Sex differences in objective measures of sleep in post‐traumatic stress disorder and healthy control subjects
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Summary: A growing literature shows prominent sex effects for risk for post‐traumatic stress disorder and associated medical comorbid burden. Previous research indicates that post‐traumatic stress disorder is associated with reduced slow wave sleep, which may have implications for overall health, and abnormalities in rapid eye movement sleep, which have been implicated in specific post‐traumatic stress disorder symptoms, but most research has been conducted in male subjects. We therefore sought to compare objective measures of sleep in male and female post‐traumatic stress disorder subjects with age‐ and sex‐matched control subjects. We used a cross‐sectional, 2 × 2 design (post‐traumatic stress disorder/control × female/male) involving83 medically healthy, non‐medicated adults aged 19–39 years in the inpatient sleep laboratory. Visual electroencephalographic analysis demonstrated that post‐traumatic stress disorder was associated with lower slow wave sleep duration (F(3,82) = 7.63, P = 0.007) and slow wave sleep percentage (F(3,82) = 6.11, P = 0.016). There was also a group × sex interaction effect for rapid eye movement sleep duration (F(3,82) = 4.08, P = 0.047) and rapid eye movement sleep percentage (F(3,82) = 4.30, P = 0.041), explained by greater rapid eye movement sleep in post‐traumatic stress disorder females compared to control females, a difference not seen in male subjects. Quantitative electroencephalography analysis demonstrated that post‐traumatic stress disorder was associated with lower energy in the delta spectrum (F(3,82) = 6.79, P = 0.011) in non‐rapid eye movement sleep. Slow wave sleep and delta findings were more pronounced in males. Removal of post‐traumatic stress disorder subjects with comorbid major depressive disorder, who had greater post‐traumatic stress disorder severity, strengthened delta effects but reduced rapid eye movement effects to non‐significance. These findings support previous evidence that post‐traumatic stress disorder is associated with impairment in the homeostatic function of sleep, especially in men with the disorder. These findings suggest that group × sex interaction effects on rapid eye movement may occur with more severe post‐traumatic stress disorder or with post‐traumatic stress disorder comorbid with major depressive disorder.
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Polysomnographic studies have shown that EEG spectral power at delta frequencies is significantly decreased in PTSD patients.
“Polysomnographic studies have also shown that EEG spectral power at delta frequencies is significantly decreased in PTSD patients [139, 141, 142].”
From Sleep and REM sleep disturbance in the pathophysiology of PTSD: the role of extinction memory (2015) · cites this paper as [139]
A recent meta-analysis found that increased stage 1 NREM sleep, decreased slow wave sleep, and increased average number of rapid eye movements per minute in REM sleep (REM sleep density) were the most consistent sleep abnormalities in PTSD compared to control groups.
“For objective sleep measures, a recent meta-analysis [134] found that, among the highly variable alterations of sleep in PTSD compared to control groups, increased stage 1 NREM sleep, decreased slow wave sleep (SWS) (see also [139]), and increased average number of rapid eye movements per minute in REM sleep (REM sleep density) were the most consistent abnormalities across studies.”
From Sleep and REM sleep disturbance in the pathophysiology of PTSD: the role of extinction memory (2015) · cites this paper as [139]
In a study comparing sleep in PTSD and healthy controls in both sexes, a gender × diagnosis interaction was reported whereby, among females, those with PTSD showed greater REM duration and percent than controls whereas, among males, this difference appeared (non-significantly) in the opposite direction.
“a study comparing sleep in PTSD and healthy controls in both sexes reported a gender × diagnosis interaction whereby, among females, those with PTSD showed greater REM duration and percent than controls whereas, among males, this difference appeared (non-significantly) in the opposite direction [139].”
From Sleep and REM sleep disturbance in the pathophysiology of PTSD: the role of extinction memory (2015) · cites this paper as [139]
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- Authors
- Richards, A., Metzler, T. J., Ruoff, L. M., Inslicht, S. S., Rao, M., Talbot, L. S., & Neylan, T. C.
- Affiliations
- San Francisco VA Medical Center (US)
- San Francisco Veterans Affairs Medical Center San Francisco CA USA
- Corresponding author
- Richards, Anne
- Venue
- Journal of Sleep Research
- Publisher
- Wiley
- Published
- 2013-06-14
- Volume
- 22
- Issue
- 6
- Pages
- 679-687
- ISSN
- 0962-1105 (ISSN-L)
- 1365-2869
- PMC
- PMC3958933
- OpenAlex
- W2047831275
- Cited by
- 49
- References
- 30
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 2 · 2023: 6 · 2022: 4 · 2021: 5 · 2020: 5 · 2019: 4 · 2018: 1 · 2017: 6 · 2016: 2 · 2015: 5 · 2014: 4
- FWCI
- 4.96
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Sleep Research (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute for Mental Health (5R01MH073978-04, 5R34MH077667-03)
- Mental Illness Research and Education Clinical Center of the US Veterans Health Administration and the Clinical Research Center of the National Center for Advancing Translational Sciences
- National Institutes of Health (UL1 RR024131)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Keywords
- post-traumatic stress disorder, sex differences, sleep architecture, slow-wave sleep, REM sleep, delta power, sleep homeostasis, major depressive disorder comorbidity, objective sleep measures
- MeSH terms
- Adult, Cross-Sectional Studies, Demography, Major Depressive Disorder, Electroencephalography, Female, Humans, Male, Sex Characteristics, Sleep, Sleep, REM, Stress Disorders, Post-Traumatic, Case-Control Studies, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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