Sleep patterns in a sample of patients with post-traumatic disorder

Abstract

background : Although sleep disturbance is considered as a hallmark of post-traumatic stress disorder (PTSD), objective evidence for sleep disturbance in patients with PTSD has been equivocal. A growing body of evidence shows that disturbed sleep is more than a secondary symptom of PTSD; it seems to be a core feature. Objectives: This study was carried out to explore subjective and objective sleep disturbances in PTSD patients and the interrelationship between the severity of PTSD and sleep disturbances. The study was designed as a case-control cross-sectional study, in which 20 patients fulfilling the criteria of PTSD according to the Diagnostic and Statistical Manual of Mental Disorders – 4th ed. were recruited from the outpatient psychiatric clinics of the Institute of Psychiatry, Ain Shams University. Patients were selected irrespective of their sex, age between 18 and 45 years, and those who had not received any psychotropic medication 2 weeks before the study. Those with Axis-I comorbidity or any concurrent medical or neurological diseases were excluded. The patient group was compared with a control group which included 10 healthy volunteers matched for age, sex, and social standard selected from among employees of the Institute of Psychiatry, Ain Shams University. All patients were subjected to: (a) general medical and neurological examinations, (b) a Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders – 4th ed. Axis-I (SCID-I), (c) A PTSD checklist, (d) a Standardized Sleep Questionnaire, and (d) polysomnography (PSG) overnight. The control group completed a General Health Questionnaire to exclude any psychiatric comorbidity and was subjected to a physical examination, SCID-I (nonpatient version), a Standardized Sleep Questionnaire, and polysomnography. Statistical analysis of the data was carried out. The case group was found to have initial insomnia and interrupted sleep; in addition, they experienced nightmares and sleep talking. Sleep latency, sleep efficiency and arousal index were markedly affected in the case group. The study showed that there was a significant increase in both stages I and II non-rapid eye movements sleep, whereas stages III and IV were significantly decreased in patients with PTSD compared to their healthy counterparts. When we compared the two groups with respect to rapid eye movements sleep parameters, respiratory variables of sleep including hypoapnea, respiratory disturbance index, and the desaturation index, we did not find any statistically significant differences. However, the apnea index and periodic leg movements were significantly higher in the PTSD group. Our study showed that patients with PTSD had a disturbed sleep profile characterized by changes affecting non-rapid eye movements sleep parameters, with no marked correlation to the severity of PTSD. Thus, sleep hygiene counseling should be included in all treatment programs for PTSD patients. Authors would like to thank all patients and volunteers who kindly accepted to participate in our work.