Seligowski Antonia V, Steuber Elizabeth R, Hinrichs Rebecca, Reda Mariam H, Wiltshire Charis N, Wanna Cassandra P, Winters Sterling J, Phillips Karlye A, House Stacey L, Beaudoin Francesca L, An Xinming, Stevens Jennifer S, Zeng Donglin, Neylan Thomas C, Clifford Gari D, Linnstaedt Sarah D, Germine Laura T, Bollen Kenneth A, Guffanti Guia, Rauch Scott L, Haran John P, Storrow Alan B, Lewandowski Christopher, Musey Paul I, Hendry Phyllis L, Sheikh Sophia, Jones Christopher W, Punches Brittany E, Kurz Michael C, Murty Vishnu P, McGrath Meghan E, Hudak Lauren A, Pascual Jose L, Seamon Mark J, Datner Elizabeth M, Chang Anna M, Pearson Claire, Peak David A, Merchant Roland C, Domeier Robert M, Rathlev Niels K, O'Neil Brian J, Sanchez Leon D, Bruce Steven E, Miller Mark W, Pietrzak Robert H, Joormann Jutta, Barch Deanna M, Pizzagalli Diego A, Sheridan John F, Luna Beatriz, Harte Steven E, Elliott James M, Koenen Karestan C, Kessler Ronald C, McLean Samuel A, Ressler Kerry J, Jovanovic Tanja
Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA.
Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA.
Neurobiol Stress. 2021 Aug 21;15:100384. doi: 10.1016/j.ynstr.2021.100384. eCollection 2021 Nov.
Cross-sectional studies have found that individuals with posttraumatic stress disorder (PTSD) exhibit deficits in autonomic functioning. While PTSD rates are twice as high in women compared to men, sex differences in autonomic functioning are relatively unknown among trauma-exposed populations. The current study used a prospective design to examine sex differences in posttraumatic autonomic functioning.
192 participants were recruited from emergency departments following trauma exposure ( age = 35.88, 68.2% female). Skin conductance was measured in the emergency department; fear conditioning was completed two weeks later and included measures of blood pressure (BP), heart rate (HR), and high frequency heart rate variability (HF-HRV). PTSD symptoms were assessed 8 weeks after trauma.
2-week systolic BP was significantly higher in men, while 2-week HR was significantly higher in women, and a sex by PTSD interaction suggested that women who developed PTSD demonstrated the highest HR levels. Two-week HF-HRV was significantly lower in women, and a sex by PTSD interaction suggested that women with PTSD demonstrated the lowest HF-HRV levels. Skin conductance response in the emergency department was associated with 2-week HR and HF-HRV only among women who developed PTSD.
Our results indicate that there are notable sex differences in autonomic functioning among trauma-exposed individuals. Differences in sympathetic biomarkers (BP and HR) may have implications for cardiovascular disease risk given that sympathetic arousal is a mechanism implicated in this risk among PTSD populations. Future research examining differential pathways between PTSD and cardiovascular risk among men versus women is warranted.
横断面研究发现，创伤后应激障碍（PTSD）患者存在自主神经功能缺陷。虽然女性的PTSD发病率是男性的两倍，但在经历创伤的人群中，自主神经功能的性别差异相对不明。本研究采用前瞻性设计来检验创伤后自主神经功能的性别差异。
从急诊科招募了192名创伤暴露后的参与者（年龄=35.88岁，68.2%为女性）。在急诊科测量皮肤电导率；两周后完成恐惧条件反射测试，包括测量血压（BP）、心率（HR）和高频心率变异性（HF-HRV）。创伤后8周评估PTSD症状。
男性的2周收缩压显著更高，而女性的2周心率显著更高，PTSD与性别的交互作用表明，患PTSD的女性心率水平最高。女性的2周HF-HRV显著更低，PTSD与性别的交互作用表明，患PTSD的女性HF-HRV水平最低。仅在患PTSD的女性中，急诊科的皮肤电导率反应与2周心率和HF-HRV相关。
我们的结果表明，创伤暴露个体的自主神经功能存在显著的性别差异。鉴于交感神经兴奋是PTSD人群心血管疾病风险的一种机制，交感生物标志物（血压和心率）的差异可能对心血管疾病风险有影响。有必要开展未来研究，探讨男性和女性PTSD与心血管风险之间的不同途径。
