The Contribution of Sleep to the Development of Post-traumatic Stress Disorder

Primary author: William Vanderheyden

Primary college/unit: Elson S. Floyd College of Medicine
Campus: Spokane

Abstract:

Post-traumatic stress disorder (PTSD) arises as the result of experiencing a physical and/or psychological trauma. Human populations with PTSD show features of sleep disturbance that include insomnia, nightmares, and difficulty staying asleep through the night. Sleep disturbances are considered a hallmark feature of PTSD, yet little is known about the contribution of sleep to the pathogenesis of the disorder.

Using a rodent model of PTSD called “Single Prolonged Stress” we have begun examining if 1) sleep deprivation prior to trauma exposure has any impact on the development of PTSD and 2) if increasing sleep quantity via optogenetics in trauma exposed animals can improve the outcomes associated with trauma exposure.

Preliminary data show that pre-trauma-exposure sleep deprivation has no impact on subsequent PTSD-like cognitive impairments. However, post-trauma-exposure sleep improvements are able to restore cognitive function back to non-trauma exposed levels.

These data identify sleep as a potential therapeutic for trauma exposed populations.

Cannabis Use and Metabolic Syndrome Among Clients with First Episode Psychosis

Primary author: Erik Stiles
Co-author(s): Karl Alcover; Oladunni Oluwoye
Faculty sponsor: Michael McDonell, PhD

Primary college/unit: Elson S. Floyd College of Medicine
Campus: Spokane

Abstract:

Aim: We sought to explore the relationship between cannabis use and metabolic syndrome (MetS) among those with a first episode psychosis (FEP).

Background: Individuals diagnosed with a psychotic disorder are three times more likely to suffer from cardiovascular disease (CVD) than the general population. CVD accounts for approximately 16% of deaths among individuals diagnosed with schizophrenia-spectrum disorders.

Methods: We conducted a retrospective analysis of 404 participants enrolled in the Recovery After Initial Schizophrenia Episode – Early Treatment Program. Metabolic syndrome was defined according to the Adult Treatment Panel III guidelines. Using multiple logistic regression, we investigated the correlation between cannabis use and rate of metabolic syndrome. Demographics, time, baseline MetS and potential confounders were separated and analyzed. Finally, we explored the derangement of MetS components among cannabis users and abstainers.

Results: Cannabis users versus abstainers had similar rates of MetS at baseline (10% versus 13.7%, p=0.520). Those who used cannabis at any time during the study period tended to have lower triglycerides (OR=0.3, p=0.001) and higher high-density lipoprotein (OR=0.4, p=0.017). Cannabis users were less likely to develop MetS, relative to non-users (OR = 0.42, 95% CI [0.22-0.80], p=0.008). This effect remained after controlling for type of psychiatric medication (e.g., first- or second-generation antipsychotics, long-acting injectables).

Conclusions: Cannabis use may be associated with lower incidence of MetS in patients experiencing psychosis. Our findings may contribute to mitigating the elevated CVD risk in this population. Further research is indicated to explore and develop these observations.

Examining pilot safety performance indicators at critical phases of flight across multiple flight legs during commercial airline trips

Primary author: Rhiannon Soriano Smith
Co-author(s): Amanda Lamp; Ian Rasmussen; Ewa Basiarz; Chandler Keller; Gregory Belenky

Primary college/unit: Elson S. Floyd College of Medicine
Campus: Spokane

Abstract:

Prior simulation and operational studies began to address whether the number of consecutive flight segments negatively affects cognitive performance, fatigue, and sleepiness, without reaching a clear consensus. This study expands this literature by determining whether there are significant changes in cognitive performance, fatigue, and sleepiness at critical phases of flight across multiple flight segments, while accounting for the number of segments, flight direction, trip day, and time-of-day.
Fifty commercial airline pilots were studied, each flying two separate short-haul trips ranging from 1-4 days and 1-10 flight segments. Cognitive performance, fatigue, and sleepiness were assessed at top-of-climb (TOC) and top-of-descent (TOD) of each flight segment and trip day. Cognitive performance, fatigue, and sleepiness were assessed using Psychomotor Vigilance Task (PVT) speed, Samn-Perelli (SP) ratings, and Karolinska Sleepiness Scale (KSS) ratings, respectively. Data were analyzed using Wilcoxon t-tests and verified using ANOVAs.
Mean PVT speed (d =0.57), SP (d = 0.73), and KSS (d = 0.63) were significantly worse at TOD than TOC (p < 0.001); and varied across flight segments (p<0.001). Cognitive performance, fatigue, and sleepiness were consistently degraded around the fifth flight segment, improved around the sixth to eighth flights segments, and were subsequently degraded around the eighth to tenth flight segments.
The results indicate that cognitive performance, fatigue, and sleepiness vary across flight segments, trip day, and phase of flight. Results suggest that these safety performance indices degrade after five segments, and further degrade after eight flight segments. The results presented could inform future airline scheduling and regulation.

Relationship between Sleepiness Symptoms Questionnaire Ratings and Psychomotor Vigilance Test Performance in a Laboratory-Based Sleep Deprivation Study

Primary author: Alicja Skwara
Co-author(s): Lillian Skeiky; Hans Van Dongen; Devon Hansen

Primary college/unit: Elson S. Floyd College of Medicine
Campus: Spokane

Abstract:

Sleep deprivation has been demonstrated to adversely impact on cognitive performance and safety. Measuring the impairment caused by sleep deprivation is best done with objective performance assessments such as the psychomotor vigilance test (PVT), but subjective self-report assessments may provide a more practical alternative in real-world settings. The Sleepiness Symptoms Questionnaire (SSQ) is a self-report instrument based on ratings of observable symptoms of sleepiness and motor vehicle driving performance impairment. In a laboratory-based sleep deprivation study, we compared SSQ ratings to performance impairment on a 10min PVT.
Twelve healthy normal sleepers (ages 21-39y, 6 females) participated in a 4-day in-laboratory study. Between a baseline day and a recovery day, participants underwent 38 hours of total sleep deprivation. Participants completed the SSQ and PVT following 6.5, 14.5, 22.5, and 30.5 hours of sleep deprivation, and 6.5 hours after recovery sleep.
As sleep deprivation progressed, the SSQ sleepiness ratings and the number of lapses (reaction times > 500 ms) on the PVT were elevated, peaking after 22.5 hours awake. Both measures returned to baseline levels after recovery sleep. There was a moderate correlation between SSQ ratings and PVT lapses (r=0.44, F1,43=24.1, p<0.001). Subjective sleepiness on the SSQ and objective performance impairment on the PVT reflected expected changes by time awake and time of day during sleep deprivation and following recovery sleep. The moderate correlation we observed suggests that the SSQ may be reasonably reliable for measuring impairment under conditions of acute sleep deprivation.

Community Organizing: A Novel Approach to Identifying Healthcare Needs

Primary author: Katie Schmidt
Co-author(s): Carly Celebrezze; Kelly Anne Hennessey; Andrew Liechty; Courtney Roberts
Faculty sponsor: Dr. Luis Manriquez

Primary college/unit: Elson S. Floyd College of Medicine
Campus: Spokane

Abstract:
The Spokane Alliance is a non-partisan organization of religious institutions, educators, unions and other civic non-profits organizing for the common good in Spokane, Washington. The Healthcare Research Action Team (HRAT) was formed in response to Alliance members attesting that healthcare is a significant stressor in their lives.

The HRAT, led by medical students from WSU and UW, conducted a health needs assessment of its 31 member organizations. Listening sessions were held with 13 Spokane Alliance organizations in 2018 to qualitatively ascertain healthcare needs among community members.

111 Spokane community members participated. Three themes emerged as common issues: healthcare system complexity, affordability, and mental health needs.

Forty-six stories were shared regarding healthcare system complexity. Members stated they had difficulty navigating both the healthcare and insurance systems. They also expressed frustration with the lack of communication between providers and confusion related to healthcare paperwork.

Twenty-six Spokane Alliance members shared about issues with healthcare affordability, regardless of their health insurance status. Eight members stated they experienced challenges accessing mental health services and stigma surrounding mental health needs.

Community organizing methods can yield rich qualitative data on healthcare needs. The issues identified by Spokane Alliance members indicate a need for improvements in healthcare system navigability, affordability, and access to mental health services in Spokane. Since this needs assessment was conducted, the WSU mobile medicine program has launched its first mobile medical unit, which is equipped to provide primary care and reproductive health services, informed, in part, by the results of this needs assessment.

Expressive language of hard of hearing toddlers as influenced by siblings

Primary author: Allison Saur
Faculty sponsor: Dr. Mark Vandam

Primary college/unit: Elson S. Floyd College of Medicine
Campus: Spokane

Abstract:

Linguistic complexity is an indicator of language development in young children. Complexity of a child’s linguistic productions have been shown to increase with development, but may be affected by factors such as disability or environmental variables. In particular, hearing impairment may affect language and speech development. In a previous study, we investigated the effect of a siblings’ and sex of the child on the mean length of utterance (MLU) in typically developing children. Here, we look at the MLU of children who are hard-of-hearing compared to their typically developing peers in the context of siblings. MLUs were extracted from the public HomeBank database [http://homebank.talkbank.org] of transcribed natural child speech for both the target toddler and for siblings. A difference in expressive language was found between children who are hard-of-hearing and their typically developing peers. Findings are discussed in terms of language development and sibling presence on expressive language in children with hearing loss.

Trait Inter-Individual Differences in Deep Sleep

Primary author: Julie Erwin

Primary college/unit: Elson S. Floyd College of Medicine
Campus: Spokane

Abstract:

Inter-individual differences in the amount of deep sleep, stage N3, in nighttime sleep have been found to be large and trait-like, even during recovery sleep after sleep deprivation. We investigated whether this phenomenon extends to daytime sleep, and whether it is robust to prior caffeine intake.

In an 18-day in-laboratory study, 12 healthy adults underwent three 48-hour periods of total sleep deprivation. In randomized, counterbalanced, double-blind fashion, participants received either placebo, 200 mg caffeine, or 300 mg caffeine every 12 hours during sleep deprivation. Each sleep deprivation period was preceded by three baseline sleep periods (21:00-07:00) and followed by a daytime recovery nap (07:00-12:00). Sleep periods were recorded polysomnographically. Analyses focused on the baseline night immediately preceding and the daytime recovery nap immediately following each sleep deprivation period.

Daytime recovery naps had 44.6±5.1 minutes (mean±SE) more stage N3 sleep than baseline sleep periods (p<0.001). Daytime naps preceded by 200 or 300 mg caffeine intake every 12 hours during sleep deprivation had 15.4±6.2 and 21.6±6.2 minutes less stage N3 sleep, respectively, than daytime naps in the placebo condition (p=0.003). Across the baseline nights and daytime naps, regardless of caffeine condition, there were large inter-individual differences in stage N3 sleep, with a standard deviation over individuals of 23.2 minutes and considerable stability (intraclass correlation coefficient: 0.70). Thus, the amount of deep sleep is a trait characteristic that is robust to sleep deprivation, time of day, and caffeine.