Investigating the link between subjective sleep quality, symptoms of PTSD, and level of functioning in a sample of trauma-affected refugees

Abstract

Study objectives To examine whether baseline sleep quality is associated with baseline symptoms of posttraumatic stress disorder (PTSD) and level of functioning, and whether baseline sleep quality and improvement of sleep quality are specific predictors of change in PTSD symptoms and level of functioning. Methods Data were derived from a four-armed randomised controlled superiority trial (N=219 trauma-affected refugees). All four groups received treatment as usual consisting of a 10-12 months bio-psycho-social treatment program with an additional differential treatment component added to each arm. We performed bivariate correlation analyses, multiple linear regression analyses and mediation analyses to examine associations between baseline sleep quality, change in sleep quality and treatment response for PTSD symptoms and level of functioning. Results Baseline sleep quality correlated with symptoms of PTSD (r = .33) and level of functioning (r=0.15). Baseline sleep quality, improvement of sleep quality and improvement of general well-being were predictors of treatment response for symptoms of PTSD and level of functioning when controlling for age, gender, and baseline symptoms of PTSD and depression. Conclusions We found that good sleep quality at baseline and improvement of sleep quality were predictors of PTSD treatment response. However, treatment response was more closely associated with improvement in general well-being. The results indicate that the effect of improved sleep quality was partly mediated by a more general mental state improvement. Further research is needed to differentiate if a selected subgroup of patients may profit from sleep enhancing treatment.

Associations between sleep problems and posttraumatic stress symptoms, social functioning, and quality of life in refugees with posttraumatic stress disorder

“…The entire sample exceeded the threshold for clinically relevant sleep problems, with participants reporting poor sleep quality and a lack of energy for daily tasks. These findings align with results reported by Sandahl et al (2017Sandahl et al ( , 2021, who assessed sleep problems among refugees with PTSD in Denmark. Our study extends these findings by focusing on refugees with PTSD in Germany and utilizing a multidimensional sleep inventory.…”

“…Our study extends these findings by focusing on refugees with PTSD in Germany and utilizing a multidimensional sleep inventory. Interestingly, the results are comparable to Sandahl and colleagues' (2021) findings, although, in contrast to that study, we did not employ sleep problems as an inclusion criterion. This underlines the significance of sleep problems in treatment‐seeking refugees with PTSD and strengthens the generalizability of our findings to refugees who are not specifically seeking treatment for sleep problems.…”

“…Moreover, in a sample of refugees and asylum seekers, Lies et al (2019) found that 75.5% of participants reported moderate-to-severe sleep difficulties, and a recent review by Richter et al (2020) established a prevalence of sleep problems in refugees ranging from 39% to 99%. Despite the high risk of PTSD in this population, only two studies (Sandahl et al, 2017(Sandahl et al, , 2021 have investigated the prevalence of sleep problems in refugees with diagnosed PTSD. However, Sandahl et al (2017) measured sleep problems using a single item with unknown psychometric properties, which cannot capture the multidimensionality of sleep problems.…”

Insomnia and post-migration stress among resettled Syrian refugees: a cross-sectional survey

“…While insomnia is also a symptom of PTSD, more than 4 in 10 of those who reported low levels of PTSS still scored above the (Short et al, 2020) and depression (Lee et al, 2016). Clinical studies of traumatised refugees suggest that improvement in sleep quality can reduce PTSS (Sandahl et al, 2021). Thus, early, and successful, intervention for insomnia could potentially improve the mental well-being of this at-risk group.…”

“…Furthermore, it is also a common symptom of post-traumatic stress disorder (PTSD) (Sandahl et al , 2017). Clinical studies suggest that improving sleep quality may reduce PTSD symptoms among refugees who have experienced trauma (Sandahl et al , 2021).…”