Acheson Dean T, Kwan Brian, Maihofer Adam X, Risbrough Victoria B, Nievergelt Caroline M, Clark Jacob W, Tu Xin M, Irwin Michael R, Baker Dewleen G
Center for Excellence in Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA.
Department of Psychiatry, University of California San Diego, San Diego, CA, USA.
Eur J Psychotraumatol. 2019 Oct 29;10(1):1679964. doi: 10.1080/20008198.2019.1679964. eCollection 2019.
: Insomnia is common in service members and associated with many mental and physical health problems. Recently, longitudinal data have been used to assess the impact of disturbed sleep on mental health outcomes. These studies have consistently shown relationships between sleep disturbance and development of mental illness. : The present study examined the longitudinal relationship between sleep disturbance and PTSD symptomatology in a cohort of Marines and Navy Corpsmen deployed to Iraq and Afghanistan (n = 2,404) assessed prior to deployment, as well as at -3 and 6 months post-deployment. Additionally, we aimed to investigate the extent to which these relationships are moderated by combat-stress severity, and to what extent these findings are replicated in a second, separate cohort of Marines and Navy corpsmen (n = 938) assessed with identical measures prior to deployment and within 3 months of return. : The present study employed latent variable path models to examine the relationships between pre-deployment sleep disturbance and post-deployment re-experiencing symptoms. Initial cross-lagged path models were conducted on discovery and replication samples to validate the hypothesized predictive relationships. Follow up moderation path models were then conducted to include the effect of combat-stress severity on these relationships. : Initial cross-lagged models supported a significant relationship between pre-deployment sleep disturbance and future re-experiencing PTSD symptoms at all time points. Initial moderation models showed a small moderator effect of combat-stress severity, though the main predictive relationship between pre-deployment sleep disturbance and PTSD symptoms remained significant. The moderator effect was not significant in the replication sample. : The results of this study support pre-deployment sleep disturbance as a risk factor for development of post-deployment PTSD symptoms. Interventions aimed at normalizing sleep may be important in preventive measures for PTSD.
失眠在军人中很常见，且与许多身心健康问题相关。最近，纵向数据已被用于评估睡眠紊乱对心理健康结果的影响。这些研究一致表明睡眠紊乱与精神疾病的发展之间存在关联。
本研究考察了部署到伊拉克和阿富汗的一批海军陆战队队员和海军医护兵（n = 2404）在部署前、部署后3个月和6个月时睡眠紊乱与创伤后应激障碍（PTSD）症状之间的纵向关系。此外，我们旨在调查这些关系在多大程度上受到战斗压力严重程度的调节，以及这些发现在另一组单独的海军陆战队队员和海军医护兵（n = 938）中能在多大程度上得到重复，这组人员在部署前和返回后3个月内采用相同的测量方法进行评估。
本研究采用潜在变量路径模型来检验部署前睡眠紊乱与部署后重新体验症状之间的关系。最初的交叉滞后路径模型在发现样本和重复样本上进行，以验证假设的预测关系。随后进行后续调节路径模型，以纳入战斗压力严重程度对这些关系的影响。
最初的交叉滞后模型支持部署前睡眠紊乱与所有时间点未来重新体验PTSD症状之间存在显著关系。最初的调节模型显示战斗压力严重程度有较小的调节作用，尽管部署前睡眠紊乱与PTSD症状之间的主要预测关系仍然显著。在重复样本中调节作用不显著。
本研究结果支持部署前睡眠紊乱是部署后PTSD症状发展的一个风险因素。旨在使睡眠正常化的干预措施在PTSD的预防措施中可能很重要。
