Baseline sleep quality moderates symptom improvement in veterans with comorbid PTSD and TBI receiving trauma-focused treatment

Sullan, Molly J.; Crocker, Laura D.; Thomas, Kelsey R.; Orff, Henry J.; Davey, Delaney K.; Jurick, Sarah M.; Twamley, Elizabeth W.; Norman, Sonya B.; Schiehser, Dawn M.; Aupperle, Robin L.; Jak, Amy J.

doi:10.1016/j.brat.2021.103892

Cited by 9 publications

(7 citation statements)

References 52 publications

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Section: Thesupporting

confidence: 84%

“…This finding is in line with evidence that fear reinstatement is associated with more severe PTSD symptoms but only among individuals with poor sleep (Zuj et al, 2018 ). Additionally, poor baseline sleep quality has been shown to interfere with trauma‐focussed treatment among Veterans with PTSD and traumatic brain injury (Sullan et al, 2021 ). Taken together, these findings suggest that poor sleep may not be a stand‐alone risk factor but may act as a vulnerability factor to reduce capacity to cope with other stressors.…”

Section: Discussionmentioning

confidence: 99%

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Worse sleep, worsening post‐traumatic stress disorder (PTSD): Poor sleep quality associated with increases in PTSD symptoms amongst those experiencing high threat of the COVID‐19 pandemic

Straus

Dolsen

Nishimi

et al. 2022

Journal of Sleep Research

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Summary The coronavirus disease 2019 (COVID‐19) pandemic is a global health crisis with the potential to elicit and worsen psychiatric symptoms, particularly post‐traumatic stress disorder (PTSD) symptoms. Identifying modifiable protective factors is critical for preventing and treating PTSD symptoms both during and following the COVID‐19 pandemic. The present study examined associations of self‐reported sleep quality and anticipatory threat appraisals of the pandemic with PTSD symptoms 6 months later in a sample enriched for pre‐pandemic trauma exposure and PTSD. The sample included 590 adults (mean age 38.2 years) who completed a baseline survey in August/September 2020 and follow‐up survey in March/April 2021. The sample was recruited from a pool of participants interested in a prior study about traumatic stress. Participants self‐reported sleep quality and pandemic‐related anticipatory threat appraisals at baseline. PTSD symptoms were assessed at baseline and follow‐up. Baseline sleep quality was associated with PTSD symptoms at follow‐up controlling for baseline PTSD symptoms ( B = −2.49, p = 0.001). Perceived anticipatory threat of the pandemic moderated this association such that worse sleep quality was related to more severe PTSD symptoms at follow‐up for participants with higher ( B = −4.07, p < 0.001) but not lower ( B = −0.43, p = 0.679) anticipatory threat about the COVID‐19 pandemic. These findings suggest that poor sleep quality may enhance vulnerability to later PTSD symptoms during the pandemic, particularly among those individuals who perceived the pandemic as threatening for their future. Treatments that address sleep problems may be beneficial for reducing trauma‐related symptoms during and following the global health crisis.

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Section: Thesupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Worse sleep, worsening post‐traumatic stress disorder (PTSD): Poor sleep quality associated with increases in PTSD symptoms amongst those experiencing high threat of the COVID‐19 pandemic

Straus

Dolsen

Nishimi

et al. 2022

Journal of Sleep Research

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“…For example, OSA is associated with higher severity of PTSD symptoms ( Mayer et al., 2021 ; Miles et al., 2022 ), worsened insomnia symptoms ( Krakow et al., 2019 ) and poorer PTSD treatment outcome ( Reist et al., 2017 ; Taylor et al., 2020 ) whereas treatment of OSA is associated with an improved PTSD therapeutic outcome ( Hurwitz and Khawaja, 2010 ; Krakow et al., 2000 , 2019 ). Similarly, pre-treatment insomnia is associated with lesser treatment gains ( Sullan et al., 2021 ) and residual sleep symptoms have been shown to predict poorer response to prolonged exposure therapy (PE) ( Brownlow et al., 2016 ; Lopez et al., 2017 ; Taylor et al., 2020 ). In addition to OSA and insomnia, primary sleep disorders such as periodic limb movement disorder (PLMD) are frequently observed in PTSD ( Brown and Boudewyns, 1996 ; Koffel et al., 2016 ; Ross et al., 1994 ).…”

Section: Sleep Extinction and The Early Development Of Ptsdmentioning

confidence: 99%

The influence of sleep on fear extinction in trauma-related disorders

Pace‐Schott

Seo

Bottary

2023

Neurobiology of Stress

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“…Overall, 16 primary studies were deemed eligible for this review. [42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57] Key characteristics for each study are presented in Table 1. RoB.…”

Section: Study Characteristicsmentioning

confidence: 99%

Effects of sleep disturbance on trauma‐focused psychotherapy outcomes in posttraumatic stress disorder: A systematic review

Bottari

Trifilio

Janicke

et al. 2023

Annals of the New York Academy of Sciences

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This study aimed to synthesize existing research on the effects of sleep disturbances on trauma‐focused psychotherapy outcomes in adults with posttraumatic stress disorder (PTSD). A systematic review using PubMed, PsycINFO, Embase, Web of Science, and PTSDpubs was performed up to April 2021. Two independent reviewers screened articles for inclusion, performed data extraction, and assessed risk of bias and certainty of the evidence. Narrative synthesis was conducted based on the type of sleep disorder symptom assessed. Sixteen primary studies were included in this review, the majority of which had a high overall risk of bias. Results suggested that sleep disorder symptoms were associated with higher overall PTSD severity across treatment; however, they did not interfere with treatment effectiveness, with the exception of sleep‐disordered breathing. Improvements in insomnia, sleep duration, and sleep quality during treatment were associated with greater treatment gains. Certainty of the evidence ranged from low to very low. These results suggest that it may not be necessary to address sleep disorder symptoms prior to initiating trauma‐focused psychotherapy. Instead, concurrent treatment of sleep‐ and trauma‐related symptoms may be most beneficial. Continued research is needed to clarify the mechanistic relationship between sleep and treatment outcomes and to guide clinical decision‐making.

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Baseline sleep quality moderates symptom improvement in veterans with comorbid PTSD and TBI receiving trauma-focused treatment

Cited by 9 publications

References 52 publications

Worse sleep, worsening post‐traumatic stress disorder (PTSD): Poor sleep quality associated with increases in PTSD symptoms amongst those experiencing high threat of the COVID‐19 pandemic

Worse sleep, worsening post‐traumatic stress disorder (PTSD): Poor sleep quality associated with increases in PTSD symptoms amongst those experiencing high threat of the COVID‐19 pandemic

The influence of sleep on fear extinction in trauma-related disorders

Effects of sleep disturbance on trauma‐focused psychotherapy outcomes in posttraumatic stress disorder: A systematic review

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