Nightmares, insomnia, and sleep-disordered breathing in fire evacuees seeking treatment for posttraumatic sleep disturbance

Sleep & Human Health Institute, 6739 Academy NE, Suite 380, Albuquerque, New Mexico 87109, USA.
Journal of Traumatic Stress (Impact Factor: 2.72). 07/2004; 17(3):257-68. DOI: 10.1023/B:JOTS.0000029269.29098.67
Source: PubMed


Eight months after the Cerro Grande Fire, 78 evacuees seeking treatment for posttraumatic sleep disturbances were assessed for chronic nightmares, psychophysiological insomnia, and sleep-disordered breathing symptoms. Within this sample, 50% of participants were tested objectively for sleep-disordered breathing; 95% of those tested screened positive for sleep-disordered breathing. Multiple regression analyses demonstrated that these three sleep disorders accounted for 37% of the variance in posttraumatic stress symptoms, and each sleep disorder was significantly and independently associated with posttraumatic stress symptoms severity. The only systematic variable associated with posttraumatic stress symptoms of avoidance was sleep-disordered breathing. The findings suggest that three common sleep disorders relate to posttraumatic stress symptoms in a more complex manner than explained by the prevailing psychiatric paradigm, which conceptualizes sleep disturbances in PTSD merely as secondary symptoms of psychiatric distress.

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    • "In addition, in one of these studies atypical symptoms included choking or gasping during sleep (Krakow et al., 2004), a symptom that in fact suggests the presence of breathing events. The lack of association between EDS or respiratory events and OSA suggests that the diagnostic criteria of mild OSA in psychiatric patients need further elaboration. "
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    ABSTRACT: Psychiatric diseases and symptoms are common among patients with obstructive sleep apnea (OSA). However, only a few studies have examined OSA in psychiatric patients. At the outpatient clinic of the Uusikaupunki Psychiatric Hospital, Finland, we used a low referral threshold to a diagnostic sleep study. An ambulatory cardiorespiratory polygraphy was performed in 114 of 221 patients. 95 patients were referred by the psychiatric clinic and 19 were examined in other clinical settings. We reviewed the medical files and retrospectively assessed the prevalence of OSA and the effect of gender, age, obesity, hypertension, type 2 diabetes, alcohol abuse, and symptoms suggesting OSA. 58 of the 221 patients (26.2%), 30 of 85 men (35.3%) and 28 of 136 women (20.6%), had OSA as determined by an apnea-hypopnea index (AHI) of 5/h or more. 20 patients (12 men and 8 women) had moderate or severe OSA (AHI ≥ 15/h). 46 patients (including 11 patients with moderate or severe OSA) were identified in the psychiatric clinic. In univariate analysis, a high body mass index, male gender, hypertension, snoring, and a history of witnessed apneas during sleep were associated with the presence of OSA. In multivariate analysis, a history of witnessed apneas did not remain significant. Age, type 2 diabetes, alcohol abuse, excessive daytime sleepiness (EDS), and fatigue did not associate with the presence of OSA. Our findings suggest that in psychiatric outpatients OSA is common but underdiagnosed. Presentation is often atypical, since many patients with OSA do not report witnessed apneas or EDS.
    Journal of Psychiatric Research 09/2015; 69:126-134. DOI:10.1016/j.jpsychires.2015.07.028 · 3.96 Impact Factor
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    • "In addition, utilizing a measure of sleep apnea will be important in future studies since this sleep disorder may contribute both to fatigue/lassitude and to psychological disorders like PTSD (Krakow et al., 2004). It would also be interesting to obtain objective measures of sleep disturbances (e.g., actigraphy and EEG) at baseline to see if these variables are related to increased risk for the development of internalizing disorders. "
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    ABSTRACT: There is growing evidence that disturbed sleep is a risk factor for the development of a number of psychiatric diagnoses including depression, PTSD and substance use. The goal of this study was to use a subset of participants from a larger prospective longitudinal study to examine whether preexisting daytime and nighttime sleep disturbances predict depression, PTSD and substance use in US National Guard Soldiers deployed to Iraq. Data on daytime and nighttime sleep complaints, baseline symptoms and personality variables were gathered prior to deployment to Iraq. Measures of psychopathology were collected at three time points post-deployment over the course of two years using both questionnaires and interviews. Multiple regressions were used to predict diagnoses and symptoms of depression, PTSD and substance use. Pre-deployment daytime and nighttime sleep complaints contributed significantly to the prediction of PTSD and depression up to two years after deployment, but not substance use. This study suggests that daytime and nighttime sleep complaints are a risk factor for internalizing disorders including PTSD and depression.
    Journal of anxiety disorders 07/2013; 27(5):512-519. DOI:10.1016/j.janxdis.2013.07.003 · 2.68 Impact Factor
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    • "Furthermore, 50Á70% of PTSD patients report recurrent nightmares (Kilpatrick et al., 1998; Leskin, Woodward, Young, & Sheikh, 2002; Neylan et al., 1998). Apart from those sleep disturbances listed in the clinical description of PTSD, periodic limb movements (PLMs) and sleep-disordered breathing (SDB) also often co-occur in PTSD patients: SDB has been found in 50Á90% of PTSD patients in different study populations (Krakow et al., 2001, 2002, 2004), and clinically significant increases in PLMs have been found in different PTSD populations of veterans and sexual assault survivors , compared to the non-PTSD control groups (Brown & Boudewyns, 1996; Krakow et al., 2000; Mellman, Kulick-Bell, Ashlock, & Nolan, 1995; Ross et al., 1994). "
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    ABSTRACT: Sleep disturbance is a common characteristic of patients with post-traumatic stress disorder (PTSD). Besides the clinical descriptions of nightmares and insomnia, periodic limb movements (PLMs) are reported to co-occur in PTSD. Although the causal relationship between sleep disturbance and PTSD is not fully understood, sleep disturbance is an independent risk factor for the development and reactivation of PTSD. In contrast, the link between PTSD and REM sleep behaviour disorder (RBD) is less clear. A case report is presented to illustrate differential diagnosis and time course of sleep disturbance in the context of PTSD. A 63-year-old man who had been successfully treated for PTSD but who suffered the re-occurrence of disturbed sleep due to RBD and PLM, which was misdiagnosed as reactivation of PTSD. RBD can mimic PTSD-related nightmares. Accurate diagnosis of sleep disturbance in PTSD is relevant for treatment and prognostic evaluation.
    European Journal of Psychotraumatology 04/2013; 4. DOI:10.3402/ejpt.v4i0.18714 · 2.40 Impact Factor
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