Sleep in posttraumatic stress disorder: A systematic review and meta-analysis of polysomnographic findings

Zhang, Ye; Ren, Rong; Sanford, Larry D.; Yang, Linghui; Zhou, Junying; Zhang, Jihui; Wing, Yun‐Kwok; Shi, Jie; Lü, Lin; Tang, Xiangdong

doi:10.1016/j.smrv.2019.08.004

Cited by 85 publications

(88 citation statements)

References 98 publications

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“…An actigraphy study found no association between sleep efficiency and nightmares in military veterans with PTSD (Miller et al, 2018). However, a meta-analysis of polysomnographic studies found that sleep efficiency was reduced among patients with PTSD (Zhang et al, 2019) and that REM interruption was also reported to correlate with nightmare complaints (Habukawa et al, 2018). Consistent with polysomnographic studies, our study also found the association between reduced sleep efficiency and frequent nightmares.…”

Section: Discussionsupporting

confidence: 84%

Reduced Sleep Duration and Sleep Efficiency Were Independently Associated With Frequent Nightmares in Chinese Frontline Medical Workers During the Coronavirus Disease 2019 Outbreak

Lin

et al. 2021

Front. Neurosci.

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ObjectivesNightmares were related to emotion and behavioral problems and also emerged as one of the core features of post-traumatic stress disorder (PTSD). Our study aimed to investigate the associations of frequent nightmares with sleep duration and sleep efficiency among frontline medical workers in Wuhan during the coronavirus disease 2019 (COVID-19) outbreak.MethodsA total of 528 health-care workers from the province of Fujian providing medical aid in Wuhan completed the online questionnaires. There were 114 doctors and 414 nurses. The age, sex, marital status, and work situation were recorded. A battery of scales including the Pittsburgh Sleep Quality Index (PSQI) and the 12-item General Health Questionnaire (GHQ-12) were used to evaluate subjects’ sleep and general mental health. Frequent nightmares were defined as the response of at least once a week in the item of “nightmare” of PSQI.ResultsFrequent nightmares were found in 27.3% of subjects. The frequent nightmare group had a higher score of PSQI-sleep duration and PSQI-habitual sleep efficiency (frequent nightmares vs. non-frequent nightmares: PSQI-sleep duration, 1.08 ± 0.97 vs. 0.74 ± 0.85, P < 0.001; PSQI-habitual sleep efficiency, 1.08 ± 1.10 vs. 0.62 ± 0.88, P < 0.001). Reduced sleep duration and reduced sleep efficiency were independently associated with frequent nightmares after adjustment for age, sex, poor mental health, and regular sleeping medication use (reduced sleep duration: OR = 1.96, 95% CI = 1.07–3.58, P = 0.029; reduced sleep efficiency: OR = 2.17, 95% CI = 1.09–4.32, P = 0.027). Subjects with both reduced sleep duration and sleep efficiency were also associated with frequent nightmares (OR = 2.70, 95% CI = 1.57–4.65, P < 0.001).ConclusionThe present study found that sleep duration and sleep efficiency were both independently associated with frequent nightmares among frontline medical workers in Wuhan during the COVID-19 pandemic. We should pay attention to nightmares and even the ensuing PTSD symptoms among subjects with reduced sleep duration or sleep efficiency facing potential traumatic exposure.

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Section: Discussionsupporting

confidence: 84%

Reduced Sleep Duration and Sleep Efficiency Were Independently Associated With Frequent Nightmares in Chinese Frontline Medical Workers During the Coronavirus Disease 2019 Outbreak

Lin

et al. 2021

Front. Neurosci.

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“…Importantly, the majority of mental disorders are not only characterized by maladaptive emotional memories but also by alterations in REM sleep, SWS and/or in spindle activity (e.g. [69][70][71][72][73]. A mechanistic impact of these sleep-related alterations in the development and maintenance of the respective disorders is likely, but far from being entirely elucidated.…”

Section: Discussionmentioning

confidence: 99%

Investigating the effect of a nap following experimental trauma on analogue PTSD symptoms

Wilhelm

Azza

Brennwald

et al. 2021

Sci Rep

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Cognitive models assume that the incomplete integration of a traumatic experience into the autobiographical memory results in typical symptoms associated with post-traumatic stress disorder (PTSD) such as intrusive re-experiencing. Sleep supports the integration of new experiences into existing memory networks through memory consolidation. In fifty-six females, we investigated whether a 90-min daytime nap (n = 33) compared to a wake period (n = 23) after being exposed to an experimental trauma (i.e. a trauma film) prevents PTSD analogue symptoms. Intrusive memories were recorded for seven days using a diary, overall PTSD symptoms were assessed using the Impact of Event Scale (IES-R) and affective response to trauma cues were measured one week after experimental trauma. The two groups did not differ in any of the analogue PTSD symptoms. However, participants obtaining rapid eye movement (REM) sleep in the nap experienced less distressing intrusive memories. Moreover, the duration of REM sleep and slow wave activity was negatively correlated with analogue PTSD symptoms. Our findings suggest that even a short sleep period after experimental trauma can play a protective role in trauma memory formation but only if the nap contains REM sleep. Our data provide additional evidence for a critical role of REM sleep in PTSD development.

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“…Therefore, sufficiently powered studies using ambulatory PSG are needed before any meaningful conclusions can be made. The pooled results of a recent meta-analysis of PSG studies found evidence of decreased total sleep time, slow wave sleep and sleep efficiency, as well as increased wake time after sleep onset in participants with PTSD compared with healthy controls, indicating the presence of differences that are not evident in the pooled results of actigraphy studies (Zhang et al, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

“…However, the extent to which these abnormalities were specific to PTSD was unclear (Kobayashi et al, 2007 ). The pooled results of a more recent meta-analysis of PSG studies found evidence of decreased total sleep time, slow wave sleep and sleep efficiency, as well as increased awakenings after sleep onset in participants with PTSD compared with healthy controls (Zhang et al, 2019 ). The review also indicated that REM sleep percentage was significantly decreased in participants with PTSD compared with healthy controls in studies including participants with mean age of less than 30, but not in studies with greater mean ages.…”

Section: Introductionmentioning

confidence: 99%

Sleep disturbance in post-traumatic stress disorder (PTSD): a systematic review and meta-analysis of actigraphy studies

Lewis

Kitchiner

et al. 2020

European Journal of Psychotraumatology

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Background: Sleep disturbance has been described as a 'hallmark' symptom of posttraumatic stress disorder (PTSD). Although there are robust findings of self-reported sleep disturbance in PTSD, evidence of sleep disturbance measured using actigraphy is less certain. Objective: To conduct a systematic review and meta-analysis to determine whether there are any significant differences between individuals with and without PTSD in actigraphderived sleep measures. Method: Case-control studies comparing participants with current PTSD to those without PTSD were eligible for inclusion. Sleep parameters of interest were: (1) total sleep time; (2) sleep onset latency; (3) wake after sleep onset (WASO); and (4) sleep efficiency. Data were meta-analysed as standardised mean differences (SMDs) and potential sources of heterogeneity were explored through meta-regression. Six actigraphy studies with 405 participants were included. Results: There was no evidence of a statistically significant difference between those with and without PTSD in total sleep time (SMD 0.09, 95%CI −0.23 to 0.42); WASO (SMD 0.18, 95% CI −0.06 to 0.43); sleep latency (SMD 0.32, 95%CI −0.04 to 0.69); or sleep efficiency (SMD −0.28, 95%CI −0.78 to 0.21). Conclusions: Further high-quality research is required to determine whether there is a true difference in sleep between those with and without PTSD. Perturbación del sueño en el Trastorno de Estrés Postraumático (TEPT): una revisión sistemática y metaanálisis de estudios de actigrafía Antecedentes: La perturbación del sueño se ha descrito como un síntoma 'distintivo' del trastorno de estrés postraumático (TEPT). Aunque existen hallazgos sólidos de trastornos del sueño en el TEPT a través de auto-reportes, la evidencia de éstos medidos con el uso de actigrafía es más incierta. Objetivo: Realizar una revisión sistemática y un metanálisis para determinar si hay diferencias significativas entre los individuos con y sin TEPT en medidas de sueño derivadas de la actigrafía. Método: Los estudios de casos y controles incluidos como elegibles fueron aquéllos que compararon participantes con TEPT en curso con aquellos participantes sin TEPT. Los parámetros de sueño de interés fueron: (1) tiempo total del sueño; (2) latencia del inicio del sueño; (3) vigilia después del inicio de sueño (wake after sleep onset, WASO, en su sigla en inglés); y (4) eficiencia del sueño. Los datos fueron meta-analizados como diferencias de medias estandarizadas (DME) y se exploraron las posibles fuentes de heterogeneidad mediante metarregresión. Se incluyeron seis estudios de actigrafía con 405 participantes. Resultados: No hubo evidencia de una diferencia estadísticamente significativa entre aquellos con y sin TEPT en el tiempo total del sueño (DME 0.09, IC 95%: −0,23 a 0,42); WASO (DME 0.18, IC 95% −0.06 a 0.43); latencia del sueño (SMD 0.32, IC 95% −0.04 a 0.69); o eficiencia del sueño (SMD −0.28, IC 95% −0.78 a 0.21). Conclusiones: Se requieren futuras investigaciones de alta calidad para determinar si existe una verdadera diferencia ...

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Sleep in posttraumatic stress disorder: A systematic review and meta-analysis of polysomnographic findings

Cited by 85 publications

References 98 publications

Reduced Sleep Duration and Sleep Efficiency Were Independently Associated With Frequent Nightmares in Chinese Frontline Medical Workers During the Coronavirus Disease 2019 Outbreak

Reduced Sleep Duration and Sleep Efficiency Were Independently Associated With Frequent Nightmares in Chinese Frontline Medical Workers During the Coronavirus Disease 2019 Outbreak

Investigating the effect of a nap following experimental trauma on analogue PTSD symptoms

Sleep disturbance in post-traumatic stress disorder (PTSD): a systematic review and meta-analysis of actigraphy studies

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