Baseline sleep quality moderates symptom improvement in veterans with comorbid PTSD and TBI receiving trauma-focused treatment.

Poor sleep quality is common among Veterans with posttraumatic stress disorder (PTSD) and history of traumatic brain injury (TBI). However, the relationship between sleep quality and treatment outcomes following trauma-focused interventions is less well-understood in this population. We sought to better understand whether 1) sleep quality changed as a result of trauma-focused treatment and 2) if baseline sleep quality moderated psychological and neurobehavioral treatment outcomes.

Neurocognition, psychiatric symptoms, and lifetime homelessness among veterans with a history of traumatic brain injury.

We retrospectively investigated archival clinical data, including correlates of lifetime homelessness, in 503 Veterans with a history of traumatic brain injuries (86.5% mild) who completed neuropsychological evaluations and passed performance validity tests. The 471 never-homeless and 32 ever-homeless Veterans were compared on demographic factors, TBI severity, psychiatric diagnosis, subjective symptoms, and neuropsychological functioning.

Early versus late wake therapy improves mood more in antepartum versus postpartum depression by differentially altering melatonin-sleep timing disturbances.

Background: Peripartum major depression (MD) disables mothers and impairs emotional and neurocognitive development of offspring. We tested the hypothesis that critically-timed wake therapy (WT) relieves peripartum MD by altering melatonin and sleep timing, differentially, in antepartum vs. postpartum depressed patients (DP).

Correlates of employment and postsecondary education enrolment in Afghanistan and Iraq veterans with traumatic brain injuries.

Primary Objective: About 20% of Iraq and Afghanistan Veterans have sustained a traumatic brain injury (TBI), which can result in postconcussive symptoms and difficulty transitioning from the military to civilian employment and postsecondary education. To better inform programs help Veterans transition back into civilian life, we evaluated correlates of employment and postsecondary education enrolment among treatment-seeking Veterans with a history of TBI.

Research Design: A cross-sectional design, using an archival database of VA medical records, was used to answer these research questions.

Pretreatment biomarkers predicting PTSD psychotherapy outcomes: A systematic review.

Although our understanding of the relationship between posttraumatic stress disorder (PTSD), brain structure and function, neural networks, stress-related systems, and genetics is growing, there is considerably less attention given to which biological markers predict evidence-based PTSD psychotherapy outcomes. Our systematic PRISMA-informed review of 20 studies examined biomarkers as predictors of evidence-based PTSD psychotherapy outcomes. Results provide preliminary evidence that specific structural and functional neural systems (involved in information processing), glucocorticoid sensitivity and metabolism (part of the hypothalamic-pituitary-adrenal axis and the response to stress), heart rate (involved with fear habituation), gene methylation, and certain genotypes (associated with serotonin and glucocorticoids) predicted positive response to PTSD treatment.

Psychometric Characteristics of the Insomnia Severity Index in Veterans With History of Traumatic Brain Injury.

Objective/background: The Insomnia Severity Index (ISI) is a widely used self-report measure of insomnia symptoms. However, to date this measure has not been validated or well-characterized in veterans who have experienced traumatic brain injury (TBI). This study assessed the psychometric properties and convergent, divergent, construct, and discriminate validity of the ISI in veterans with a history of TBI.

Multivariate assessment of subjective and objective measures of social and family satisfaction in Veterans with history of traumatic brain injury.

Approximately 20% of current-era Veterans have sustained a traumatic brain injury (TBI), which can result in persistent postconcussive symptoms. These symptoms may disrupt family and social functioning. We explored psychiatric, postconcussive, and cognitive factors as correlates of objective functioning and subjective satisfaction in family and social relationships.

Postconcussive symptom overreporting in Iraq/Afghanistan Veterans with mild traumatic brain injury.

A comprehensive evaluation, including the assessment of neurobehavioral symptoms, has been instituted at the Department of Veterans Affairs (VA) healthcare system to address the large number of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) Veterans returning with mild traumatic brain injuries (mTBIs). The Validity-10 is measure of symptom overreporting embedded within the Neurobehavioral Symptom Inventory, a component of the comprehensive evaluation that assesses postconcussive symptom severity. The Validity-10 is composed of 10 unlikely/low-frequency items and a validated cutoff score to identify postconcussive symptom overreporting.

Predictors of cognitive and physical fatigue in post-acute mild-moderate traumatic brain injury.

Post-traumatic fatigue (PTF) is a common, disabling, and often chronic symptom following traumatic brain injury (TBI). Yet, the impact of chronic cognitive and physical fatigue and their associations with psychiatric, sleep, cognitive, and psychosocial sequelae in mild-moderate TBI remain poorly understood. Sixty Veterans with a history of mild-moderate TBI and 40 Veteran controls (VC) were administered the Modified Fatigue Impact Scale, a validated measure of TBI-related cognitive and physical fatigue as well as measures of neuropsychiatric, psychosocial, sleep, and objective cognitive functioning.

Neuropsychological performance in treatment-seeking Operation Enduring Freedom/Operation Iraqi Freedom Veterans with a history of mild traumatic brain injury.

Introduction: Clinical neuropsychological presentation of treatment-seeking Veterans with a remote history of mild traumatic brain injury (mTBI) is widely variable. This manuscript seeks to better characterize cognitive concerns in the post-acute phase following mTBI and to identify the neuropsychological profiles of a large sample of clinically referred Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) Veterans with a history of mTBI and current cognitive complaints. We hypothesized that a minority of cases would exhibit valid and widespread neuropsychological deficits.

A quantitative review of cognitive functioning in homeless adults.

Homeless people experience elevated rates of risk factors for cognitive impairment. We reviewed available peer-reviewed studies reporting data from objective measures of cognition in samples identified as homeless. Pooled sample-weighted estimates of global cognitive screening measures, full-scale intelligence quotient (IQ), and premorbid IQ were calculated, in addition to pooled sample characteristics, to understand the representativeness of available studies.

The Relationship Between Postconcussive Symptoms and Quality of Life in Veterans With Mild to Moderate Traumatic Brain Injury.

Objective: To assess the relationship between postconcussive symptoms and quality of life (QOL) in Veterans with mild to moderate traumatic brain injury (TBI).

Methods: Sixty-one Operation Enduring Freedom/Operation Iraqi Freedom/Persian Gulf War Veterans with a history of mild or moderate TBI, more than 6 months postinjury, and 21 demographically matched Veteran controls were administered self-report measures of QOL (World Health Organization Quality of Life-BREF) and postconcussive symptom severity (Neurobehavioral Symptom Inventory).

Results: Perceived QOL was significantly worse in Veterans with mild-moderate TBI than in controls.

The effects of sleep deprivation on brain functioning in older adults.

Few studies have examined the effects of total sleep deprivation (TSD) on cognitive performance and brain activation using functional MRI (fMRI) in older adults. The current study examines blood oxygen level-dependent (BOLD) activation in older adults and younger adults during the sustained attention (GO) and response inhibition (NOGO) portions of a GO-NOGO cognitive task following 36 hr of total sleep deprivation. No significant performance differences were observed between the groups on the behavioral outcome measures of total hits and false alarms.

Validation of the Modified Fatigue Impact Scale in mild to moderate traumatic brain injury.

Objective: To evaluate the validity of the Modified Fatigue Impact Scale (MFIS) in veterans with a history of mild to moderate traumatic brain injury (TBI).

Participants: Veterans (N = 106) with mild (92%) or moderate (8%) TBI.

Setting: Veterans Administration Health System.

Polysomnographic evaluation of sleep quality and quantitative variables in women as a function of mood, reproductive status, and age.

This archival cross-sectional investigation examined the impact of mood, reproductive status (RS), and age on polysomnographic (PSG) measures in women. PSG was performed on 73 normal controls (NC) and 64 depressed patients (DP), in the course of studies in menstruating, pregnant, postpartum, and peri- and postmenopausal women. A two-factor, between-subjects multivariate analysis of variance (MANOVA) was used to test the main effects of reproductive status (RS: menstrual vs pregnant vs postpartum vs menopausal) and diagnosis (NC vs DP), and their interaction, on PSG measures.

Subjective sleepiness and daytime functioning in bariatric patients with obstructive sleep apnea.

Purpose: The purpose of this study was to evaluate associations between obstructive sleep apnea (OSA) severity and self-reported sleepiness and daytime functioning in patients considering bariatric surgery for treatment of obesity.

Methods: Using a retrospective cohort design, we identified 342 patients who had sleep evaluations prior to bariatric surgery. Our final sample included 269 patients (78.

Traumatic brain injury and sleep disturbance: a review of current research.

Objective: To summarize the current literature regarding the significant prevalence and potential consequences of sleep disturbance following traumatic brain injury (TBI), particularly mild TBI.

Design: PubMed and Ovid/MEDLINE databases were searched by using key words "sleep disturbance," "insomnia," "TBI," "brain injury," and "circadian rhythms." Additional sources (eg, abstracts from the annual Associated Professional Sleep Societies meeting) were also reviewed.

Discrepancy between subjective symptomatology and objective neuropsychological performance in insomnia.

Study Objectives: While daytime impairment is a defining feature of primary insomnia (PI), prior research using objective measures has not yielded clear and reliable evidence of global or specific deficits. In this investigation subjective and neuropsychological measures of daytime impairment were concurrently evaluated in subjects with primary insomnia (PIs) and in healthy good sleeper subjects (GSs). The goals for the study were to assess (1) whether PIs differ from GSs on subjective and/or objective measures and (2) the extent to which subjective and objective measures provide discordant information.

The effects of one night of sleep deprivation on known-risk and ambiguous-risk decisions.

Sleep deprivation has been shown to alter decision-making abilities. The majority of research has utilized fairly complex tasks with the goal of emulating 'real-life' scenarios. Here, we use a Lottery Choice Task (LCT) which assesses risk and ambiguity preference for both decisions involving potential gains and those involving potential losses.

Compensatory recruitment after sleep deprivation and the relationship with performance.

This study examined the effects of total sleep deprivation (TSD) on cerebral responses to a verbal learning task with two levels of word difficulty. A total of 32 subjects were studied with functional magnetic resonance imaging (FMRI) after normal sleep and following 36 h of TSD. Cerebral responses to EASY words were identical on both nights, but several brain regions showed increased activation to HARD words following TSD compared with following a normal night of sleep (NORM).

The effects of modafinil and cognitive behavior therapy on sleep continuity in patients with primary insomnia.

Background: Daytime fatigue, if not frank sleepiness, is a common symptom among patients with insomnia, one that is exacerbated during acute treatment with cognitive behavior therapy (CBT). The present study was undertaken to assess whether modafinil could be used to reduce daytime fatigue, sleepiness, or both in patients with primary insomnia and whether the pharmacologic augmentation of wakefulness might produce improved sleep by itself or in combination with CBT.

Methods: 30 subjects with primary insomnia were enrolled in this study and were randomly assigned to 1 of 3 treatment conditions: (1) placebo plus CBT, (2) 100 mg modafinil plus CBT, or (3) 100 mg modafinil plus a contact control (monitor-only condition).

Functional imaging of the sleeping brain: review of findings and implications for the study of insomnia.

Despite the growing literature indicating that insomnia is prevalent and a substantial risk factor for medical and psychiatric morbidity, the pathophysiology of both Primary and Secondary Insomnia is poorly understood. Multiple trait and state factors are thought to give rise to and/or moderate illness severity in insomnia, but 'hyperarousal' is widely believed to be the final common pathway of the disorder. To date, very little work has been undertaken using functional imaging to explore the CNS correlates, underpinnings, or consequences of hyperarousal as it occurs in Primary Insomnia.

No association of sleep with total daily physical activity in normal sleepers.

The aim of two studies was to examine both between-subjects and within-subjects associations between daily amounts of physical activity and sleep in the home environment. Study 1 examined self-reported exercise durations and sleep diaries for 105 consecutive days in 31 college students who were normal sleepers. Between-subjects associations of mean exercise with mean sleep were assessed with Spearman rank-order correlations.