is a construct linked to posttraumatic stress disorder (PTSD). We have reported a relationship between fear of sleep and insomnia in urban residing African Americans. Our objective is to report the relative contributions of neighborhood stress along with PTSD to fear of sleep.The present study features a nonclinical sample of 117 African Americans (ages 18-35) who reside in DC.After controlling for gender, hierarchical linear regression analyses revealed that PTSD severity and perceptions of the neighborhood environment accounted for approximately 32% of the variance in sleep-related fears (∆R2 = .320, p.001). Regression coefficients suggest that perceptions of the neighborhood (β = .360) predict sleep-related fears to a similar degree as PTSD severity (β = .368).Results from this study have implications for interventions to help African Americans to cope with their neighborhood environments effect on their sleep.

Poor sleep is common in our society, particularly for African Americans, and is associated with adverse mental and physical health outcomes. Unwanted, intrusive thoughts contribute to sleep disturbances and can be engendered by living in stressful urban environments, which are disproportionately inhabited by African Americans. Studies of other populations have shown that cognitive coping strategies to manage intrusive thoughts vary in their adaptiveness.To examine the relationship between thought control strategies and insomnia severity in urban residing young-adult African Americans.Sixty-four young adult African Americans completed a demographic questionnaire, the Thought Control Questionnaire for Insomnia-revised, and the Insomnia Severity Index.There were moderate to strong positive correlations of aggressive suppression, worry, behavioral distraction, and social avoidance with ISI scores. Poor sleepers endorsed greater use of worry and aggressive suppression than good sleepers. Results from a multiple linear regression analysis revealed that aggressive suppression, social avoidance, and behavioral distraction significantly predicted insomnia severity, and aggressive suppression was the strongest predictor in the model.These results extend findings of aggressive suppression as a correlate of insomnia severity to an urban-residing young adult African American sample. Future research should identify adaptive approaches and the utility of modifying maladaptive strategies.

There is a need to identify strategies to increase the effectiveness of treatments for posttraumatic stress disorder (PTSD). Sleep is often disturbed in PTSD and has been implicated in learning processes that underlie recovery from PTSD, including extinction of conditioned fear. Our prior study suggested that diminished arousal during sleep may enhance benefits of therapeutic exposure for PTSD. The orexin system regulates arousal, and blocking the system diminishes arousal and promotes sleep. We, therefore, examined whether a dual orexin receptor antagonist, suvorexant, administered following evening exposure sessions, would enhance their therapeutic effectiveness for PTSD. In this randomized double-blind placebo-controlled trial, adults with PTSD completed four written narrative exposure (WNE) sessions, two of which took place in the evening, and two the next morning. Participants received either suvorexant or placebo after each evening WNE. We found that suvorexant increased N3 sleep and decreased N2 sleep and rapid-eye-movement latency measured by polysomnography. Between session habituation indexed by subjective distress ratings was greater with suvorexant, but there was no group difference in the reduction of PTSD severity from baseline to 1-week follow-up. No safety concerns emerged. The present findings provide preliminary support for enhancement of an effect of therapeutic exposure for PTSD by suvorexant. Further studies with larger samples are needed to translate the present findings into clinical applications, including studies to develop optimal suvorexant administration and exposure session schedules to achieve persistent benefits to sleep and possibly greater treatment augmentation.

Sleep disturbances are common among previously deployed Veterans. Cognitive behavioral therapy for insomnia (CBT-I) has shown promise for Veterans but may not optimally target nocturnal vigilance. ...

Study Objectives Self-reported sleep disturbance has been established as a risk factor and predictor for posttraumatic stress disorder (PTSD); however, less is known about the relationship between objective sleep and PTSD symptom clusters, and the specific role of hyperarousal. The present study examined the relationships between sleep continuity and architecture on PTSD symptom clusters. Methods Participants underwent two in-laboratory sleep studies to assess sleep continuity and architecture. They also completed the Clinician-Administered PTSD-IV scale and the Structured Clinical Interview for the DSM-IV to assess for PTSD diagnosis and other psychiatric disorders. Results Sleep continuity (i.e. total sleep time, sleep efficiency percent, wake after sleep onset, sleep latency) was significantly related to PTSD Cluster B (reexperiencing) symptom severity (R2 = .27, p < .001). Sleep architecture, specifically Stage N1 sleep, was significantly associated with PTSD Cluster B (t = 2.98, p = .004), C (Avoidance; t = 3.11, p = .003), and D (Hyperarosual; t = 3.79, p < .001) symptom severity independently of Stages N2, N3, and REM sleep. REM sleep variables (i.e. REM latency, number of REM periods) significantly predicted Cluster D symptoms (R2 = .17, p = .002). Conclusions These data provide evidence for a relationship between objective sleep and PTSD clusters, showing that processes active during Stage N1 sleep may contribute to PTSD symptomatology in civilians and veterans. Further, these data suggest that arousal mechanisms active during REM sleep may also contribute to PTSD hyperarousal symptoms. This paper is part of the War, Trauma, and Sleep Across the Lifespan Collection. This collection is sponsored by the Sleep Research Society.

Study Objectives Effective pharmacological treatments for sleep disturbance related to trauma with and without co-occurring posttraumatic stress disorder (PTSD) are needed. There is debate regarding what effects on rapid eye movement sleep (REMS) would be beneficial. Suvorexant is the first dual orexin receptor antagonist (DORA) approved for the treatment of insomnia. In contrast to most psychotropic agents, DORAs can enhance REMS while reducing arousal. We evaluated 6 weeks of suvorexant treatment for trauma-related insomnia in a double-blind, placebo-controlled clinical trial with clinical and polysomnographic evaluation. Methods Participants with insomnia that followed a traumatic event were recruited from the community. Representation of current, past-only, and never having met criteria for PTSD was similar and most participants had experienced trauma-related nightmares. Participants were randomly assigned to receive suvorexant or placebo, initially at 10 mg and increased to 20 mg after 1 week, if tolerated. Polysomnography was obtained for screening, at baseline, and at 2 weeks of treatment. Results The thirty-seven evaluable participants had significant improvement of PTSD and insomnia symptoms, however, there were no significant interactions with treatment condition. Medication was well tolerated with only one dropout being related to side effects. Within the suvorexant group increased REM segment duration correlated with concurrent PTSD symptom reduction. Nightmares remitted in all of the participants who received suvorexant and all but one of those receiving placebo. Conclusions A robust placebo response undermined detecting a medication effect. Further evaluation of DORAs for trauma-related insomnia, as well as factors contributing to placebo-response, are warranted.

Objectives This study was undertaken to evaluate the diagnostic performance of the BinaxNOW COVID-19 Ag Card rapid antigen assay (Abbott; Chicago, IL, USA) in the detection of COVID-19 infection compared to the reference standard of PCR testing. Methods We evaluated the BinaxNOW COVID-19 Ag Card rapid antigen assay relative to a standard reference PCR test. We tested 3810 nasal swabs from symptomatic and asymptomatic adults undergoing surveillance COVID-19 testing at Howard University using one swab for each nostril. One swab was tested using the rapid antigen assay and the other using the PCR test. Results The sensitivity of the BinaxNOW COVID-19 Ag Card rapid antigen assay was 91.84% (95% confidence interval (CI): 80.40-97.73%) and the specificity was 99.95% (95% CI: 99.81-99.99%). The range of Ct values for the N gene was 10.74-34.90 (M=26.88, SD=4.86). Fourteen (28.6%) samples had an N gene Ct value > 30. The average N gene Ct value for rapid test negative (i.e. false negative) samples as 31.92. Conclusions The sensitivity of the test in our symptomatic and asymptomatic cohort was lower than the manufacturer's reported sensitivity in a symptomatic cohort (97.1%). Despite their relatively lower sensitivity (especially in asymptomatic individuals), rapid tests have undeniable benefits (i.e., ease of use and rapid results) that make them a helpful tool in the control of the SARS-CoV-2 pandemic. Given the diagnostic accuracy of these tests as evidenced by this study, rapid tests can be thoughtfully employed in situations where swift results are critical.

Inpatient dialysis patients cannot isolate, resulting in a higher rate of coronavirus disease 2019 (COVID-19) infections, with increased severity and higher mortality rate [1]. We present 2 African American dialysis patients who developed severe COVID-19 infections after vaccination. Both patients had not mounted antibody response to the COVID-19 vaccine or to hepatitis B vaccination.

Introduction Much attention has been given to stress-related symptoms including insomnia related to the COVID-19 pandemic. Exposure to racially targeted police violence and the disproportionate impact of COVID on their communities have been particularly salient stressors for African Americans. Aims for this presentation are to illuminate the emotional impact of COVID and racism on young adult African Americans and their relationship to sleep problems. Methods An online survey was sent to participants in an ongoing study focusing on sleep and health along with new participants recruited through a snowball method. The survey included the Insomnia Severity Index (ISI), Impact of Event scale (IES), as well as items to assess experiences with COVID, exposure to racially targeted violence, and disparate community impact. Results Respondents were African Americans age 18–35. 45% endorsed worsening sleep during the pandemic. 25% had ISI scores of probable insomnia and 61% had IES scores above the symptom threshold for clinical concern. Racism-related distress was endorsed at higher levels than worries related to COVID. There was a significant relationship of insomnia severity with the number of COVID related stressors and a trend level relationship with COVID worries. Sleep outcomes were not correlated with racism-related distress. Conclusion While distress related to racism was endorsed more than COVID worries, our preliminary findings suggest COVID worries but not racism exposure negatively impact sleep health. This may be a consequence of habituation to the chronic stress of racism in contrast with the novel stress of COVID. Support (if any) 5R01HL136626 from the National Heart Lung and Blood Institute

STUDY OBJECTIVES: To determine whether high-frequency heart rate variability (HF-HRV) during sleep differs between those with and without posttraumatic stress disorder (PTSD) as a function of sleep type (non-rapid eye movement [NREM] vs. rapid eye movement [REM]), and to explore this relationship across successive sleep cycles. Participants with PTSD were hypothesized to have lower HF-HRV across both REM and NREM sleep. METHODS: Sixty-two post-9/11 military veterans and service members completed self-report measures of sleep quality, insomnia severity, and disruptive nocturnal behaviors. Participants then completed a laboratory-based polysomnographic study night with concurrent HRV assessment. RESULTS: Participants with PTSD (N = 29) had lower HF-HRV in overall NREM sleep relative to those without PTSD (N = 33) (F(1, 54) = 4.24, p = .04). Groups did not differ on overall HF-HRV during REM sleep. HF-HRV increased over the night for the sample as a whole during both NREM and REM sleep. PTSD status did not moderate the association between HF-HRV and sleep cycles. However, the PTSD group had lower HF-HRV in the first t(155) = 2.67, p = .008, and fourth NREM cycles, t(155) = 2.11, p = .036, relative to participants without PTSD. CONCLUSIONS: Findings suggest blunted parasympathetic modulation during NREM sleep in a young cohort of military veterans and service-members with PTSD. Findings are concerning considering the increased risk of incident cardiovascular events associated with impaired parasympathetic nervous system function. Reduced parasympathetic modulation may be one mechanism underlying the increased prevalence of cardiovascular disease (CVD) among veterans with PTSD.

Introduction Poor sleep is common in our society, particularly for African Americans. Unwanted, intrusive thoughts at bedtime contribute to sleep disturbances, and the nature of intrusive thoughts may be influenced by perception of threat among people living in stressful urban environments. Research has suggested that strategies to control intrusive thoughts vary in their adaptiveness and may be modifiable. These findings need to be confirmed in populations residing in stressful urban environments where perceived threats contribute to intrusive thoughts.The present study attempts to replicate prior research examining the relationship between thought control strategies and insomnia in urban residing young-adult African Americans. Methods Sixty-three young-adult African Americans completed the Thought Control Questionnaire for Insomnia-Revised and the Insomnia Severity Index (ISI). Results Thought control strategies previously associated with insomnia were significantly correlated with the ISI (aggressive suppression r=0.51, p0.05). In a grouped comparison between good sleepers and those with insomnia worry was the only subscale that was endorsed significantly greater among those with insomnia (t(61)=-2.91, p Conclusion These preliminary data replicate prior findings that suggest that aggressive suppression and worry are maladaptive thought control strategies. in a young-adult African American sample. Future research with a larger sample is needed to identify strategies that can improve sleep in this population. Support (if any) 5R01HL136626 from the National Heart Lung and Blood Institute

Introduction Finding medication treatment that improves sleep disturbances with posttraumatic stress disorder (PTSD) has challenged the field of psychopharmacology with debate regarding the desirable profile of effects on sleep physiology. Evidence for fragmentation of REM sleep during the earlier stages of PTSD drew our interest to the first marketed dual orexin antagonist, suvorexant, which has been suggested in some studies to enhance REM sleep. This property has also raised concerns regarding potential exacerbation of nightmares and REM sleep related parasomnias. Insomnia is a common sequela of trauma exposure and can occur with and without other PTSD symptoms. The objective of our study was to evaluate the tolerability and preliminary efficacy of suvorexant for trauma related insomnia in a double blind, placebo controlled trial. Methods 64 met initial inclusion criteria and 42 participants had evaluable results. 65% were female, and 66% African-American, mean age was 35yrs.All participants were screened by the Duke Sleep Disorders Interview to met criteria for insomnia that began or was exacerbated following a DSM5 Criterion A trauma. Approximately a third of the study group met criteria for either current PTSD, past (remitted PTSD), or no PTSD, and 56% reported histories of traumatic nightmares hat generally had diminished from their initial severity. Results Medication intolerance was infrequent with one participant in the med group reporting mild sedation that precluded a dose increase to 20mg, and another, moderate sedation with feelings of derealization that led to discontinuation. There was no evidence for emerging nightmare symptoms or REM-related parasomnias. Overall there was significant improvement in sleep and PTSD symptoms in both the placebo and med group and a modest rise in REM sleep in the med group that did not differentiate statistically from placebo. Conclusion Our findings suggest that distressing trauma related insomnia can occur with and without PTSD and that suvorexant is well tolerated in this population. A larger and more symptomatic group is required to more definitively evaluate efficacy. Support (if any) supported by a grant from Merck (MISP 53678)

Introduction Chronic insufficient sleep is linked to a variety of adverse health outcomes, with African Americans reporting and objectively receiving poorer sleep outcomes in comparison to their non-Hispanic white counterparts. African Americans live disproportionately in low-income and disordered neighborhoods that increase one’s risk of experiencing a traumatic event and interfere with sleep. It has been demonstrated that posttraumatic stress disorder disrupts sleep in part due to its association with sleep-related fears. However, less research has evaluated the additional contribution of perceived neighborhood stress on the sleep-related fears African Americans experience in their sleep environments. Methods The present study features a nonclinical sample of 163 African American participants (ages 18–35) who reside in DC to investigate whether PTSD severity (Clinician Administered PTSD Scale for DSM-5 Severity Score, CAPS-5) and perceived neighborhood stress (City Stress Index, CSI) are predictive of sleep-related fears (Fear of Sleep Inventory, FoSI). Results After controlling for gender, hierarchical linear regression analyses revealed that PTSD severity and perceptions of the neighborhood environment accounted for approximately 33% of the variance in sleep-related fears (∆R2 = .329, p = .000). Regression coefficients suggest that subjective perceptions of the neighborhood (β = .388) may be a stronger predictor of sleep-related fears than PTSD severity (β = .300) Conclusion Results from this study have implications for future interventions that involve improving coping skills among African Americans in the context of their sleep environments. Support (if any) 5R01HL136626 from the National Heart Lung and Blood Institute

Post-traumatic stress disorder (PTSD) is a common and potentially disabling disorder that develops in 1/5 to 1/3 of people exposed to severe trauma. Twin studies indicate that genetic factors account for at least one third of the variance in the risk for developing PTSD, however, the specific role for genetic factors in the pathogenesis of PTSD is not well understood. We studied genome-wide gene expression and DNA methylation profiles in 12 participants with PTSD and 12 participants who were resilient to similar severity trauma exposure. Close to 4,000 genes were differentially expressed with adjusted p < 0.05, fold-change > 2, with all but 3 upregulated with PTSD. Eight odorant/olfactory receptor related genes were up-regulated with PTSD as well as genes related to immune activation, the Gamma-Aminobutyric Acid A (GABAA) receptor, and vitamin D synthesis. No differences with adjusted significance for DNA methylation were found. We conclude that increased gene expression may play an important role in PTSD and this expression may not be a consequence of DNA methylation. The role of odorant receptor expression warrants independent replication.

Posttraumatic stress disorder (PTSD) has been associated with sleep disturbances including alterations in sleep stages and recently, elevated nocturnal autonomic nervous system (ANS) arousal (i.e., dominance of the sympathetic nervous system over the parasympathetic nervous system). Data suggest that sleep contributes to the regulation of ANS activity. In our previous ambulatory heart rate variability (HRV) monitoring study, strong relationships between sleep and nocturnal ANS activity in resilient participants (i.e., individuals who had never had PTSD despite exposure to high-impact trauma) were not seen with PTSD. In this study, we examined the impact of PTSD vs. resilience on ANS activity as a function of sleep stage and time of sleep. Participants (age 18–35) with current PTSD (n = 38) and resilience (n = 33) completed two overnight polysomnography recordings in a lab setting. The second night electrocardiogram was analyzed for frequency domain HRV parameters and heart rate within rapid-eye-movement (REM) and non-REM (NREM) sleep periods. Results indicated that ANS arousal indexed by HRV was greater during REM compared with NREM sleep and that the REM–NREM difference was greater in the PTSD than in the resilient participants. This effect of PTSD was reduced to non-significance when analyses controlled for REM sleep percentage, which was lower with PTSD. Exploratory analyses revealed that the REM–NREM difference in HRV was correlated with REM sleep percentage in resilient participants, but not with PTSD. In contrast with our data from home settings, the present study did not find increased overall nocturnal ANS arousal with PTSD. Analyses did reveal higher heart rate during initial NREM sleep with more rapid decline over the course of NREM sleep with PTSD compared with resilience. Findings suggest that elevated ANS arousal indexed by heart rate with PTSD is specific to the early part of sleep and possible impairment in regulating ANS activity with PTSD related to REM sleep.

This study examined the relationship between sleep fears and insomnia in veterans. Participants completed questionnaires assessing mental health, pain, insomnia, and sleep fears. Most veterans (84....

Introduction Sleep disturbance is common following military deployment, and insomnia is associated with many adverse psychiatric and medical outcomes. Deployment to a threatening environment can engender nocturnal vigilance, which may be a salient feature of sleep disturbance in formerly deployed Veterans. Cognitive behavioral therapy for insomnia (CBTI) is an effective treatment; however, CBTI emphasizes targeting dysfunctional beliefs about sleep (DBAS) and generalized worries rather than vigilance. The goal of the present study was to investigate the role of vigilance, in relation to other potential types of sleep-interfering cognitions in formerly deployed Veterans with sleep disturbance. Methods Thirty-nine formerly deployed Veterans with disturbed sleep completed measures prior to an intervention. Insomnia was measured with the Insomnia Severity Index (ISI) and measures derived from actigraphy and morning sleep diaries administered for one week. Measures for sleep interfering cognitions included Dysfunctional Beliefs about Sleep (DBAS), the Penn State Worry Questionnaire (PSWQ), a measure of generalized worry, and the Fear of Loss of Vigilance (FLV) subscale of the Fear of Sleep Inventory (FOSI). Results All of the measures of sleep-interfering cognitions were significantly associated with ISI score. Generalized worries (PSWQ scores) were strongly and significantly correlated with both FLV and DBAS, which were not significantly correlated with each other. FOSI FLV explained 7.1% more variance in ISI score than DBAS alone (p = .04) while DBAS explained 23.1% additional variance in ISI score over FOSI FLV alone (p < .001). Conclusion It may be important to target both nocturnal vigilance and dysfunctional beliefs about sleep in the treatment of insomnia in formerly deployed Veterans. Support Supported by W81XWH-14-1-0066 from the Congressionally Directed Peer-Reviewed Medical Research Program of the Department of Defense.

Introduction Sleep disturbances are common among previously deployed Veterans. Cognitive behavioral therapy for insomnia (CBT-I) has shown promise for Veterans but there are limitations and CBT-I may not optimally target the nocturnal vigilance conditioned by threatening environments. We developed and preliminarily evaluated a brief educational/behavioral intervention that combined established behavioral sleep principles with cognitive exercises intended to reduce the impact of vigilant thoughts and behaviors on sleep. Methods Participants were 40 Veterans recruited from the community and local VAMC who had been deployed to combat zones or hazardous duty areas. The mean age was 40, and the majority were male, African American, and screened positively for PTSD. They were assigned to the study intervention or an educational control that utilized a pamphlet promoting healthy sleep habits. Assignment at a 2:1 ratio was intended to allow for refinement of the study intervention during the early phase of the trial. Initial assessment was followed by a week of sleep diary collection, then two intervention sessions a week apart, followed by a repeat assessment. Participants of the study intervention were assessed again 3-months later. Results Improvements in sleep efficiency, ratings for feeling rested in the morning, and reduced Insomnia Severity Index scores were seen in the post-treatment week but did not differ between groups. At 3-months, these improvements were sustained in the 14 retained participants of the study intervention, engagement in vigilance reducing exercises remained high, and ratings of how rested one felt in the morning were significantly improved over ratings from the post-treatment week. Conclusion Brief behavioral intervention for post-deployment insomnia can provide benefits and cognitive exercises to reduce the impact of vigilant thoughts and behaviors warrant further evaluation. Support Supported by W81XWH-14-1-0066 from the Congressionally Directed Peer-Reviewed Medical Research Program of the Department of Defense

Background Heightened autonomic nervous system (ANS) arousal is a well-established contributor to the effect of stress on adverse cardiovascular health outcomes which disproportionately affect African Americans. ANS arousal is normally attenuated during sleep and compromise of this shift is associated with multiple adverse cardiovascular outcomes. Parasympathetic nervous system (PNS) dominance during sleep can be altered by stress. Racism has been recognized to have many negative health consequences in African Americans. Perceived racism has been linked to ANS activity, however, we are not aware of prior research on racism and nocturnal ANS balance. Objective: To examine relationships between perceived racism and nocturnal ANS activity indexed by heart rate variability (HRV) in healthy African American men and women age 18–35. Methods Fifty-four participants completed the Perceived Racism Scale and had 24-hour ambulatory electrocardiogram recordings in their homes. Power spectral analysis was used to derive normalized high frequency (nHF) to index PNS activity which was computed by 5-minute epochs during wake and sleep. Results Endorsement of racism and negative emotional reactions during the past year were inversely related to nHF during time in bed. Multiple regression analysis indicated that negative emotional reactions were a significant predictor of nHF during the sleep period F(2,54) = 4.213, p = .020, R2 = 0.135 (adjusted R2 = 0.103). Relationships during wake were not statistically significant. Conclusion Findings suggest that perseverative thoughts triggered by negative emotional reactions to racism influencing nocturnal ANS activity may be a pathway by which perceived racism affects health. Support: 3UL1TR001409-02S1 and R01HL087995 to Dr. Mellman.

The Chapter reviews two long standing concerns of sleep research in PTSD. The first is characterizing dysregulations of arousal that manifest in relation to sleep including disturbances of sleep initiation, maintenance, and depth. The other is characterizing nightmare disturbances in PTSD and establishing the role of the neurophysiological substrate of dreams, rapid eye movement sleep (REMS), in the disorder. While there has been uncertainty and controversy regarding these issues, a comprehensive look at findings and their context (e.g. duration of PTSD, setting of recordings) allows some reconciliation of findings. Recent developments include assessment of autonomic balance during sleep and application of functional brain imaging. Emerging research on the role of sleep, particularly REMS, on emotional learning has been linked to PTSD. Treatments specifically targeting nightmares and other sleep disruptions, such as the alpha adrenergic antagonist prazosin and imagery rehearsal therapy, continue to be developed and evaluated.

Study objectives Stressful neighborhood environments are known to adversely affect health and contribute to health disparities but underlying mechanisms are not well understood. Healthy sleep can provide a respite from sustained sympathetic nervous system (SNS) activity. Our objective was to evaluate relationships between neighborhood stress and nocturnal and daytime SNS and parasympathetic nervous system (PNS) activity. Methods Eighty-five urban-residing African Americans (56.5% female; mean age of 23.0) participated. Evaluation included surveys of neighborhood stress and sleep-related vigilance, and continuous electrocardiogram (ECG) and actigraphic recording in participants' homes from which heart rate variability (HRV) analysis for low frequency/high frequency (LF/HF) ratio and normalized high frequency (nHF), as indicators of SNS and PNS activity, respectively, and total sleep time (TST), and wake after sleep onset were derived. Results All significant relationships with HRV measures were from the sleep period. Neighborhood disorder correlated negatively with nHF (r = -.24, p = .035). There were also significant correlations of HRV indices with sleep duration and sleep fears. Among females, LF/HF correlated with exposure to violence, r = .39, p = .008, and nHF with census tract rates for violent crime (r = -.35, p = .035). In a stepwise regression, TST accounted for the variance contributed by violent crime to nHF in the female participants. Conclusions Further investigation of relationships between neighborhood environments and SNS/PNS balance during sleep and their consequences, and strategies for mitigating such effects would have implications for health disparities.

In randomized trials, prazosin, an αWe recruited veterans from 13 Department of Veterans Affairs medical centers who had chronic PTSD and reported frequent nightmares. Participants were randomly assigned to receive prazosin or placebo for 26 weeks; the drug or placebo was administered in escalating divided doses over the course of 5 weeks to a daily maximum of 20 mg in men and 12 mg in women. After week 10, participants continued to receive prazosin or placebo in a double-blind fashion for an additional 16 weeks. The three primary outcome measures were the change in score from baseline to 10 weeks on the Clinician-Administered PTSD Scale (CAPS) item B2 ("recurrent distressing dreams"; scores range from 0 to 8, with higher scores indicating more frequent and more distressing dreams); the change in score from baseline to 10 weeks on the Pittsburgh Sleep Quality Index (PSQI; scores range from 0 to 21, with higher scores indicating worse sleep quality); and the Clinical Global Impression of Change (CGIC) score at 10 weeks (scores range from 1 to 7, with lower scores indicating greater improvement and a score of 4 indicating no change).A total of 304 participants underwent randomization; 152 were assigned to prazosin, and 152 to placebo. At 10 weeks, there were no significant differences between the prazosin group and the placebo group in the mean change from baseline in the CAPS item B2 score (between-group difference, 0.2; 95% confidence interval [CI], -0.3 to 0.8; P=0.38), in the mean change in PSQI score (between-group difference, 0.1; 95% CI, -0.9 to 1.1; P=0.80), or in the CGIC score (between-group difference, 0; 95% CI, -0.3 to 0.3; P=0.96). There were no significant differences in these measures at 26 weeks (a secondary outcome) or in other secondary outcomes. At 10 weeks, the mean difference between the prazosin group and the placebo group in the change from baseline in supine systolic blood pressure was a decrease of 6.7 mm Hg. The adverse event of new or worsening suicidal ideation occurred in 8% of the participants assigned to prazosin versus 15% of those assigned to placebo.In this trial involving military veterans who had chronic PTSD, prazosin did not alleviate distressing dreams or improve sleep quality. (Funded by the Department of Veterans Affairs Cooperative Studies Program; PACT ClinicalTrials.gov number, NCT00532493 .).

The U.S. National Institutes of Health (NIH) announced last May that steps will be taken to address the over-reliance on male cells and animals in preclinical research. To further address this announcement, in September 2014, scientists with varying perspectives came together at Georgetown University to discuss the following questions. (1) What metrics should the NIH use to assess tangible progress on policy changes designed to address the over-reliance on male cells and animals in preclinical research? (2) How effective can education be in reducing the over-reliance on male cells and animals in preclinical research and what educational initiatives sponsored by the NIH would most likely effect change? (3) What criteria should the NIH use to determine rigorously defined exceptions to the future proposal requirement of a balance of male and female cells and animals in preclinical studies? (4) What additional strategies in addition to proposal requirements should NIH use to reduce the overreliance of male cells and animals in preclinical research? The resulting consensus presented herein includes input from researchers not only from diverse disciplines of basic and translational science including biology, cell and molecular biology, biochemistry, physiology, pharmacology, neuroscience, cardiology, endocrinology, nephrology, psychiatry, and obstetrics and gynecology, but also from recognized experts in publishing, industry, advocacy, science policy, clinical medicine, and population health. We offer our recommendations to aid the NIH as it selects, implements, monitors, and optimizes strategies to correct the over-reliance on male cells and animals in preclinical research.—Sandberg, K., Umans, J. G., Georgetown Consensus Conference Work Group. Recommendations concerning the new U.S. National Institutes of Health initiative to balance the sex of cells and animals in preclinical research.

Posttraumatic stress disorder (PTSD) has been associated with heightened nocturnal autonomic nervous system (ANS) arousal and sleep disturbances. It has been suggested that relationships between sleep and nocturnal ANS activity are influenced by insomnia; however, investigation of this relationship has been limited in PTSD. This study examined nocturnal ANS activity and its relationship to sleep in PTSD and resilience. Physically healthy young adult African Americans with current PTSD (n = 20) or who had never had PTSD despite exposure to a high-impact traumatic event (resilient, n = 18) were monitored with ambulatory electrocardiograms and actigraphy for 24-hr periods. Frequency-domain heart-rate variability measures, that is, low-frequency to high-frequency ratios (LF/HF), which index sympathetic nervous system activity, and normalized HF (nHF), which indexes parasympathetic nervous system activity were examined. Normalized HF during the time-in-bed period was lower for those with PTSD than those with resilience (p = .041). Total sleep time was strongly correlated with time-in-bed LF/HF (r = -.72) and nHF (r = .75) in the resilient group, but these were not correlated in the PTSD group. The results suggest elevated nocturnal ANS arousal and dissociation between ANS activity and total sleep time in PTSD.

Disturbed sleep is a prominent feature of posttraumatic stress disorder (PTSD). PTSD and disrupted sleep have been independently linked to cognitive deficits; however, synergistic effects of PTSD and poor sleep on cognition have not been investigated. The purpose of this study was to examine the effects of PTSD symptoms and objectively measured disruptions to sleep on cognitive function. Forty-four young-adult African American urban residents comprised the study sample. The Clinician-Administered PTSD Scale (CAPS; Blake et al., 1995) was utilized to determine the severity of PTSD symptoms. Participants underwent 2 consecutive nights of polysomnography. The Automated Neuropsychological Assessment Metrics (Reeves, Winter, Bleiberg, & Kang, 2007) was utilized to assess sustained attention and the Rey Auditory Verbal Learning Test (Schmidt, 1996) was used to evaluate verbal memory. PTSD symptom severity, r(42) = .40, p = .007, was significantly associated with omission errors on the sustained attention task, and sleep duration, r(42) = .41, p = .006, and rapid eye movement sleep, r(42) = .43, p = .003, were positively correlated with verbal memory. There was an interaction of PTSD symptom severity and sleep duration on omission errors such that more than 7 hours 12 minutes of sleep mitigated attentional lapses that were associated with PTSD. Traditional and Simplified Chinese Abstracts by AsianSTSS 標題：非裔美國年輕人中創傷後壓力症和睡眠測量與認知表現的關係 撮要：睡眠困擾是創傷後壓力左(PTSD)的顯著病癥。PTSD和睡眠問題各自與認知受損有關，但PTSD和失眠對認知的協同效應則未有探討。本研究檢視PTSD症狀的影響和客觀地量度睡眠困擾對認知功能的效果。樣本是53名非裔美國年輕市區居民。醫生施行PTSD量表(CAPS)測量PTSD症狀的嚴重程度，而參加者亦會連續兩晚接受多重睡眠電圖測試。持續注意力會採用自動化神經心理評估指標來評核，而雷伊聽覺言語學習測試則評定言語記憶。PTSD症狀的嚴重程度 r(42)= .40, p= .007統計上顯著與持續注意力任務的遺漏錯誤相連，而睡眠持續時間r(42)= .41, p= .006和快速眼動睡眠r(42)= .43, p= .003均與言語記憶有正相連。PTSD症狀嚴重程度和睡眠持續時間對遺漏錯誤有相互影響，以致多於7小時12分的睡眠可減輕與PTSD相關的注意力失誤。 标题：非裔美国年轻人中创伤后压力症和睡眠测量与认知表现的关系 撮要：睡眠困扰是创伤后压力左(PTSD)的显著病症。PTSD和睡眠问题各自与认知受损有关，但PTSD和失眠对认知的协同效应则未有探讨。本研究检视PTSD症状的影响和客观地量度睡眠困扰对认知功能的效果。样本是53名非裔美国年轻市区居民。医生施行PTSD量表(CAPS)测量PTSD症状的严重程度，而参加者亦会连续两晚接受多重睡眠电图测试。持续注意力会采用自动化神经心理评估指标来评核，而雷伊听觉言语学习测试则评定言语记忆。PTSD症状的严重程度 r(42)= .40, p= .007统计上显著与持续注意力任务的遗漏错误相连，而睡眠持续时间r(42)= .41, p= .006和快速眼动睡眠r(42)= .43, p= .003均与言语记忆有正相连。PTSD症状严重程度和睡眠持续时间对遗漏错误有相互影响，以致多于7小时12分的睡眠可减轻与PTSD相关的注意力失误。

The Fear of Sleep Inventory (FOSI) was developed to identify factors that contribute to sleep disturbances in individuals exposed to trauma. This investigation examined the psychometric properties of the FOSI in a sample of African American young adults residing in urban areas. A 5-factor structure was derived from an exploratory factor analysis and then verified by confirmatory factor analysis. FOSI factors were positively correlated with the severity of PTSD (rs = .30 to .58, all ps < .001) and insomnia symptoms (rs = .36 to .64, all ps < .001). Individuals with probable PTSD or insomnia had higher scores on the total FOSI and each of the factors compared to those without probable PTSD (all ps < .001; effect sizes: r = .32 to .62) or insomnia (all ps < .001; effect sizes: r = .42 to .70). These data expand the evidence that the FOSI identifies factors contributing to sleep disturbances in trauma-exposed individuals. Traditional and Simplified Chinese Abstracts by AsianSTSS 標題： 使用年輕非裔美籍成人樣本來驗證恐懼睡眠清單(FOSI) 撮要：恐懼睡眠清單(FOSI)有助辨認受創人士睡眠障礙的成因。本研究在一批居住市區的年輕非裔美籍成人中檢視FOSI 的心理測量特性。從探索性因子分析得出一個5因子結構，再用驗證性因子分析來確認。FOSI 因子與PTSD嚴重度(rs=.30至.58, 總ps

Health disparities are an immense challenge to American society. Clinical and Translational Science Awards (CTSAs) housed within the National Center for Advancing Translational Science (NCATS) are designed to accelerate the translation of experimental findings into clinically meaningful practices and bring new therapies to the doorsteps of all patients. Research Centers at Minority Institutions (RCMI) program at the National Institute on Minority Health and Health Disparities (NIMHD) are designed to build capacity for biomedical research and training at minority serving institutions. The CTSA created a mechanism fostering formal collaborations between research intensive universities and minority serving institutions (MSI) supported by the RCMI program. These consortium-level collaborations activate unique translational research approaches to reduce health disparities with credence to each academic institutions history and unique characteristics. Five formal partnerships between research intensive universities and MSI have formed as a result of the CTSA and RCMI programs. These partnerships present a multifocal approach; shifting cultural change and consciousness toward addressing health disparities, and training the next generation of minority scientists. This collaborative model is based on the respective strengths and contributions of the partnering institutions, allowing bidirectional interchange and leveraging NIH and institutional investments providing measurable benchmarks toward the elimination of health disparities.

Background Polysomnographic (PSG) studies of children with psychiatric illness have primarily focused on depressed samples. Children with generalized anxiety disorder (GAD) report high rates of sleep problems yet investigation of objective sleep patterns in non-depressed children with GAD are unavailable. Identification of unique clinical features linking early GAD with sleep disturbance, including possible HPA activation during the pre-sleep period, is needed to inform effective treatments. Method Thirty non-medicated, pre-pubescent children (ages 7–11 years) were assessed including 15 children with GAD and 15 matched healthy controls. Anxious children had GAD as their primary diagnosis and did not meet criteria for secondary mood disorders. All participants underwent structured diagnostic assessment and laboratory-based polysomnography (PSG). State anxiety and salivary cortisol were assessed prior to light out on the PSG night. Results Children with GAD showed significantly increased sleep onset latency and reduced latency to rapid eye movement (REM) sleep compared to controls. Marginal differences in the form of reduced sleep efficiency and increased total REM sleep also were found in the GAD group. Pre-sleep anxiety and cortisol levels did not differ between the two groups. Limitations A small sample size, time-limited assessment of cortisol, and possible first night effects should be considered. Conclusions Results of this study provide initial evidence of PSG-based differences in children with GAD compared to controls. Follow-up studies are needed to explore the course of sleep alterations and whether targeting sleep problems early in the course of GAD might improve clinical outcomes.

Compromised sleep and increased sympathetic nervous system (SNS) activity are implicated in the pathogenesis of, and disparities in, cardiovascular disease. Parasympathetic dominance during sleep may be important for cardiovascular health. Sleep and autonomic balance influence immune activity, which impacts atherogenesis. We evaluated relationships between autonomic balance during sleep and morning levels of the immune activating cytokines, C-reactive protein (CRP) and interleukin (IL)-6. Ninety-four (59 female) young adult African Americans without medical conditions and substance use disorders spent 2 consecutive nights in a clinical research unit for sleep recordings and blood drawing on awakening. Cardiac tracings from the second sleep recording were analysed for heart rate variability (HRV). Body mass index was the only non-HRV measure correlated with cytokine levels. Indicators of SNS activity for the presleep, and first non-rapid eye movement (REM) and REM sleep periods were correlated independently with morning IL-6 levels. Altered autonomic balance during sleep may be a modifiable factor that influences immune activation.

Sleep-disordered breathing (SDB) is reported in up to 69% of adolescents and children with sickle cell disease (SCD) [1], but data regarding the prevalence of SDB in adults with SCD are limited. In order to obtain a preliminary assessment of the frequency and degree of sleep-related hypoxemia and potential associations with cardiovascular function in adults with SCD, we conducted overnight sleep studies, 6-min walk tests, echocardiograms, and hematologic and chemistry panels, calculated the Pittsburgh sleep quality index (PSQI), and conducted fatigue- and health-related quality-of-life measurement in 20 young adults with SCD visiting a sickle cell clinic for routine care. Sleep apnea, defined as an apnea-hypopnea index (AHI) > 5 events/h, was found in 50% of patients. Traditional clinical indicators, such as obesity, the presence of snoring, and reported sleep complaints, did not reliably differentiate them. The patients with AHI > 5 had higher mean systolic blood pressure (p = 0.03), evidence of impaired left ventricular diastolic function (i.e., increased mitral valve E/A ratio, p = 0.05), a trend toward higher reduction in 6-min walk distances (p = 0.06), and lower health-related quality-of-life scores (p ≤ 0.01). Three of nine patients with more severe anemia (total Hb

Sleep has been implicated in learning processes that appear to underlie recovery from posttraumatic stress disorder (PTSD). The importance of quality and timing of sleep following exposure-based therapies has been suggested. The present study evaluated relationships between sleep and adaptive emotional processing following written narrative exposure (WNE) to memories of traumatic events experienced by participants with clinically significant PTSD symptoms. Participants included 21 urban-residing nontreatment-seeking adults with full or subthreshold symptoms of PTSD who completed 4 sessions of 30-minutes WNE with the first session either in the evening or the morning. There was a significant reduction of PTSD symptom severity after WNE sessions (partial η(2) = .65), but there was no interaction between group assignment based on the initial session’s proximity to sleep and initial reduction of PTSD symptom severity (partial η(2) = .01). Polysomnography following evening WNE revealed increased duration of total sleep and N2 percent, reduced N3 percent, and increased eye movement density during rapid-eye-movement (REM) sleep compared with baseline recordings (dz = 0.65 to 1.15). Reduced N3 percent and increased REM density were associated with less improvement of PTSD symptoms (r = .58 & −.63). These findings suggest a relationship between preservation of diminished arousal during sleep and adaptive trauma memory processing.

Posttraumatic stress disorder (PTSD) is common following the experience of a natural disaster and sleep disturbance is an important influence on its course in adults, but little research is available examining sleep and PTSD in youths. This study's objective was to evaluate the role of sleep disturbance and the developmentally influenced factor of fear of sleeping alone in the maintenance of posttraumatic stress (PTS) symptoms in youths. Deidentified data of 191 Hurricane Katrina survivors ages 8 to 15 were used in this study. We found cross-sectional relationships of sleep disturbance and fear of sleeping alone with PTS symptom severity. Longitudinal analysis also indicated that general sleep disturbance at 24 months (T1) was predictive of PTS symptoms severity at 30 months (T2) even after adjusting for PTS symptom severity at T1, age, sex, and continued disrepair to the home. These results have implications for intervention strategies among youth exposed to traumatic events.

Objectives The goals of this study were (i) to report the prevalence and nature of sleep disturbances, as determined by clinically significant insomnia symptoms, in a sample of African-American breast cancer survivors; (ii) to assess the extent to which intrusive thoughts about breast cancer and fear of recurrence contributes to insomnia symptoms; and (iii) to assess the extent to which insomnia symptoms contribute to fatigue. Methods African-American breast cancer survivors completed surveys pertaining to demographics, medical history, insomnia symptoms, and intrusive thoughts about breast cancer, fear of cancer recurrence, and fatigue. Hierarchical regression models were performed to investigate the degree to which intrusive thoughts and concerns of cancer recurrence accounted for the severity of insomnia symptoms and insomnia symptom severity's association with fatigue. Results Forty-three percent of the sample was classified as having clinically significant sleep disturbances. The most commonly identified sleep complaints among participants were sleep maintenance, dissatisfaction with sleep, difficulty falling asleep, and early morning awakenings. Intrusive thoughts about breast cancer were a significant predictor of insomnia symptoms accounting for 12% of the variance in insomnia symptom severity. After adjusting for covariates, it was found that insomnia symptom severity was independently associated with fatigue accounting for 8% of variance. Conclusions A moderate proportion of African-American breast cancer survivors reported significant problems with sleep. Sleep disturbance was influenced by intrusive thoughts about breast cancer, and fatigue was associated with the severity of participants' insomnia symptoms. This study provides new information about sleep-related issues in African-American breast cancer survivors. Copyright © 2011 John Wiley & Sons, Ltd.

OBJECTIVES/SPECIFIC AIMS: Emotional processing theory and some observations suggest that activation of subjective and physiological distress during therapeutic exposure and habituation across exposure sessions are key to improvement. This study sought to determine whether initial subjective and physiological activation and between-session habituation would predict PTSD symptom reduction after a series of written trauma narrative exposure sessions. METHODS/STUDY POPULATION: In total, 29 urban-residing African-American participants with PTSD participated in four 30-minute writing sessions. Writing sessions 1 and 2 were 12 hours apart and session 3 and 4 were performed 1 week later, also 12 hours apart. PTSD symptoms were measured at baseline, after session 2, and 1 week after all 4 writing sessions with the Clinician Administered PTSD Scale. During each session, Subjective Units of Distress Scores (SUDS) were assessed 4 times and heart rate was measured continuously. RESULTS/ANTICIPATED RESULTS: Participants exhibited PTSD symptom improvement and habituation of subjective distress, but not physiological arousal, across writing sessions. First session baseline-corrected SUDS maximum and SUDS decrease from the initial to the final writing session were both positively associated with symptom improvement. DISCUSSION/SIGNIFICANCE OF IMPACT: Increased subjective, but not physiological, distress in the first exposure session and diminished subjective distress across sessions may be a helpful marker of emotional processing for clinicians and predictor of symptom improvement after written trauma narrative exposure.

Objective: To evaluate the relationship between posttraumatic stress disorder (PTSD) and nocturnal blood pressure (BP) dipping in young adult African Americans (AAs). PTSD is associated with physical illnesses including cardiovascular conditions. Sleep disturbances related to heightened arousal likely contribute to physical health risk; however, this possibility has not been studied. The studies that have found a relationship between PTSD and hypertension (HTN) have substantial representation of AAs. AAs have elevated rates of HTN and are more likely to exhibit an absence of the normal “dip” of BP at night. Nocturnal BP “nondipping” is an established risk factor for HTN and its cardiovascular complications. Nocturnal BP nondipping and sleep disturbances of PTSD have both been linked to sympathetic nervous system function. Methods: Thirty healthy young adult AAs (60% female; mean age = 20.0 years; 17 with lifetime full or subthreshold PTSD, 4 with current symptoms) received 24-hour BP and actigraphy monitoring, filled out sleep diaries, and had structured clinical assessment of PTSD. Results: There were significant associations of lifetime full and subthreshold PTSD and BP nondipping, and the degree of nocturnal dipping correlated with lifetime and current PTSD severity. Conclusion: Elevated nocturnal BP may be a link between PTSD and cardiovascular morbidity in AAs that can be targeted in prevention.

Objective: Despite increased risk for psychiatric disorders after trauma exposure, many people are able to adapt with minimal life disruption, and others eventually recover after a symptomatic period. This study examined psychosocial factors associated with resilience and recovery from psychiatric disorders in a high-risk sample of African American adults exposed to a range of severe traumas, who participated in structured diagnostic interviews. Method: The sample included 259 patients exposed to at least one severe traumatic event, recruited from primary care offices at Howard University and administered the Structured Clinical Interview for DSM-IV Axis I disorders. Multinomial logistic regression was used to identify potential psychosocial factors associated with resilience and recovery, including purpose in life, mastery, and coping strategies. Results: Forty-seven patients had no lifetime psychiatric disorders (resilient), 85 met criteria for at least one past DSM-IV disorder but no current disorders (recovered), and 127 met criteria for at least one current DSM-IV disorder (currently ill). The resilient group was characterized by a significantly lower lifetime trauma load. Female gender was predictive of currently ill status. In the final model, purpose in life emerged as a key factor associated with both resilience and recovery, and mastery was also significantly associated with recovery. Conclusions: The identification of psychosocial factors associated with resistance to severe trauma can inform future studies of preventive and treatment interventions for high-risk populations. Further study is needed to determine which psychosocial factors are consistently associated with resilience and to what extent they can be modified through clinical intervention.

The occurrence of sleep paralysis (SP) absent narcolepsy appears to not be uncommon in African Americans and probably other non-European groups. Prior research has linked SP to trauma and psychiatric disorders and suggested a specific relationship to panic disorder in African Americans. The objective of our study was to evaluate relationships of SP with trauma, concurrent psychiatric symptoms and lifetime psychiatric diagnoses in an adult African American population recruited from primary care. Cross sectional study with surveys and diagnostic interviews; Patients attending primary care clinics filled out a survey that determined the 6 month prevalence and associated features of SP, a panic disorder screen, the self-rated Hamilton Depression Scale, and an inventory of trauma exposure. A subset of trauma-exposed participants (N = 142) received comprehensive diagnostic interviews that incorporated the Structured Clinical Interview for DSM-IV and the Clinician Assessed PTSD Scale. Four hundred and forty-one adults participated (mean age-40.0 SD = 13.3, 68% female, 95% African American). Fourteen percent endorsed recent SP. In approximately 1/3 of those with SP, episodes also featured panic symptoms. SP was strongly associated with trauma history, and concurrent anxiety and mood symptoms. SP was not associated with specific psychiatric disorders other than lifetime (but not current) alcohol or substance use disorders. Our findings suggest that SP is not uncommon in adult African Americans and is associated with trauma and concurrent distress but not with a specific psychiatric diagnosis.

Trauma-related nightmares and sleep disturbance are distressing and often treatment resistant symptoms of posttraumatic stress disorder (PTSD) (1, 2, 3). Increased central nervous system (CNS) adrenergic activity may contribute to the pathophysiology of PTSD in general (4, 5) and to PTSD nighttime symptoms specifically (6). Increased CNS adrenergic activity in PTSD could interfere with normal REM sleep (7) as suggested by increased phasic motor activity, stage shifts and arousals during REM sleep (8, 9) and REM fragmentation during early PTSD development (10). REM disruption could contribute to trauma nightmares (10, 11) and interfere with the normal cognitive processing of traumatic events (12). Prazosin is a generic alpha-1 adrenergic antagonist that is centrally active (13). Prazosin is a promising treatment for trauma nightmares and sleep disturbance in PTSD (14, 15, 16). However, prazosin effects on objective measures of sleep in PTSD have not been investigated. We used the REMView portable sleep assessment device to quantify effects of prazosin on sleep physiology (17, 18).