Detailed Polysomnography in Australian Vietnam Veterans With and Without Posttraumatic Stress Disorder.

STUDY OBJECTIVES Recent results from the PTSD Initiative, a cross-sectional cohort study in Australian Vietnam veterans (VV) with and without posttraumatic stress disorder (PTSD), demonstrated an increased prevalence of self-reported sleep disturbances in those with PTSD. This study aimed to objectively assess the prevalence of sleep disorders in the same cohort using detailed polysomnography (PSG). METHODS Participants from the PTSD Initiative were recruited to undergo PSG. PTSD status was determined with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5). Subjective sleep information was attained via structured questionnaires. Data from single night PSG were compared between trauma-exposed VV with and without PTSD. RESULTS A total of 74 trauma-exposed male VV (40 with PTSD) underwent PSG (prospective n = 59, retrospective n = 15). All PSG parameters were similar between groups. No difference was seen in PSG-diagnosed obstructive sleep apnea (OSA) or periodic limb movements of sleep (PLMS). VV with PTSD showed a trend toward increased duration of sleep with oxygen saturations < 90% (10% versus 1.8%; P = .07). VV with PTSD reported increased sleep onset latency (42.4 versus 13.3 minutes; P < .01); were less likely to report sleeping well (32.5% versus 67.5%; P < .01); had higher OSA risk using Berlin Questionnaire (BQ) (70% versus 38.2%; P < .01); and had higher rates of partner-reported limb movements (56.4% versus 17.6%; P < .01). No association between PSG-diagnosed OSA and PTSD severity was evident. CONCLUSIONS In Australian VV with and without PTSD, no difference was seen across all PSG parameters including the diagnosis and severity of OSA and PLMS. However, VV with PTSD demonstrated an increased perception of sleep disturbances.

[1]  V. Mysliwiec,et al.  Trauma associated sleep disorder: A parasomnia induced by trauma. , 2018, Sleep medicine reviews.

[2]  R. Young,et al.  Physical comorbidities of post‐traumatic stress disorder in Australian Vietnam War veterans , 2017, The Medical journal of Australia.

[3]  R. Soufer,et al.  Post-traumatic Stress Disorder and Cardiovascular Disease , 2016, Current Cardiology Reports.

[4]  M. R. Ghadami,et al.  Sleep disturbances in veterans with chronic war-induced PTSD , 2016, Journal of injury & violence research.

[5]  B. Duce,et al.  The 2012 AASM Respiratory Event Criteria Increase the Incidence of Hypopneas in an Adult Sleep Center Population. , 2015, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[6]  B. Krakow,et al.  Posttraumatic stress disorder and sleep-disordered breathing: a review of comorbidity research. , 2015, Sleep medicine reviews.

[7]  Ursula S. Myers,et al.  Obstructive Sleep Apnea and Posttraumatic Stress Disorder among OEF/OIF/OND Veterans. , 2015, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[8]  J. Collen,et al.  Sleep disorders in combat-related PTSD , 2015, Sleep and Breathing.

[9]  A. El‐Solh,et al.  Sleep-disordered breathing in patients with post-traumatic stress disorder. , 2015, Annals of the American Thoracic Society.

[10]  M. Gupta,et al.  Obstructive sleep apnea and psychiatric disorders: a systematic review. , 2015, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[11]  V. Mysliwiec,et al.  Trauma associated sleep disorder: a proposed parasomnia encompassing disruptive nocturnal behaviors, nightmares, and REM without atonia in trauma survivors. , 2014, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[12]  Taura L. Barr,et al.  Sleep disorders in US military personnel: a high rate of comorbid insomnia and obstructive sleep apnea. , 2013, Chest.

[13]  Kevin F. Bieniek,et al.  Validation of the Mayo Sleep Questionnaire to screen for REM sleep behavior disorder in a community-based sample. , 2013, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[14]  V. Mysliwiec,et al.  Sleep disorders and associated medical comorbidities in active duty military personnel. , 2013, Sleep.

[15]  B. Arnetz,et al.  Obstructive Sleep Apnea, Posttraumatic Stress Disorder, and Health in Immigrants , 2012, Psychosomatic medicine.

[16]  J. Yesavage,et al.  Sleep-disordered breathing in Vietnam veterans with posttraumatic stress disorder. , 2012, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[17]  J. Holty,et al.  Opioids, sleep, and sleep-disordered breathing. , 2011, Current pharmaceutical design.

[18]  H. Westenberg,et al.  Obstructive sleep apnea in combat-related posttraumatic stress disorder: a controlled polysomnography study , 2011, European journal of psychotraumatology.

[19]  Parmjit Singh,et al.  The new AASM criteria for scoring hypopneas: impact on the apnea hypopnea index. , 2009, Sleep.

[20]  B. Grant,et al.  Sleep-disordered breathing and chronic opioid therapy. , 2008, Pain medicine.

[21]  D. Delahanty,et al.  Polysomnographically measured sleep abnormalities in PTSD: a meta-analytic review. , 2007, Psychophysiology.

[22]  R. Arora,et al.  Cardiovascular manifestations of posttraumatic stress disorder. , 2007, Journal of the National Medical Association.

[23]  G. Asnis,et al.  Sleep Disturbances in Patients with Post-Traumatic Stress Disorder , 2006, CNS drugs.

[24]  W. Rodriguez-Cintron,et al.  The veteran population: one at high risk for sleep-disordered breathing , 2006, Sleep and Breathing.

[25]  D. White,et al.  Antidepressants and Periodic Leg Movements of Sleep , 2005, Biological Psychiatry.

[26]  A C McFarlane,et al.  Post-traumatic stress disorder: findings from the Australian National Survey of Mental Health and Well-being , 2001, Psychological Medicine.

[27]  D. Kaloupek,et al.  A Meta-Analytic Examination of Basal Cardiovascular Activity in Posttraumatic Stress Disorder , 2001, Psychosomatic medicine.

[28]  K. Strohl,et al.  Using the Berlin Questionnaire To Identify Patients at Risk for the Sleep Apnea Syndrome , 1999, Annals of Internal Medicine.

[29]  D S Weiss,et al.  Sleep disturbances in the Vietnam generation: findings from a nationally representative sample of male Vietnam veterans. , 1998, The American journal of psychiatry.

[30]  M. Johns,et al.  A new method for measuring daytime sleepiness: the Epworth sleepiness scale. , 1991, Sleep.

[31]  R. Yehuda POST-TRAUMATIC STRESS DISORDER , 1985, The Lancet.

[32]  D. Sheehan,et al.  The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. , 1998, The Journal of clinical psychiatry.

[33]  T. M. Brown,et al.  Periodic limb movements of sleep in combat veterans with posttraumatic stress disorder. , 1996, Journal of traumatic stress.

[34]  B. Nolan,et al.  Sleep events among veterans with combat-related posttraumatic stress disorder. , 1995, The American journal of psychiatry.