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Sleep as a Mediator of mTBI and PTSD

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Sleep and Combat-Related Post Traumatic Stress Disorder

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Abstract

The frequently comorbid relationship between post-traumatic stress disorder (PTSD) and post-concussion syndrome (PCS) has been described and discussed extensively, and the fact that there is significant overlap in the symptomology of these disorders has generated considerable discussion and speculation regarding the nature of both. Indeed, it has been pointed out that the extent of this overlap, and the nonspecific nature of those symptoms common to both diagnoses, has essentially made it impossible to place any confidence in efforts to differentially screen for these disorders in a post hoc manner (e.g., in military personnel returning from deployment; see Fear et al. Psychol Med. 39(8):1379–1387, 2009).

The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Army, the Department of the Navy, the Department of Defense, the Department of Health and Human Services, the National Institutes of Health, the US Government, or any of the institutions with which the authors are affiliated. This work was supported by the US Army Military Operational Medicine Research Program.

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Notes

  1. 1.

    Nevertheless, assessment of NAA levels may ultimately prove useful for management of concussion, especially if, as hypothesized by Vagnozzi et al. [55], it is found that NAA mediates (or at least serves as a marker of) increased vulnerability to subsequent mTBI events (the so-called second-impact syndrome). If this proves to be the case, then the duration of the rest period following an mTBI event (e.g., the post-injury period during which athletes are sidelined and soldiers are restricted to limited duty) might be extended considerably (relative to current practice – generally, a 1-week hiatus from activity) since NAA levels typically fail to recover to normal levels until about 30 days post-injury.

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Authors and Affiliations

  1. Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA

    Dante Picchioni & Thomas J. Balkin

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  1. Dante Picchioni
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  2. Thomas J. Balkin
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Correspondence to Thomas J. Balkin .

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  1. Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands

    Eric Vermetten

  2. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

    Anne Germain

  3. University of California, San Francisco, California, USA

    Thomas C. Neylan

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Picchioni, D., Balkin, T.J. (2018). Sleep as a Mediator of mTBI and PTSD. In: Vermetten, E., Germain, A., Neylan, T. (eds) Sleep and Combat-Related Post Traumatic Stress Disorder. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-7148-0_3

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