PURPOSE: Poor sleep quality, insomnia and daytime somnolence are common among recently deployed Soldiers and those with Post Traumatic Stress Disorder. We sought to determine the prevalence of sleep complaints and sleep disorders among recently deployed Soldiers with PTSD.
METHODS: We analyzed the records of 80 consecutive Soldiers returning from combat and diagnosed with PTSD. We determined the rate of sleep complaints and prevalence of insomnia and obstructive sleep apnea. We compared demographic data, psychoactive medication use, psychiatric disorders and concomitant traumatic brain injury (TBI) to determine if any variables correlated with increased sleep complaints or disorders.
RESULTS: 80 consecutive patients were included. 89.6% were men (mean age 37.7±0.3 years, mean BMI 29.0±0.3 Kg/m2). 76.1% had depression and 30.1% had anxiety. 91% were taking psychoactive medications (average 3.9 Rx/patient). 92.5% reported sleep complaints (46.8% difficulty falling asleep, 35.8% nocturnal awakenings). Insomnia was diagnosed in 52.8%. Mean ESS was 10.5±0.5. 72% underwent polysomnography (mean sleep latency 17.8±6.6 minutes, mean sleep efficiency 84.5±9.2%). Sleep fragmentation was common (mean arousal index 27.7±2.6 events/hour). 61% were diagnosed with OSA (mean AHI 21.8±3.3 events/hour). Those with OSA had less use of narcotics and benzodiazepines and a lower prevalence of TBI than those without OSA.TBI occurred in 50.7%, equally divided among blast and blunt mechanism. TBI was associated with more sleep fragmentation and insomnia, but less OSA, sleepiness and depression than those without TBI. Blast injuries were more significantly associated with insomnia, sleep fragmentation and anxiety, while blunt trauma led to more somnolence and OSA.
CONCLUSION: Sleep complaints were almost universal among Soldiers with PTSD. The majority were diagnosed with insomnia and/or OSA. While most were taking psychoactive medications that can disrupt sleep or cause somnolence, the only variable that increased the presence of sleep disorders was concomitant TBI, with type of sleep disturbance differing based on mechanism of injury.
CLINICAL IMPLICATIONS: Given the common occurrence of sleep complaints and their potential clinical impact, patients with PTSD should be screened for sleep disorders.
DISCLOSURE: Nick Orr, No Financial Disclosure Information; No Product/Research Disclosure Information