Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas.
J Clin Sleep Med. 2023 Aug 1;19(8):1389-1398. doi: 10.5664/jcsm.10584.
Sleep disturbances are common in military personnel with posttraumatic stress disorder (PTSD) and may persist following treatment. This study examined service members seeking treatment for PTSD, reporting insomnia symptoms, nightmares, excessive daytime sleepiness, and potential obstructive sleep apnea at baseline and the impact of sleep disturbances on a course of PTSD treatment.
In this secondary analysis, sleep was evaluated in 223 service members who participated in a randomized clinical trial comparing Cognitive Processing Therapy for PTSD delivered in individual or group formats. Sleep assessments included the Insomnia Severity Index, the Trauma-Related Nightmare Survey, and Epworth Sleepiness Scale administered at baseline and 2 weeks posttreatment.
Following PTSD treatment, there were significant improvements for insomnia symptoms ( = -1.49; = -0.27), nightmares ( = -0.35; = -0.27), and excessive daytime sleepiness ( = -0.91; = -0.16). However, mean scores remained in clinical ranges at posttreatment. Participants with baseline insomnia symptoms had worse PTSD severity throughout treatment. Participants with baseline excessive daytime sleepiness or probable obstructive sleep apnea had greater PTSD severity reductions when treated with Cognitive Processing Therapy individually vs. in a group. Those with insomnia symptoms, nightmare disorder, and sleep apnea had greater depressive symptoms throughout treatment.
Insomnia symptoms, nightmares, and excessive daytime sleepiness were high at baseline in service members seeking treatment for PTSD. While sleep symptoms improved with PTSD treatment, these sleep disorders were related to worse treatment outcomes with regards to symptoms of PTSD and depression. Individual Cognitive Processing Therapy is recommended over group Cognitive Processing Therapy for patients with either excessive daytime sleepiness or probable obstructive sleep apnea.
Registry: ClinicalTrials.gov; Name: Group vs. Individual Cognitive Processing Therapy for Combat-related PTSD; URL: https://clinicaltrials.gov/ct2/show/NCT02173561; Identifier: NCT02173561.
Puriksma KE, Taylor DJ, Wachen JS, et al. Self-reported sleep problems in active-duty US Army personnel receiving posttraumatic stress disorder treatment in group or individual formats: secondary analysis of a randomized clinical trial. . 2023;19(8):1389-1398.
创伤后应激障碍（PTSD）患者常伴有睡眠障碍，且这些障碍可能在治疗后持续存在。本研究旨在调查接受 PTSD 治疗的现役军人，报告失眠症状、噩梦、日间嗜睡和潜在阻塞性睡眠呼吸暂停的基线情况，并评估睡眠障碍对 PTSD 治疗过程的影响。
在这项二次分析中，对 223 名参加比较个体或小组形式认知加工治疗 PTSD 的随机临床试验的现役军人进行睡眠评估。睡眠评估包括基线和治疗后 2 周时的失眠严重程度指数、创伤相关噩梦调查和 Epworth 嗜睡量表。
PTSD 治疗后，失眠症状（ = -1.49； = -0.27）、噩梦（ = -0.35； = -0.27）和日间嗜睡（ = -0.91； = -0.16）均有显著改善。然而，治疗后平均得分仍处于临床范围。基线时存在失眠症状的参与者在整个治疗过程中 PTSD 严重程度更差。与小组认知加工治疗相比，个体认知加工治疗对基线时日间嗜睡或可能的阻塞性睡眠呼吸暂停的参与者，PTSD 严重程度降低更大。基线时有失眠症状、噩梦障碍和睡眠呼吸暂停的患者在整个治疗过程中抑郁症状更严重。
寻求 PTSD 治疗的现役军人基线时失眠症状、噩梦和日间嗜睡均较高。虽然睡眠症状随着 PTSD 治疗而改善，但这些睡眠障碍与 PTSD 和抑郁症状的治疗结局较差有关。对于日间嗜睡或可能的阻塞性睡眠呼吸暂停患者，建议使用个体认知加工治疗而非小组认知加工治疗。
注册号：ClinicalTrials.gov；名称：团体与个体认知加工疗法治疗与战斗相关 PTSD；网址：https://clinicaltrials.gov/ct2/show/NCT02173561；标识符：NCT02173561。
Puriksma KE, Taylor DJ, Wachen JS, et al. Self-reported sleep problems in active-duty US Army personnel receiving posttraumatic stress disorder treatment in group or individual formats: secondary analysis of a randomized clinical trial.. 2023;19(8):1389-1398.
