A Meta-Analysis of Sleep Disturbances in Panic Disorder

Abstract

The nature and prevalence of sleep disturbances in panic disorder (PD) have been often discussed but remain unclear. The objective of this systematic review and meta-analysis is to document sleep disturbances in PD. Systematic database search and standardized extraction were conducted. Meta-analysis was computed on self-report (subjective) and polysomnographic (PSG) (objective) data and on prevalence rates of nocturnal panic attacks (NPA). Of the 1262 publications retrieved, 31 were included. PD patients were compared to healthy controls on subjective and objective measures. Patients had higher Pittsburgh sleep quality index (PSQI) global scores (hedges' g = 1.306, 95% CI [0.532, 2.081]), longer PSG sleep latency (hedges' g = 0.81, 95% CI [0.576, 1.035]), poorer PSG sleep efficiency (hedges' g = −0.79, 95% CI [−1.124, −0.432]), and shorter stage 2 (hedges' g = 0.70, 95% CI [−1.231, −0.120]) and total sleep time (hedges' g = −0.739, 95% CI [−1.127, −0.351]). Among patients, 52.1% (95% CI [0.464, 0.577]) reported NPA (≥1/lifetime). Patients with PD demonstrate subjective and objective sleep alterations. More than half have experienced NPA. These sleep disturbances could have a significant role in maintaining PD symptoms.

Sleep Disturbances in Panic Disorder with Comorbid Complex PTSD: A Possible Relationship and Different Psychopathology?

“…Former research underlined that PTSD and PD are both characterized by subjective difficulties in the initiation and maintenance of sleep and, in a substantial percentage of cases, by episodic parasomnias, namely trauma-related nightmares, and nocturnal panic attacks [ 35 , 36 ]. As consequence, alteration in sleep quality and duration may have a negative impact on quality of life, reducing performance or daytime wellbeing [ 37 ], and represents a risk factor for the early development of both disorders, maintenance, and treatment difficulties [ 38 , 39 , 40 ].…”