A brief Sleep Scale for Posttraumatic Stress Disorder: Pittsburgh Sleep Quality Index Addendum for PTSD

Study Objectives: Sleep disturbances are common in United States military personnel. Despite their exposure to combat and trauma, little is known about nightmares in this population. The purpose of this study was to describe the prevalence and associated clinical and polysomnographic characteristics of nightmares in United States military personnel with sleep disturbances. Methods: Retrospective review of 500 active duty United States military personnel who underwent a sleep medicine evaluation and polysomnography at our sleep center. The Pittsburgh Sleep Quality Index and the Pittsburgh Sleep Quality Index-Addendum were used to characterize clinically significant nightmares. Subjective and objective sleep attributes were compared between groups. Results: At least weekly nightmares were present in 31.2%; yet, only 3.9% reported nightmares as a reason for evaluation. Trauma-related nightmares occurred in 60% of those patients with nightmares. Patients with nightmares had increased sleep onset latency (SOL) and rapid eye movement (REM) sleep latency (mean SOL/REM sleep latency 16.6/145 minutes, P = .02 and P = .01 respectively) compared to those without (mean SOL/REM sleep latency 12.5/126 minutes I NTRO DUCTI O NNightmares are defined by repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that cause clinically significant distress or impairment in social, occupational, or other areas of functioning. 1 Occasional nightmares are part of a normal adaptive response to life stressors and are not pathologic, with 85% of adults reporting at least one nightmare per year. 2 The prevalence of clinically significant nightmares, which occur at least once per week, is estimated between 0.9% and 6.8%. [3][4][5][6][7][8][9] In the largest study to date (69,813 adults), the prevalence of nightmares was 3.5% in men and 4.8% in women. 10 Participants from the World War II generation had a significantly higher prevalence of 7.2% in men and 7% in women. Nightmares are more common among patients with sleep disturbances, sleep disorders, depression, anxiety, and posttraumatic stress disorder However, most research evaluating sleep disorders in active duty military personnel has focused on insomnia, obstructive sleep apnea (OSA), and PTSD, noting that a recent study focusing on OSA and PTSD did not evaluate nightmares. [18][19][20] Following traumatic experiences, sleep disturbances are frequently reported, including trauma-related nightmares (TRN). 21 The nightmares of trauma survivors tend to be more severe and distressing than idiopathic nightmares. 1,3 Though not exclusive to PTSD, TRN have been referred to as the "hallmark" of this disorder, with rates as high as 90%. 22,23 Addressing nightmares as a distinct sleep disorder following a BRIEF SUMMARY Current Knowledge/Study Rationale: The spectrum of sleep disorders in military personnel is varied and complicated by the presence of comorbidities and psychological disorders. Currently, little is known regarding nightmares, especially trauma-related nig...

Section: Nightmares and Trauma-related Nightmaresmentioning

confidence: 99%

Nightmares in United States Military Personnel With Sleep Disturbances

Creamer

Brock

Matsangas

et al. 2018

“…42 There was slightly more heterogeneity in the measures used for evaluating PTSS in the studies. The instruments used included the CAPS, the Pittsburgh Sleep Quality Index-Addendum (PSQI-A), 43 PTSD Checklist (PCL), 44 the Impact of Event Scale-Revised (IES-R), 45 or the Clinical Global Impression (CGI) scales. 46 …”

Section: Total Of 4 Records Identifiedmentioning

confidence: 99%

Comparative Meta-Analysis of Prazosin and Imagery Rehearsal Therapy for Nightmare Frequency, Sleep Quality, and Posttraumatic Stress

Seda

Sánchez-Ortuño

Welsh

et al. 2015

Study Objective:In this meta-analysis, we compare the shortterm effi cacy of prazosin vs. IRT on nightmares, sleep quality, and posttraumatic stress symptoms (PTSS). Methods: Reference databases were searched for randomized controlled trials using IRT or prazosin for nightmares, sleep disturbance, and/or PTSS. Effect sizes were calculated by subtracting the mean posttest score in the control group from the mean posttest score in the treatment group, and dividing the result by the pooled standard deviation of both groups. Mixed effects models were performed to evaluate effects of treatment characteristics, as well as sample characteristics (veteran vs. civilian) on treatment effi cacy. Results: Four studies used prazosin, 10 used IRT alone or in combination with another psychological treatment, and 1 included a group receiving prazosin and another group receiving IRT. Overall effect sizes of both treatments were of moderate magnitude for nightmare frequency, sleep quality, and PTSS (p < 0.01). Effect size was not signifi cantly different with type of treatment (psychological vs. pharmacological However, when these frightening dreams occur in a recurrent fashion, the nightmare activity may constitute a disorder. In fact, nightmare disorder is listed in both the DSM-5 and in the ICSD-3 as a distinct disorder whose essential features are the presence of repeated negative dreams that lead to awakening, such that the individual becomes fully alert and aware of his or her surroundings. 2,3Nightmares can have an idiopathic origin or may occur after traumatic events. 4 Along with other sleep disturbances (e.g., insomnia and poor sleep quality), 5 nightmares are a typical symptom of posttraumatic stress disorder (PTSD). 6 Indeed, it has been estimated that around 70% of individuals with PTSD report posttraumatic nightmares. 7,8 Nonetheless, nightmares are not exclusive to PTSD, since they are also associated with anxiety and depression, among other mental health comorbidities. BRIEF SUMMARYCurrent Knowledge/Study Rationale: Imagery rehearsal therapy (IRT) and prazosin are both used for treatment of nightmares in posttraumatic stress. The main aim of this study was a comparative meta-analysis of each treatment on nightmare frequency, sleep quality, and posttraumatic stress disorder symptoms. Study Impact: IRT and prazosin had similar effects for nightmare frequency, sleep quality, and posttraumatic stress disorder symptoms; however, adding cognitive-behavior therapy for insomnia to IRT enhanced its effects for improving sleep quality as well as posttraumatic stress disorder symptoms.

“…Lack of diagnostic criteria is likely secondary to the discrepancy between frequent self-reported DNB and the rare occurrence of DNB in laboratory settings. 1,7,8 Thus, the exact nature of DNB in terms of their sleep stage, electromyographic (EMG) characteristics, and physiologic parameters are relatively unknown.Nightmare disorder is reported in up to 80% of patients with PTSD.9 This diagnosis does not acknowledge the presence of the DNB that trauma survivors frequently report.2,4,9 Secondary REM behavior disorder is reported to occur in patients with PTSD when REM without atonia (RWA) is present on a polysomnogram (PSG) and dream enactment behaviors are reported or are present on PSG 4,10 ; however, the onset of DNB and nightmares after an inciting traumatic event and the autonomic hyperactivity reported with trauma associated sleep disturbances are clinical and physiologic abnormalities that are not associated with REM behavior disorder (RBD). …”

mentioning

confidence: 99%

Trauma Associated Sleep Disorder: A Proposed Parasomnia Encompassing Disruptive Nocturnal Behaviors, Nightmares, and REM without Atonia in Trauma Survivors

Mysliwiec¹,

O’Reilly

Polchinski

et al. 2014

Self Cite

101

S C I E N T I F I C I N V E S T I G A T I O N SD isruptive nocturnal behaviors (DNB) consisting of excessive movements, autonomic hyperarousal, abnormal vocalizations and complex motor behaviors, and nightmares which are replays of traumatic experiences are frequently reported sleep disturbances in combat veterans and trauma survivors with and without posttraumatic stress disorder (PTSD).1-6 Despite their frequent occurrence, there is no established diagnosis that accurately encompasses these sleep disturbances. Lack of diagnostic criteria is likely secondary to the discrepancy between frequent self-reported DNB and the rare occurrence of DNB in laboratory settings. 1,7,8 Thus, the exact nature of DNB in terms of their sleep stage, electromyographic (EMG) characteristics, and physiologic parameters are relatively unknown.Nightmare disorder is reported in up to 80% of patients with PTSD.9 This diagnosis does not acknowledge the presence of the DNB that trauma survivors frequently report.2,4,9 Secondary REM behavior disorder is reported to occur in patients with PTSD when REM without atonia (RWA) is present on a polysomnogram (PSG) and dream enactment behaviors are reported or are present on PSG 4,10 ; however, the onset of DNB and nightmares after an inciting traumatic event and the autonomic hyperactivity reported with trauma associated sleep disturbances are clinical and physiologic abnormalities that are not associated with REM behavior disorder (RBD).