Autonomic Dysfunction, Cardiovascular Diseases, Endothelial Dysfunction, Kidney Diseases, Nightmare, Post Traumatic Stress Disorder, Renal Dysfunction, Trauma and Stressor Related Disorders, Vascular Stiffness
Conditions
Keywords
Sleep, Trauma and Stressor Related Disorders, Post Traumatic Stress Disorder, Cardiovascular Diseases, Kidney Diseases, Renal Dysfunction, Autonomic Dysfunction
Brief summary
The purpose of this study is to determine whether NightWare therapeutic intervention improves biomarkers of vascular and renal function in premenopausal women with PTSD-related nightmares, and examine whether these improvements restore them to levels observed in age-matched women without PTSD.
Detailed description
Women are disproportionally affected by posttraumatic stress disorder (PTSD), a debilitating mental health disorder that profoundly increases cardiovascular disease (CVD) risk. Biological processes including vascular dysfunction (i.e., impaired endothelial function, arterial stiffening), increased renin-angiotensin-aldosterone system (RAAS) activity, and altered renal vascular control and function may contribute to the pathophysiological link between PTSD and CVD. Sleep is a key regulator of cellular and tissue repair, free radical detoxification, oxidative stress, inflammation, autonomic and endocrine balance and crucial for cardiovascular health. Sleep disturbances due to nightmares are a hallmark symptom of PTSD that cause significant distress and may independently contribute to elevated CVD risk in individuals with PTSD. As such, interventions aimed at treating trauma-related nightmares are a promising therapeutic approach in ameliorating the cardiovascular consequences of PTSD. NightWare™, a smart-watch based application that uses biometric data and vibrotactile feedback to disrupt nightmares, is an FDA approved digital therapeutic system for the treatment of nightmares in adults (≥22 years) with PTSD. While a preliminary study demonstrated that 30 days of NightWare treatment improved subjective sleep quality in Veterans, the influence of NightWare treatment on vascular and renal function in young women with PTSD-related nightmares is unknown. These investigations are critical among women who, despite having 2x greater prevalence of PTSD compared to men, and a differential progression of PTSD, CVD, and chronic kidney disease (CKD), are underrepresented in the literature. Accordingly, the investigators will examine if the NightWare digital therapeutic system improves vascular and renal function in premenopausal women with PTSD-related nightmares, and whether these improvements restore them to levels observed in age-matched women without PTSD. We will employ 1) cross-sectional comparisons between two groups of women: those with PTSD and nightmares (PTSD group) and those without PTSD and nightmares (age-matched control group); and 2) a short-term (8-week) NightWare or sham intervention in women with nightmares related to PTSD.
Interventions
DEVICENightWare
A wearable digital therapeutic platform consisting of an Apple Watch and iPhone pre-provisioned with Nightware intervention app that will deliver a mild vibration to the watch after detecting individual having a nightmare based on Nightware proprietary algorithm, arousing the individual and disrupting nightmare without awakening.
DEVICESham NightWare
NightWare decive will not deliver an intervention (i.e., no vibration)
Sponsors
Ludeman Family Center for Women's Health Research
University of Colorado, Denver
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Intervention model description
Observational study (women with PTSD-related nightmares vs control group without PTSD-related nightmares); In women with PTSD-related nightmares only: randomized, double-blind, placebo (i.e., sham intervention) controlled parallel pilot study
Eligibility
Sex/Gender
FEMALE
Age
22 Years to 40 Years
Healthy volunteers
Yes
Inclusion criteria
* Healthy, as determined by medical history * Group Specific Eligibility * PTSD Group * Lifetime PTSD: screened using Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) and confirmed via Clinician Administered PTSD Scale for DSM-5 (CAPS-5) * Prior trauma exposure: screened using Brief Trauma Questionnaire (BTQ) * Self-report having repetitive nightmares contributing to disrupted sleep * Poor overall sleep quality: PSQI score 6 or higher * Control Group * No lifetime PTSD: screened using PC-PTSD-5 * No prior trauma exposure: screened using BTQ * Do not self-report having repetitive nightmares contributing to disturbed sleep
Exclusion criteria
* Pre-existing (e.g., diabetes, liver, kidney disease) or unstable medical condition (e.g., uncontrolled hypertension or active CVD or cancer) or systemic illness that would interfere with interpretation of the study outcomes * Body Mass Index ≥ 40 kg/m2 * Use of medications that might influence cardiovascular or renal function (i.e., antihypertensive, lipid lowering medications, GLP-1/GIP RAs) * Active infection (note, anyone with an active infection would become eligible once the infection has ended) * Abnormal thyroid, liver, or kidney function testing during the screening examination or bloodwork. Abnormal kidney function defined as creatinine \>1.3mg/dL. Abnormal liver function tests within 1.5x ULN. UCH Clinical Lab ULN for AST and ALT are 39 and 52, respectively. Women with TSH levels outside of the normal range (0.5-5.0 mLU/L) will be referred to their PCP and will be allowed study entry once their TSH levels are normalized \> 3 months * Plasma glucose \>126 mg/dl under fasting conditions * Use of insulin or sulfonylureas * Pregnant, within 12 months postpartum or currently breast feeding * Current history of substance (excluding marijuana) or alcohol abuse per the SCID-5. Adults with past substance or alcohol use disorders will be allowed to participate. * Report elevated acute risk for suicidal self-directed violence warranting immediate hospitalization (e.g., suicidal ideation with intent, evaluated by the C-SSRS). * Shift workers * Diagnosis of active disorder of arousal from non-rapid eye movement sleep, rapid eye movement sleep behavior disorder, or narcolepsy * Nocturia that causes awakening from sleep * Epworth Sleepiness Scale: Question #8 score above 0 will prompt an additional question: Do you drive (get behind the wheel) when you are drowsy? The answer must be No to be enrolled in the study due to safety concerns * Known sleep walking or acting out dreams (contraindication to NightWare use) * Diagnosis or suspicion of dementia * Participants experiencing severe cognitive impairment or current psychiatric symptoms of such severity that would preclude participation (e.g., active psychosis, imminently suicidal) * Current use of vitamin/supplements (including melatonin) or anti-inflammatory medications, participants will be included if they are willing to stop taking vitamin/supplements or anti-inflammatory medications 2 weeks prior to the first vascular visit. * Current or planned participation in an interventional study during the present study * Participants must have access to wireless internet and two power outlets where they sleep
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Brachial artery flow-mediated dilation (FMD) | PTSD vs controls at baseline. In PTSD group only, change with NightWare vs Sham (measured before and after 8 weeks of NightWare or sham conditions). | FMD of the brachial artery, calculated as a percentage, is an index of vascular function. A higher number is a general indicator of better vascular function. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Large artery elastic stiffness | PTSD vs controls at baseline. In PTSD group only, change with NightWare vs Sham (measured before and after 8 weeks of NightWare or sham conditions). | Carotid-femoral pulse wave velocity (PWV). A higher number is a general indicator of worse vascular function. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Autonomic function- heart rate variability | PTSD vs controls at baseline. In PTSD group only, change with NightWare vs Sham (measured before and after 8 weeks of NightWare or sham conditions). | Heart rate variability |
| Blood pressure | PTSD vs controls at baseline. In PTSD group only, change with NightWare vs Sham (measured before and after 8 weeks of NightWare or sham conditions). | Seated blood pressure measured in mmHg |
| Estimated glomerular filtration rate (eGFR) | PTSD vs controls at baseline. In PTSD group only, change with NightWare vs Sham (measured before and after 8 weeks of NightWare or sham conditions). | Serum cystatin C, alongside demographic information, will be used to estimate kidney filtration of waste and excess water. A low eGFR can indicate renal dysfunction. |
| Renal vascular control | PTSD vs controls at baseline. In PTSD group only, change with NightWare vs Sham (measured before and after 8 weeks of NightWare or sham conditions). | Peak change in renal vascular resistance in response to sympathoexcitation via cold pressor test |
| Renal functional reserve | PTSD vs controls at baseline. In PTSD group only, change with NightWare vs Sham (measured before and after 8 weeks of NightWare or sham conditions). | Peak change in creatinine clearance (calculated using urine creatinine, serum creatinine, urine flow rate) following ingestion of oral protein |
| Large artery elastic stiffness-carotid artery | PTSD vs controls at baseline. In PTSD group only, change with NightWare vs Sham (measured before and after 8 weeks of NightWare or sham conditions). | Carotid artery compliance using carotid artery ultrasound; a higher carotid artery compliance is a general indicator of better vascular function. |
| Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A) | PTSD vs controls at baseline. In PTSD group only, change with NightWare vs Sham (measured before and after 8 weeks of NightWare or sham conditions). | Sleep questionnaire to assess frequency of seven disruptive nocturnal behaviors; scores range from 0-21 with higher scores indicating more severe PTSD-related sleep disturbances. |
| PTSD Checklist for DSM-5 (PCL-5) | PTSD vs controls at baseline. In PTSD group only, change with NightWare vs Sham (measured before and after 8 weeks of NightWare or sham conditions). | Presence and severity of PTSD symptoms questionnaire; scores range from 0-80 with higher scores indicating more severe PTSD symptoms. |
| Nightmare Disorder Index (NDI) | PTSD vs controls at baseline. In PTSD group only, change with NightWare vs Sham (measured before and after 8 weeks of NightWare or sham conditions). | 5-item questionnaire related to nightmares; scores range from 0-20 with higher score indicates more severe nightmare symptoms. |
| Columbia Suicide Severity Rating Scale (CSSR-S) | PTSD vs controls at baseline. In PTSD group only, change with NightWare vs Sham (measured before and after 8 weeks of NightWare or sham conditions). | Questionnaire used for suicide risk assessment; categorizes level of suicide risk (low, moderate, high) based on responses to questions about suicidal ideation and behavior. |
| Pittsburgh Sleep Quality Index (PSQI) | PTSD vs controls at baseline. In PTSD group only, change with NightWare vs Sham (measured before and after 8 weeks of NightWare or sham conditions). | Sleep questionnaire with a scale of 0 to 21 with a higher score indicating a significant sleep disturbance |
| Autonomic function-baroreflex sensitivity | PTSD vs controls at baseline. In PTSD group only, change with NightWare vs Sham (measured before and after 8 weeks of NightWare or sham conditions). | Cardiovagal baroreflex sensitivity (cBRS) measured using beat-to-beat time series of systolic blood pressures (finger photo-plethysmography) and R-R interval (three-lead electrocardiogram) will be recorded simultaneously at 1,000 Hz. |
Countries
United States
Contacts
Primary ContactEmily Larson, PhD
Backup ContactKerrie Moreau, PhD
Outcome results
None listed