Friday, April 4, 2025
4/4/2025
Identifying sleep-related risk factors for PTSD and their underlying mechanisms - Project Summary Posttraumatic stress disorder (PTSD) is a debilitating condition that develops after exposure to a traumatic event. Despite the availability of evidence-based treatments for PTSD, over half of patients dropout of these treatments prematurely, and up to 72% still meet criteria for PTSD at posttreatment. Thus, there is an urgent need to identify the factors that increase risk of PTSD to guide prevention and early intervention strategies. Sleep disturbances (i.e., difficulties falling or staying asleep) are a significant risk factor that contribute to PTSD. Sleep disturbances are common within the acute aftermath of trauma and thus represent a treatment target for early intervention to prevent PTSD. However, the ability to leverage this information for preventive efforts is thwarted because individuals vary in their susceptibility to stress-related sleep disturbances, yet no research has identified who is at greatest risk of sleep disturbances within the acute aftermath of trauma. This precludes the ability to triage high-risk trauma patients most in need of early intervention. Further, despite understanding sleep disturbances increase PTSD risk, we do not know the mechanisms that explain this relationship and hence cannot yet develop early interventions focused on specific mechanisms that modify risk for the disorder. Therefore, this study aims to: 1) identify individuals with a trait susceptibility to acute sleep disturbances after trauma, and 2) determine the mechanisms by which these sleep disturbances predict PTSD. This study will leverage data from the AURORA study (NIMH U01MH110925), a large emergency department-based network that longitudinally followed trauma survivors from the acute aftermath of trauma (e.g., motor vehicle collision) to one year later. The AURORA dataset includes multiple assessments of patient- reported outcomes and psychophysiological functioning, including objective sleep using actigraphy and fear extinction using fear-potentiated startle. The applicant will learn to use these psychophysiological methods to accomplish the study aims, as well as skin conductance response and heart rate, and advanced statistical techniques for longitudinal analyses. To support the applicant’s long-term career goals of investigating the sleep physiology underlying mechanisms of PTSD risk, the applicant will also receive advanced training in sleep physiology and polysomnographic (PSG) assessment, such as quantitative measures of PSG using spectral analysis, with a special focus on Rapid Eye Movement sleep. This study is expected to be significant because it will enable the early identification of potentially vulnerable individuals who might develop PTSD, toward whom sleep-focused preventive efforts can be targeted. This is a vital step in reducing the significant burden that PTSD imposes on both the individual and society because efforts to prevent PTSD require the ability to accurately screen for risk to target those most in need of early interventions. This is a major priority of the NIMH and is directly in line with Objective 2.2 of its Strategic Plan of identifying and understanding risk factors, biomarkers, and behavioral indicators of mental illness.
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