REM sleep rhythm impairment in people with PTSD

Abstract Study objectives Sleep disturbances are reported by approximately 90% of people with post-traumatic stress disorder (PTSD), yet objective characterizations of their sleep remain inconsistent across studies. This inconsistency likely stems from the limitations of standard, single-night, laboratory-based polysomnography (PSG), which often fails to capture naturalistic sleep patterns in hypervigilant individuals. To address this critical gap, our objective was to characterize the architecture of naturalistic sleep using multi-night, in-home PSG. A more precise understanding of these sleep abnormalities is crucial for advancing our knowledge of PTSD pathophysiology and is expected to provide a foundation for developing novel, targeted therapeutic strategies. Methods In-home sleep recordings using only five electrodes and a portable PSG device were obtained from 29 people with PTSD and 29 matched healthy control individuals across multiple nights. Results Although total sleep time was similar between people with PTSD and matched healthy control individuals, people with PTSD exhibited disruptions in several rapid eye movement (REM) sleep parameters, including prolonged latency to REM sleep, shorter REM sleep episodes, fragmentation of REM sleep, and weaker REM sleep rhythmicity. Conclusion These results offer novel insights into the sleep pathophysiology of PTSD by identifying REM sleep as a core domain of disruption. These findings also underscore the urgent need for further research into how REM sleep disturbances contribute to PTSD symptoms and highlight the importance of ecologically valid sleep assessments and REM sleep-targeted therapeutic strategies for more effective treatment of PTSD. Clinical trial registration Registry: jRCT (Japan Registry of Clinical Trials): https://jrct.mhlw.go.jp/ Name: An Observational Study to Acquire Patient EEG Data for the Development of a Device Enabling Acoustic Exposure Therapy during Sleep for Post-Traumatic Stress Disorder (PTSD). Registration number: jRCT1032220029 Statement of significance Posttraumatic stress disorder (PTSD) is commonly associated with sleep-related disturbances, particularly trauma-related nightmares. Using multi-night in-home polysomnography, this study characterizes people with PTSD’ naturalistic sleep patterns. While total sleep time was comparable between people with PTSD and healthy control individuals, people with PTSD exhibited disruptions in several aspects of rapid eye movement (REM) sleep, including weaker REM sleep rhythmicity across the night. These findings offer novel insights into the sleep pathophysiology of PTSD by identifying REM sleep as a core domain of disruption and further highlight the importance of ecologically valid sleep assessments and REM sleep-targeted therapeutic strategies for more effective treatment of PTSD.