VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, United States; University of California, Department of Psychiatry, 9500 Gilman Drive, San Diego, CA 92093, United States; VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, MC 116A, San Diego, CA 92161, United States; National Center for PTSD, 215 North Main Street, White River Junction, VT 05009, United States.
Department of Psychiatry, University of California, San Francisco, United States; Sierra Pacific Mental Illness Research Education and Clinical Centers, San Francisco VA Healthcare System, United States.
Drug Alcohol Depend. 2020 Apr 1;209:107905. doi: 10.1016/j.drugalcdep.2020.107905. Epub 2020 Feb 11.
Insomnia is highly co-occurring with both posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). This is concerning since insomnia contributes to worse substance abuse and PTSD, and a host of negative health consequences. No study has tracked how sleep indices and insomnia change related to integrated PTSD and AUD treatment using evidence-based exposure therapy. This study examined how insomnia changes over time in a randomized control trial of two integrated PTSD and AUD treatments.
Participants were 119 adult veterans (90 % male) seeking treatment for AUD and PTSD at a large urban VA. Participants were randomized to either COPE (integrated treatment using prolonged exposure) or Seeking Safety (integrated therapy using cognitive behavioral, interpersonal techniques and case management). Assessments were done at pre- and post-treatment and include: Clinician Administered PTSD Scale, Timeline Follow-back calendar-assisted interview for AU, insomnia severity index (ISI), sleep diary and actigraphy for 7 days.
ISI showed significant decreases, but a majority remained above the clinical cutoff at post-treatment. Wake after sleep onset decreased, but only by 8 min, remaining above clinical thresholds. Decreases in PTSD, but not in heavy drinking, predicted change in ISI. No significant changes were observed in other sleep variables measured.
Findings suggested some statistical improvements in sleep quality, but sleep indices remained above clinical cut-offs. This study provides evidence that insomnia is an independent disorder and not responsive to PTSD or AUD treatments alone. Sleep symptoms should be assessed and treated in patients with comorbid mental health conditions.
失眠症与创伤后应激障碍（PTSD）和酒精使用障碍（AUD）高度共病。这令人担忧，因为失眠症会导致更严重的物质滥用和 PTSD，以及一系列负面的健康后果。没有研究跟踪使用基于证据的暴露疗法对综合 PTSD 和 AUD 治疗时睡眠指数和失眠症的变化。本研究通过两项综合 PTSD 和 AUD 治疗的随机对照试验，考察了失眠症随时间的变化。
参与者是 119 名寻求治疗 AUD 和 PTSD 的成年退伍军人（90%为男性），他们在一家大型城市退伍军人事务部接受治疗。参与者被随机分配到 COPE（使用延长暴露的综合治疗）或寻求安全（使用认知行为、人际技术和案例管理的综合治疗）。在治疗前和治疗后进行评估，包括：临床医生管理的 PTSD 量表、用于 AU 的时间表随访日历辅助访谈、失眠严重程度指数（ISI）、睡眠日记和 7 天的活动记录仪。
ISI 显著下降，但大多数仍高于治疗后的临床截止值。睡眠后醒来时间减少，但仅减少 8 分钟，仍高于临床阈值。PTSD 的减少，但不是大量饮酒，预测 ISI 的变化。未观察到其他测量的睡眠变量有显著变化。
研究结果表明睡眠质量有一些统计学上的改善，但睡眠指数仍高于临床截止值。本研究提供了证据表明失眠症是一种独立的疾病，不能仅通过 PTSD 或 AUD 治疗来改善。应评估和治疗患有共病精神健康状况的患者的睡眠症状。
