{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T10:03:13Z","timestamp":1790762593063,"version":"4.1.0"},"reference-count":58,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2023,10,17]],"date-time":"2023-10-17T00:00:00Z","timestamp":1697500800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Rationale: Sleep disturbances (insomnia and nightmare symptoms) are the most sensitive and persistent symptoms of pediatric post-traumatic stress disorder (PTSD). Untreated, these sleep disturbances (SD) associated with PTSD are predictive of PTSD persistence and increased psychiatric complications. The aim of this study was to evaluate sleep and circadian rhythms in children with PTSD under both laboratory and ecological conditions in comparison with a control population and to test for the first time the hypothesis that SD and circadian rhythms are positively correlated with PTSD severity and its comorbidities. Method: This prospective pilot study evaluated PTSD, SD (insomnia, nightmares), and sleep-wake rhythms in 11 children with PTSD (aged 3\u201318), compared with the age and sex-matched control groups. Assessment of PTSD and subjective and objective measures of sleep and sleep-wake rhythms (questionnaires, 24-h in-laboratory video-polysomnography, 15-day at-home actigraphy recording) were performed between 1 and 6 months after the traumatic event. Results: Children with PTSD had higher sleep fragmentation (increased wake-after-sleep onset, increased number of sleep stage changes) compared to controls, with a change in sleep microarchitecture (micro-arousal index at 14.8 versus 8.2, p = 0.039). Sleep fragmentation parameters correlated with PTSD symptomatology, insomnia, and post-traumatic nightmare severity. The within-group comparison revealed a better sleep architecture in the controlled (sleep laboratory) than in the ecological condition (at home) (total sleep time 586 versus 464 min, p = 0.018). Conclusions: Sleep and rhythm disturbances are strongly associated with PTSD in children. The assessment of SD in children with PTSD should be carried out systematically and preferentially under ecological conditions, and management of SD should integrate the environment (environmental design, psycho-education for the children and their parents) more fully into therapy focused on sleep and trauma.<\/jats:p>","DOI":"10.3390\/jcm12206570","type":"journal-article","created":{"date-parts":[[2023,10,17]],"date-time":"2023-10-17T08:25:09Z","timestamp":1697531109000},"page":"6570","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Nightmares and Sleep Disturbances in Children with PTSD: A Polysomnographic and Actigraphy Approach Evaluation"],"prefix":"10.3390","volume":"12","author":[{"given":"Julie","family":"Rolling","sequence":"first","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, Strasbourg University Hospital, 67091 Strasbourg, France"},{"name":"Regional Center for Psychotraumatism Great East, Strasbourg University Hospital, 67091 Strasbourg, France"},{"name":"Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France"},{"name":"CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliette","family":"Rabot","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, Strasbourg University Hospital, 67091 Strasbourg, France"},{"name":"Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France"},{"name":"CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France"},{"name":"Center for Research, Integrated University Health and Social Services Center (CIUSSS) Nord-de-l\u2019\u00cele-de-Montr\u00e9al, Montr\u00e9al, QC H2M 2W1, Canada"},{"name":"Department of Psychiatry & Addictology, University of Montreal, Montreal, QC H3T 1C5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7798-8366","authenticated-orcid":false,"given":"Eve","family":"Reynaud","sequence":"additional","affiliation":[{"name":"Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France"},{"name":"CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France"},{"name":"CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, Forgetting, Universit\u00e9 Claude Bernard Lyon 1, 69500 Bron, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oriane","family":"Kolb","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, Strasbourg University Hospital, 67091 Strasbourg, France"},{"name":"Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France"},{"name":"CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2268-5840","authenticated-orcid":false,"given":"Patrice","family":"Bourgin","sequence":"additional","affiliation":[{"name":"Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France"},{"name":"CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen M.","family":"Schroder","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, Strasbourg University Hospital, 67091 Strasbourg, France"},{"name":"Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France"},{"name":"CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2459","DOI":"10.1056\/NEJMra1612499","article-title":"Post-Traumatic Stress Disorder","volume":"376","author":"Shalev","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/S2215-0366(19)30031-8","article-title":"The Epidemiology of Trauma and Post-Traumatic Stress Disorder in a Representative Cohort of Young People in England and Wales","volume":"6","author":"Lewis","year":"2019","journal-title":"Lancet Psychiatry"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1192\/bjp.bp.113.131227","article-title":"Rates of Post-Traumatic Stress Disorder in Trauma-Exposed Children and Adolescents: Meta-Analysis","volume":"204","author":"Alisic","year":"2014","journal-title":"Br. J. Psychiatry"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1037\/tra0001436","article-title":"ICD-11 PTSD and Complex PTSD in Lithuanian University Students: Prevalence and Associations with Trauma Exposure","volume":"15","author":"Truskauskaite","year":"2023","journal-title":"Psychol. Trauma Theory Res. Pract. Policy"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1010957","DOI":"10.3389\/fpsyt.2022.1010957","article-title":"A 3-Year Retrospective Study of 866 Children and Adolescent Outpatients Followed in the Nice Pediatric Psychotrauma Center Created after the 2016 Mass Terror Attack","volume":"13","author":"Gindt","year":"2022","journal-title":"Front. Psychiatry"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"501","DOI":"10.5664\/jcsm.2678","article-title":"Sleep Disturbance in Pediatric PTSD: Current Findings and Future Directions","volume":"9","author":"Kovachy","year":"2013","journal-title":"J. Clin. Sleep Med."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [5th ed.]. (DSM-5).","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1111\/sjop.12366","article-title":"Why Did Adolescents Have Sleep Problems after Earthquakes? Understanding the Role of Traumatic Exposure, Fear, and PTSD","volume":"58","author":"Zhou","year":"2017","journal-title":"Scand. J. Psychol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1378\/chest.14-0970","article-title":"International Classification of Sleep Disorders-Third Edition","volume":"146","author":"Sateia","year":"2014","journal-title":"Chest"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"zsx188","DOI":"10.1093\/sleep\/zsx188","article-title":"An Ambulatory Polysomnography Study of the Post-Traumatic Nightmares of Post-Traumatic Stress Disorder","volume":"41","author":"Phelps","year":"2018","journal-title":"Sleep"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1176\/ajp.147.11.1526","article-title":"Children\u2019s PTSD Reactions One Year after a Sniper Attack at Their School","volume":"147","author":"Pynoos","year":"1990","journal-title":"Am. J. Psychiatry"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/S0145-2134(99)00127-1","article-title":"Post Traumatic Stress Disorder Reactions in Children of War: A Longitudinal Study","volume":"24","author":"Thabet","year":"2000","journal-title":"Child Abus. Negl."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1016\/S0013-7006(07)92059-X","article-title":"\u00c9tat de stress post-traumatique chez l\u2019enfant: S\u00e9miologie et comorbidit\u00e9","volume":"33","author":"Mghaieth","year":"2007","journal-title":"L\u2019Enc\u00e9phale"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1002\/jts.20680","article-title":"Sleep Fears, Sleep Disturbance, and PTSD Symptoms in Minority Youth Exposed to Hurricane Katrina","volume":"24","author":"Brown","year":"2011","journal-title":"J. Trauma. Stress"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1093\/jpepsy\/jsj040","article-title":"Sleep Disturbances and Childhood Sexual Abuse","volume":"31","author":"Noll","year":"2006","journal-title":"J. Pediatr. Psychol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.5665\/sleep.6018","article-title":"The Manifestations of Sleep Disturbances 16 Years Post-Trauma","volume":"39","author":"Thordardottir","year":"2016","journal-title":"Sleep"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1002\/jts.22139","article-title":"Influence of Sleep Disturbance on Global Functioning After Posttraumatic Stress Disorder Treatment: PTSD Treatment, Sleep, Global Functioning","volume":"29","author":"Brownlow","year":"2016","journal-title":"J. Trauma. Stress"},{"key":"ref_18","first-page":"660","article-title":"Polysomnographically Measured Sleep Abnormalities in PTSD: A Meta-Analytic Review","volume":"44","author":"Kobayashi","year":"2007","journal-title":"Psychophysiology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1016\/j.sleep.2011.06.004","article-title":"Insomnia Characteristics and Clinical Correlates in Operation Enduring Freedom\/Operation Iraqi Freedom Veterans with Post-Traumatic Stress Disorder and Mild Traumatic Brain Injury: An Exploratory Study","volume":"12","author":"Wallace","year":"2011","journal-title":"Sleep Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1016\/S0006-3223(03)00071-4","article-title":"Sleep Pathophysiology in Posttraumatic Stress Disorder and Idiopathic Nightmare Sufferers","volume":"54","author":"Germain","year":"2003","journal-title":"Biol. Psychiatry"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1696","DOI":"10.1176\/appi.ajp.159.10.1696","article-title":"REM Sleep and the Early Development of Posttraumatic Stress Disorder","volume":"159","author":"Mellman","year":"2002","journal-title":"Am. J. Psychiatry"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/0006-3223(94)91152-5","article-title":"Rapid Eye Movement Sleep Disturbance in Posttraumatic Stress Disorder","volume":"35","author":"Ross","year":"1994","journal-title":"Biol. Psychiatry"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1097\/00004583-199506000-00023","article-title":"Sleep and Psychological Characteristics of Children on a Psychiatric Inpatient Unit","volume":"34","author":"Sadeh","year":"1995","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1236","DOI":"10.1097\/00004583-199709000-00016","article-title":"Increased Nocturnal Activity and Impaired Sleep Maintenance in Abused Children","volume":"36","author":"Glod","year":"1997","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1080\/07420528.2023.2189952","article-title":"Associations between Post-Traumatic Stress Symptoms and Sleep\/Circadian Parameters: Exploring the Effect of Chronotype as a Moderator Variable","volume":"40","author":"Bruno","year":"2023","journal-title":"Chronobiol. Int."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1176\/appi.ajp.158.8.1227","article-title":"CSF Norepinephrine Concentrations in Posttraumatic Stress Disorder","volume":"158","author":"Geracioti","year":"2001","journal-title":"Am. J. Psychiatry"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1111\/jsr.12415","article-title":"Human Amygdala Activation during Rapid Eye Movements of Rapid Eye Movement Sleep: An Intracranial Study","volume":"25","author":"Velasco","year":"2016","journal-title":"J. Sleep Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"724","DOI":"10.3389\/fpsyt.2020.00724","article-title":"Use of Prazosin for Pediatric Post-Traumatic Stress Disorder With Nightmares and\/or Sleep Disorder: Case Series of 18 Patients Prospectively Assessed","volume":"11","author":"Ferrafiat","year":"2020","journal-title":"Front. Psychiatry"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1097\/JCP.0000000000000638","article-title":"Prazosin in Children and Adolescents with Posttraumatic Stress Disorder Who Have Nightmares: A Systematic Review","volume":"37","author":"Akinsanya","year":"2017","journal-title":"J. Clin. Psychopharmacol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1016\/j.cpr.2012.06.002","article-title":"A Meta-Analysis of Imagery Rehearsal for Post-Trauma Nightmares: Effects on Nightmare Frequency, Sleep Quality, and Posttraumatic Stress","volume":"32","author":"Casement","year":"2012","journal-title":"Clin. Psychol. Rev."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1176\/ajp.148.1.10","article-title":"Childhood Traumas: An Outline and Overview","volume":"148","author":"Terr","year":"1991","journal-title":"Am. J. Psychiatry"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Olliac, B., Birmes, P., Bui, E., Allenou, C., Brunet, A., Claudet, I., Sales de Gauzy, J., Grandjean, H., and Raynaud, J.-P. (2014). Validation of the French Version of the Child Post-Traumatic Stress Reaction Index: Psychometric Properties in French Speaking School-Aged Children. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0112603"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Boyes, M.E., Cluver, L.D., and Gardner, F. (2012). Psychometric Properties of the Child PTSD Checklist in a Community Sample of South African Children and Adolescents. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0046905"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1192\/bjp.181.2.158","article-title":"Brief Screening Instrument for Post-Traumatic Stress Disorder","volume":"181","author":"Brewin","year":"2002","journal-title":"Br. J. Psychiatry"},{"key":"ref_35","first-page":"995","article-title":"The Children\u2019s Depression, Inventory (CDI)","volume":"21","author":"Kovacs","year":"1985","journal-title":"Psychopharmacol. Bull."},{"key":"ref_36","unstructured":"Spielberg, C.D., Gorsuch, R.L., Lushene, R., Vagg, P.R., and Jacobs, G.A. (1983). Manualfor the State-Trait Anxiety Inventory (STAI), Consulting Psychologists Press."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1093\/sleep\/34.5.601","article-title":"The Insomnia Severity Index: Psychometric Indicators to Detect Insomnia Cases and Evaluate Treatment Response","volume":"34","author":"Morin","year":"2011","journal-title":"Sleep"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.sleep.2019.09.014","article-title":"French Validation of the Sleep Disturbance Scale for Children (SDSC) in Young Children (Aged 6 Months to 4 Years)","volume":"67","author":"Lecuelle","year":"2020","journal-title":"Sleep Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1037\/h0094355","article-title":"The Relationship of Nightmare Frequency to Nightmare Suffering with Implications for Treatment and Research","volume":"2","author":"Belicki","year":"1992","journal-title":"Dreaming"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1080\/07420520903044505","article-title":"Assessment of Chronotype in Four- to Eleven-Year-Old Children: Reliability and Validity of the Children\u2019s ChronoType Questionnaire (CCTQ)","volume":"26","author":"Werner","year":"2009","journal-title":"Chronobiol. Int."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.smrv.2007.07.005","article-title":"Epidemiology of the Human Circadian Clock","volume":"11","author":"Roenneberg","year":"2007","journal-title":"Sleep Med. Rev."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/0165-1781(89)90047-4","article-title":"The Pittsburgh Sleep Quality Index: A New Instrument for Psychiatric Practice and Research","volume":"28","author":"Buysse","year":"1989","journal-title":"Psychiatry Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.5664\/jcsm.7228","article-title":"Use of Actigraphy for the Evaluation of Sleep Disorders and Circadian Rhythm Sleep-Wake Disorders: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment","volume":"14","author":"Smith","year":"2018","journal-title":"J. Clin. Sleep Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.5664\/jcsm.5100","article-title":"Clinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep-Wake Disorders: Advanced Sleep-Wake Phase Disorder (ASWPD), Delayed Sleep-Wake Phase Disorder (DSWPD), Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD), and Irregular Sleep-Wake Rhythm Disorder (ISWRD). An Update for 2015: An American Academy of Sleep Medicine Clinical Practice Guideline","volume":"11","author":"Auger","year":"2015","journal-title":"J. Clin. Sleep Med."},{"key":"ref_45","unstructured":"Berry, R.B., Brooks, R., Gamaldo, C.E., Harding, S.M., Lloyd, R.M., Marcus, C.L., and Vaughn, B.V. (2023, July 20). The American Association of Sleep Medicine Manual for the Scoring of Sleep and Associated Events: Scoring Manual; Version 2.2; 2015. Available online: https:\/\/aasm.org\/resources\/pdf\/scoring-manual-preface.pdf."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1097\/00004583-199909000-00023","article-title":"Twelve-Year Follow-up Study of Khmer Youths Who Suffered Massive War Trauma as Children","volume":"38","author":"Sack","year":"1999","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"882","DOI":"10.4088\/JCP.15m10206","article-title":"Sleep Disturbance Predicts Posttraumatic Stress Disorder and Depressive Symptoms: A Cohort Study of Chinese Adolescents","volume":"78","author":"Fan","year":"2017","journal-title":"J. Clin. Psychiatry"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1002\/jts.21973","article-title":"Nocturnal Autonomic Balance and Sleep in PTSD and Resilience: Nocturnal Autonomic Balance and Sleep in PTSD","volume":"27","author":"Kobayashi","year":"2014","journal-title":"J. Trauma. Stress"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0165-1781(00)00195-5","article-title":"Autonomic Dysregulation in Panic Disorder and in Post-Traumatic Stress Disorder: Application of Power Spectrum Analysis of Heart Rate Variability at Rest and in Response to Recollection of Trauma or Panic Attacks","volume":"96","author":"Cohen","year":"2000","journal-title":"Psychiatry Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.5664\/jcsm.8514","article-title":"Impact of Parental Injury on Adolescent Sleep","volume":"16","author":"Ahmed","year":"2020","journal-title":"J. Clin. Sleep Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1093\/sleep\/20.1.46","article-title":"A Polysomnographic Comparison of Veterans with Combat-Related PTSD, Depressed Men, and Non-Ill Controls","volume":"20","author":"Mellman","year":"1997","journal-title":"Sleep"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"zsy174","DOI":"10.1093\/sleep\/zsy174","article-title":"Posttraumatic Stress Disorder Diagnosis Is Associated with Reduced Parasympathetic Activity during Sleep in US Veterans and Military Service Members of the Iraq and Afghanistan Wars","volume":"41","author":"Ulmer","year":"2018","journal-title":"Sleep"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"e12820","DOI":"10.1111\/jsr.12820","article-title":"Aetiology and Treatment of Nightmare Disorder: State of the Art and Future Perspectives","volume":"28","author":"Gieselmann","year":"2019","journal-title":"J. Sleep Res."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1023\/A:1007812321136","article-title":"Dreams in the Acute Aftermath of Trauma and Their Relationship to PTSD","volume":"14","author":"Mellman","year":"2001","journal-title":"J. Trauma. Stress"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1542\/peds.111.2.302","article-title":"Sleep Duration from Infancy to Adolescence: Reference Values and Generational Trends","volume":"111","author":"Iglowstein","year":"2003","journal-title":"Pediatrics"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1038\/npp.2015.209","article-title":"Prefrontal-Amygdala Dysregulation to Threat in Pediatric Posttraumatic Stress Disorder","volume":"41","author":"Wolf","year":"2016","journal-title":"Neuropsychopharmacol. Publ. Am. Coll. Neuropsychopharmacol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1146\/annurev-clinpsy-032813-153716","article-title":"The Role of Sleep in Emotional Brain Function","volume":"10","author":"Goldstein","year":"2014","journal-title":"Annu. Rev. Clin. Psychol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1111\/jsr.12254","article-title":"Mental Health Problems in Adolescents with Delayed Sleep Phase: Results from a Large Population-Based Study in Norway","volume":"24","author":"Sivertsen","year":"2015","journal-title":"J. Sleep Res."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/20\/6570\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:08:16Z","timestamp":1760130496000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/20\/6570"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,17]]},"references-count":58,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["jcm12206570"],"URL":"https:\/\/doi.org\/10.3390\/jcm12206570","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,17]]}}}