Strong correlation of novel sleep electroencephalography coherence markers with diagnosis and severity of posttraumatic stress disorder

Mo H Modarres, Ryan A Opel, Kristianna B Weymann, Miranda M Lim, Mo H Modarres, Ryan A Opel, Kristianna B Weymann, Miranda M Lim

Abstract

Objective biomarkers of the presence and severity of posttraumatic stress disorder (PTSD) are elusive, yet badly needed. Electroencephalographic (EEG) coherence represents a promising approach to identifying and understanding brain biomarker activity in PTSD. Overnight polysomnography data containing EEG across sleep and wake states was collected in n = 76 Veterans with and without PTSD from a single site under IRB approval. Brain coherence markers (BCM) were calculated from EEG signals using a novel approach to produce one index for PTSD diagnosis (PTSDdx), and another index for PTSD severity (PTSDsev). PTSDdx showed strong sensitivity to the presence of PTSD in the awake state, during non-rapid eye movement (NREM) stage N2 sleep, and in a hybrid BCM incorporating both awake and NREM sleep states. PTSDsev showed a strong correlation with PTSD symptom severity (using the PTSD Checklist 5, or PCL5 survey) in the awake state, during N2 sleep, and in a hybrid BCM incorporating both awake and NREM sleep states. Thus, sleep EEG-based brain coherence markers can be utilized as an objective means for determining the presence and severity of PTSD. This portable, inexpensive, and non-invasive tool holds promise for better understanding the physiological mechanisms underlying PTSD and for tracking objective responses to treatment.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Consort diagram showing inclusion/exclusion criteria. PSG = Polysomnography; AHI = apnea-hypopnea index; PTSD = posttraumatic stress disorder.
Figure 2
Figure 2
Electrode locations of International 10–20 system for EEG (electroencephalography) recording. PSG data were recorded at standard clinical sleep EEG locations according the International 10–20 EEG placement sites. The EEG Montage for the sleep study consisted of the following, highlighted leads: Frontal: F3 and F4, Central: C3 and C4, and Occipital: O1 and O2. The panel on the right indicates all possible EEG coherence pairs for computation.
Figure 3
Figure 3
Comparison of PTSDdx between PTSD and Control groups (Left Column); PCL-5 vs PTSDsev of PTSD group (Right Column). Left column: Boxplots of PTSDdx brain coherence marker for control and PTSD groups in wakefulness (Panel A), N1 Sleep (Panel C), N2 Sleep (Panel E). On each box, the central mark is the median, the edges of the box are the 25th and 75th percentiles, the whiskers extend to the most extreme data-points the algorithm considers to be not outliers, and the outliers are plotted individually. Right Column: Scatter plots of PTSDsev vs PCL-5 in groups in wakefulness (Panel B), N1 Sleep (Panel D), N2 Sleep (Panel F), as well as the regression line for each state.
Figure 4
Figure 4
Comparison of Hybrid PTSDdx and PTSDsev Brain Coherence Markers. Boxplot of PTSDdx for Control and PTSD subjects in the combined W, N1, and N2 (Panel A). Scatter plot of PTSDsev vs. PCL-5 in the combined W, N1, and N2 (Panel B).

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Source: PubMed

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