Prior sleep problems and adverse post-traumatic neuropsychiatric sequelae of motor vehicle collision in the AURORA study

Abstract

Study objectives Many patients in Emergency Departments (ED) after motor vehicle collisions (MVC) develop posttraumatic stress disorder (PTSD) or major depressive episodes (MDE). This report from the AURORA study focuses on associations of pre-MVC sleep problems with these outcomes 8 weeks after MVC mediated through peritraumatic distress and dissociation and 2-week outcomes. Methods 666 AURORA patients completed self-report assessments in the ED and at 2 and 8 weeks after MVC. Peritraumatic distress, peritraumatic dissociation and pre-MVC sleep characteristics (insomnia, nightmares, daytime sleepiness and sleep duration in the 30 days before the MVC, trait sleep stress reactivity) were assessed retrospectively in the ED. The survey assessed acute stress disorder (ASD) and MDE at 2 weeks and at 8 weeks assessed PTSD and MDE (past 30 days). Control variables included demographics, MVC characteristics, and retrospective reports about PTSD and MDE in the 30 days before the MVC. Results Prevalence estimates were 41.0% for 2-week ASD, 42.0% for 8-week PTSD, 30.5% for 2-week MDE, and 27.2% for 8-week MDE. Pre-MVC nightmares and sleep stress reactivity predicted 8-week PTSD (mediated through 2-week ASD) and MDE (mediated through the transition between 2-week and 8-week MDE). Pre-MVC insomnia predicted 8-week PTSD (mediated through 2-week ASD). Estimates of population attributable risk suggest that blocking effects of sleep disturbance might reduce prevalence of 8-week PTSD and MDE by as much as one-third. Conclusions Targeting disturbed sleep in the immediate aftermath of MVC might be one effective way of reducing MVC-related PTSD and MDE.

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

“…This finding extends previous literature on the COVID‐19 pandemic linking short sleep duration with more severe PTSD when examined cross‐sectionally (Tang et al, 2020 ). Additionally, our results are consistent with other longitudinal studies identifying disrupted sleep as a risk factor for worsening PTSD symptoms (Neylan et al, 2021 ). Sleep disruption leads to impairments in fear processing (Colvonen et al, 2019 ), which in turn underlies many symptoms of PTSD.…”

“…et al, 2020). Additionally, our results are consistent with other longitudinal studies identifying disrupted sleep as a risk factor for worsening PTSD symptoms (Neylan et al, 2021). Sleep disruption leads to impairments in fear processing (Colvonen et al, 2019), which in turn underlies many symptoms of PTSD.…”

“…Sleep quality is an important risk factor for PTSD. Short sleep duration has been associated with PTSD symptoms during the COVID‐19 pandemic in cross‐sectional studies (Tang et al, 2020 ) and longitudinal studies have identified sleep disturbance as a risk factor for PTSD prior to and immediately after traumatic events (Neylan et al, 2021 ). Poor sleep is a treatable condition even with short‐term interventions (Germain & Buysse, 2011 ), making sleep an ideal potential target for reducing or preventing PTSD symptoms during and following the pandemic.…”

Disturbed Sleep in PTSD: Thinking Beyond Nightmares

“…Sleep disturbances prior to and/or shortly after trauma increase the risk for PTSD ( 5 , 12 ). For instance, in patients admitted to an emergency department after a motor vehicle collision both pre-trauma insomnia and nightmares predicted subsequent PTSD development ( 19 ). Furthermore, sleep disturbances affect the clinical course of PTSD: poor sleep quality is associated with reduced responsiveness to trauma-focused therapy [e.g., ( 20 , 21 )], while interventions targeting insomnia, nightmares or OSA improve sleep quality and ameliorate daytime PTSD symptoms ( 22 ).…”

Morning blue light treatment improves sleep complaints, symptom severity, and retention of fear extinction memory in post-traumatic stress disorder

“…The sleep problems often observed may be attributable to the occurrence of reduced slow-wave sleep, prolonged time spent in stage 1 sleep, as well as a higher density of rapid-eye movements during sleep cycles ( Kobayashi et al, 2007 ). The severity of sleep disturbance is also associated with PTSD symptom severity, and evidence suggests that sleep problems play a mediating role between exposure to stressors and the manifestation of symptoms contributing to PTSD ( Gehrman et al, 2013 ; Wang et al, 2019 ; Neylan et al, 2021 ). Restorative sleep offers one of the most potent non-pharmacologic mechanisms for influencing behavior and affect.…”