January 9, 2020
Caleb Rans | Psychiatry Advisor
Insomnia-related sleep complaints were found to be highly prevalent in veterans with post-traumatic stress disorder (PTSD), according to the results of a study published in the Journal of Traumatic Stress.
The researchers analyzed data from 1649 combat-exposed United States military veterans who were evaluated at a Veterans Affairs facility from 2009 to 2012 after deployment to the wars in Iraq and/or Afghanistan. Overall, the cohort was well-balanced, including near equal numbers of male and female veterans, socioeconomic diversity, and a wide range of comorbidities. The study included both veterans with PTSD (n=1039) and controls without PTSD (n=610). Data were collected from various sources, including electronic medical records, diagnostic interviews, and self-report evaluations. The patients were assessed at 2 timepoints: baseline (T1) and follow-up (T2), with 2.5 years comprising the average time between evaluations.
The researchers found that 74% of patients with PTSD reported insomnia-related sleep disturbances for at least 50% of the nights in the previous 30 days when measured at T1. Overall, 33% of patients had received a sedative-hypnotic drug prescription in the past year. Patients without a clinical diagnosis of PTSD had fewer sleep difficulties, but the prevalence was high among all veterans.
With respect to gender differences, the overall prevalence of sleep complaints was similar between male and female patients; however, the number of prescriptions for sedative hypnotics was greater for female veterans with PTSD compared with their male counterparts (40.4% vs 35.0%, respectively; P =.006).
Across timepoints T1 and T2, levels of PTSD symptom severity and insomnia frequency were highly consistent and strongly associated with one another (all P <.001). A significant cross-lagged effect was found, with insomnia frequency at T1 predicting PTSD severity at T2 (B, 0.27; P <.001) and PTSD severity at T1 predicting the frequency of sleep problems at T2 (B, 0.04; P <.001). In a regression model, sleep problem frequency predicted PTSD symptoms at T2 for veterans with PTSD at T1 (B, 0.20; P =.011).
“Given the frequency of sleep disturbance complaints in our cohort overall, insomnia is an obvious, high-value target for intervention in veterans with PTSD,” the investigators reported.
One key study limitation was the use of self-reported outcome measures and, as the investigators noted, the official diagnostic criteria for PTSD changed between the 2 timepoints.
“Ongoing efforts are currently under way in the VA to focus on treating insomnia (eg, implementing the provision of cognitive behavioral therapy for insomnia). Our findings support the value of these efforts, particularly among veterans with PTSD,” the researchers concluded.
Rosen RC, Cikesh B, Fang S, et al. Posttraumatic stress disorder severity and insomnia-related sleep disturbances: longitudinal associations in a large, gender-balanced cohort of combat-exposed veterans [published online December 4, 2019]. J Trauma Stress. doi:10.1002/jts.22462