Shannon R Miles1,2, Kristi E Pruiksma3,4, Danica Slavish5, Jessica R Dietch6, Sophie Wardle-Pinkston7, Brett T Litz8,9,10, Matthew Rodgers11, Karin L Nicholson11, Stacey Young-McCaughan3,4, Katherine A Dondanville3, Risa Nakase-Richardson1,12, Jim Mintz3,4, Terence M Keane9,13, Alan L Peterson3,4,14, Patricia A Resick15, Daniel J Taylor7. 1. James A. Haley Veterans' Hospital, Tampa, Florida. 2. Department of Psychiatry & Behavioral Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida. 3. Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas. 4. Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas. 5. Department of Psychology, University of North Texas, Denton, Texas. 6. School of Psychological Science, Oregon State University, Corvallis, Oregon. 7. Department of Psychology, University of Arizona, Tucson, Arizona. 8. Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts. 9. Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts. 10. Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts. 11. Carl R. Darnall Army Medical Center, Fort Hood, Texas. 12. Division of Pulmonary and Sleep Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida. 13. Behavioral Science Division, National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts. 14. Department of Psychology, University of Texas at San Antonio, San Antonio, Texas. 15. Duke Health, Durham, North Carolina.
Abstract
STUDY OBJECTIVES: Characterize associations between sleep impairments and posttraumatic stress disorder (PTSD) symptoms, including anger, in service members seeking treatment for PTSD. METHODS: Ninety-three US Army personnel recruited into a PTSD treatment study completed the baseline assessment. State-of-the-science sleep measurements included 1) retrospective, self-reported insomnia, 2) prospective sleep diaries assessing sleep patterns and nightmares, and 3) polysomnography measured sleep architecture and obstructive sleep apnea-hypopnea severity. Dependent variables included self-report measures of PTSD severity and anger severity. Pearson correlations and multiple linear regression analyses examined if sleep symptoms, not generally measured in PTSD populations, were associated with PTSD and anger severity. RESULTS: All participants met PTSD, insomnia, and nightmare diagnostic criteria. Mean sleep efficiency = 70%, total sleep time = 5.5 hours, obstructive sleep apnea/hypopnea (obstructive sleep apnea-hypopnea index ≥ 5 events/h) = 53%, and clinically significant anger = 85%. PTSD severity was associated with insomnia severity (β = .58), nightmare severity (β = .24), nightmare frequency (β = .31), and time spent in Stage 1 sleep (β = .27, all P < .05). Anger severity was associated with insomnia severity (β = .37), nightmare severity (β = .28), and obstructive sleep apnea-hypopnea during rapid eye movement sleep (β = .31, all P < .05). CONCLUSIONS: Insomnia and nightmares were related to PTSD and anger severity, and obstructive sleep apnea-hypopnea was related to anger. Better assessment and evidence-based treatment of these comorbid sleep impairments in service members with PTSD and significant anger should result in better PTSD, anger, and quality-of-life outcomes. CLINICAL TRIALS REGISTRATION: Registry: ClinicalTrials.gov; Name: Treatment of Comorbid Sleep Disorders and Post Traumatic Stress Disorder; Identifier: NCT02773693; URL: https://clinicaltrials.gov/ct2/show/NCT02773693. CITATION: Miles SR, Pruiksma KE, Slavis D, et al. Sleep disorder symptoms are associated with greater posttraumatic stress and anger symptoms in US Army service members seeking treatment for posttraumatic stress disorder. J Clin Sleep Med. 2022;18(6):1617-1627.
STUDY OBJECTIVES: Characterize associations between sleep impairments and posttraumatic stress disorder (PTSD) symptoms, including anger, in service members seeking treatment for PTSD. METHODS: Ninety-three US Army personnel recruited into a PTSD treatment study completed the baseline assessment. State-of-the-science sleep measurements included 1) retrospective, self-reported insomnia, 2) prospective sleep diaries assessing sleep patterns and nightmares, and 3) polysomnography measured sleep architecture and obstructive sleep apnea-hypopnea severity. Dependent variables included self-report measures of PTSD severity and anger severity. Pearson correlations and multiple linear regression analyses examined if sleep symptoms, not generally measured in PTSD populations, were associated with PTSD and anger severity. RESULTS: All participants met PTSD, insomnia, and nightmare diagnostic criteria. Mean sleep efficiency = 70%, total sleep time = 5.5 hours, obstructive sleep apnea/hypopnea (obstructive sleep apnea-hypopnea index ≥ 5 events/h) = 53%, and clinically significant anger = 85%. PTSD severity was associated with insomnia severity (β = .58), nightmare severity (β = .24), nightmare frequency (β = .31), and time spent in Stage 1 sleep (β = .27, all P < .05). Anger severity was associated with insomnia severity (β = .37), nightmare severity (β = .28), and obstructive sleep apnea-hypopnea during rapid eye movement sleep (β = .31, all P < .05). CONCLUSIONS: Insomnia and nightmares were related to PTSD and anger severity, and obstructive sleep apnea-hypopnea was related to anger. Better assessment and evidence-based treatment of these comorbid sleep impairments in service members with PTSD and significant anger should result in better PTSD, anger, and quality-of-life outcomes. CLINICAL TRIALS REGISTRATION: Registry: ClinicalTrials.gov; Name: Treatment of Comorbid Sleep Disorders and Post Traumatic Stress Disorder; Identifier: NCT02773693; URL: https://clinicaltrials.gov/ct2/show/NCT02773693. CITATION: Miles SR, Pruiksma KE, Slavis D, et al. Sleep disorder symptoms are associated with greater posttraumatic stress and anger symptoms in US Army service members seeking treatment for posttraumatic stress disorder. J Clin Sleep Med. 2022;18(6):1617-1627.
Authors: Joan M Cook; Gerlinde C Harb; Philip R Gehrman; Mark S Cary; Geraldine M Gamble; David Forbes; Richard J Ross Journal: J Trauma Stress Date: 2010-10
Authors: Patricia L Haynes; Iva Skobic; Dana R Epstein; Sarah Emert; Sairam Parthasarathy; Suzanne Perkins; James Wilcox Journal: Behav Sleep Med Date: 2019-11-18 Impact factor: 2.964
Authors: Shannon R Miles; Kirsten H Dillon; Vanessa M Jacoby; Willie J Hale; Katherine A Dondanville; Jennifer Schuster Wachen; Jeffrey S Yarvis; Alan L Peterson; Jim Mintz; Brett T Litz; Stacey Young-McCaughan; Patricia A Resick Journal: J Clin Psychol Date: 2019-11-16