Journal
BEHAVIOURAL BRAIN RESEARCH
Volume 404, Issue -, Pages -Publisher
ELSEVIER
DOI: 10.1016/j.bbr.2021.113172
Keywords
Sleep apnea; Fear conditioning; Inhibitory learning; Fear extinction; Acoustic startle; Posttraumatic stress disorder
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Funding
- Southern California Institute for Research and Education
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Patients with obstructive sleep apnea (OSA) showed significant improvements in fear acquisition, inhibition, and extinction after continuous positive airway pressure (CPAP) therapy. More severe OSA patients were more likely to show enhanced fear inhibition and extinction after CPAP usage. Patients with OSA and co-morbid posttraumatic stress disorder (PTSD) displayed impairments in discriminating between reinforced and nonreinforced conditioned stimuli, fear inhibition, and fear extinction, suggesting the need to address disrupted sleep prior to PTSD exposure therapies.
Obstructive sleep apnea (OSA) is a respiratory condition characterized by interrupted sleep due to repeated, temporary collapse of the soft tissue of the upper airway that can lead to a cascade of physiological and psychological adverse health outcomes. The most common therapeutic interventions for OSA patients include the application of continuous positive airway pressure (CPAP) which acts to keep the airway open and, as such, provides less interrupted and more restorative sleep. Improved sleep has been linked to more efficacious treatments for psychiatric conditions most notably those that include cognitive-behavioral elements, new learning, and memory consolidation. In the current study, we investigated the acquisition, inhibition, and extinction of conditioned fear in OSA patients, before and after CPAP therapy, using an established fear potentiated startle paradigm. Patients with OSA displayed an intact ability to acquire, inhibit, and extinguish fear prior to CPAP treatment and this ability was significantly enhanced following CPAP usage. In addition, those patients with more severe OSA, as measured by apnea-hypopnea index (AHI), were more likely to show improved fear inhibition and extinction. Lastly, we observed impairments in discrimination between reinforced and nonreinforced conditioned stimuli, in the inhibition of fear, and in fear extinction in a subset of patients with OSA and co-morbid posttraumatic stress disorder (PTSD). These data suggest that evolving treatment algorithms for PTSD should address disrupted sleep problems prior to initiation of inhibition/extinction-based exposure therapies.
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