Background
Posttraumatic stress disorder (PTSD) has been linked to increased morbidity. An inflexibility
of the autonomic nervous system might be the underlying mechanism. We aimed to assess
whether PTSD and combat trauma exposure are associated with lower heart rate variability
(HRV), a measure of autonomic function and a predictor of death.
Methods
We measured HRV by power spectral analysis on 24-hour ambulatory electrocardiogram
in 459 middle-aged veteran male twins. Combat trauma was assessed with the combat
exposure scale, and current and remitted PTSD was assessed with the Structured Clinical
Interview for Psychiatry Disorders. Mixed-effects regression models were used to test
associations of PTSD and HRV between and within twin pairs.
Results
Of all twins, 211 had combat exposure, 31 had current PTSD, and 43 had remitted PTSD.
Current PTSD was inversely associated with very-low-frequency and low-frequency HRV
both in individual twins and within 20 pairs discordant for current PTSD. Twins with
current PTSD had a 49% lower low-frequency HRV than their brothers without PTSD (p<.001). Remitted PTSD was not associated with HRV. Results were robust to adjustment
for depression and other risk factors. Combat exposure was inversely associated with
most HRV frequencies, but this association mostly diminished after adjustment for
current PTSD.
Conclusion
In middle-aged veteran men, combat exposure and current PTSD are associated with measures
of autonomic inflexibility previously shown to have prognostic significance. The negative
health impact of combat exposure on autonomic function is mediated largely through
PTSD and might reverse with remission of PTSD.
Key Words
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Article info
Publication history
Published online: February 25, 2013
Accepted:
January 8,
2013
Received in revised form:
January 7,
2013
Received:
July 2,
2012
Identification
Copyright
© 2013 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
