The association of polysomnographic sleep on posttraumatic stress disorder symptom clusters in trauma-exposed civilians and veterans

Janeese A Brownlow; Katherine E Miller; Richard J Ross; Holly Barilla; Mitchel A Kling; Seema Bhatnagar; Thomas A Mellman; Philip R Gehrman

doi:10.1093/sleepadvances/zpac024

The association of polysomnographic sleep on posttraumatic stress disorder symptom clusters in trauma-exposed civilians and veterans

Sleep Adv. 2022 Aug 11;3(1):zpac024. doi: 10.1093/sleepadvances/zpac024. eCollection 2022.

Authors

Janeese A Brownlow¹, Katherine E Miller², Richard J Ross^{2

3}, Holly Barilla³, Mitchel A Kling^{2

3}, Seema Bhatnagar^{4

3}, Thomas A Mellman⁵, Philip R Gehrman^{3

2}

Affiliations

¹ College of Health and Behavioral Sciences, Delaware State University, Dover, DE, USA.
² Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.
³ Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
⁴ Children's Hospital of Philadelphia, Philadelphia, PA, USA.
⁵ Howard University College of Medicine, Washington, DC, USA.

Abstract

Study objectives: Self-reported sleep disturbance has been established as a risk factor and predictor for posttraumatic stress disorder (PTSD); however, less is known about the relationship between objective sleep and PTSD symptom clusters, and the specific role of hyperarousal. The present study examined the relationships between sleep continuity and architecture on PTSD symptom clusters.

Methods: Participants underwent two in-laboratory sleep studies to assess sleep continuity and architecture. They also completed the Clinician-Administered PTSD-IV scale and the Structured Clinical Interview for the DSM-IV to assess for PTSD diagnosis and other psychiatric disorders.

Results: Sleep continuity (i.e. total sleep time, sleep efficiency percent, wake after sleep onset, sleep latency) was significantly related to PTSD Cluster B (reexperiencing) symptom severity (R ² = .27, p < .001). Sleep architecture, specifically Stage N1 sleep, was significantly associated with PTSD Cluster B (t = 2.98, p = .004), C (Avoidance; t = 3.11, p = .003), and D (Hyperarosual; t = 3.79, p < .001) symptom severity independently of Stages N2, N3, and REM sleep. REM sleep variables (i.e. REM latency, number of REM periods) significantly predicted Cluster D symptoms (R ² = .17, p = .002).

Conclusions: These data provide evidence for a relationship between objective sleep and PTSD clusters, showing that processes active during Stage N1 sleep may contribute to PTSD symptomatology in civilians and veterans. Further, these data suggest that arousal mechanisms active during REM sleep may also contribute to PTSD hyperarousal symptoms.This paper is part of the War, Trauma, and Sleep Across the Lifespan Collection. This collection is sponsored by the Sleep Research Society.

Keywords: hyperarousal; posttraumatic stress disorder; sleep architecture; sleep continuity.

Abstract

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