Cognitive-behavioral therapy for sleep disturbances in treating posttraumatic stress disorder symptoms: A meta-analysis of randomized controlled trials

Investigating sleep in mental disorders has the potential to reveal both disorder-specific and transdiagnostic psychophysiological mechanisms. This meta-analysis aimed at determining the polysomnographic (PSG) characteristics of several mental disorders. Relevant studies were searched through standard strategies. Controlled PSG studies evaluating sleep in affective, anxiety, eating, pervasive developmental, borderline and antisocial personality disorders, ADHD, and schizophrenia were included. PSG variables of sleep continuity, depth, and architecture, as well as rapid-eye movement (REM) sleep were considered. Calculations were performed with the “Comprehensive Meta-Analysis” and “R” softwares. Using random effects modeling, for each disorder and each variable, a separate meta-analysis was conducted if at least 3 studies were available for calculation of effect sizes as standardized means (Hedges’g). Sources of variability, i.e., sex, age, and mental disorders comorbidity, were evaluated in subgroup analyses. Sleep alterations were evidenced in all disorders, with the exception of ADHD and seasonal affective disorders. Sleep continuity problems were observed in most mental disorders. Sleep depth and REM pressure alterations were associated with affective, anxiety, autism and schizophrenia disorders. Comorbidity was associated with enhanced REM sleep pressure and more inhibition of sleep depth. No sleep parameter was exclusively altered in one condition; however, no two conditions shared the same PSG profile. Sleep continuity disturbances imply a transdiagnostic imbalance in the arousal system likely representing a basic dimension of mental health. Sleep depth and REM variables might play a key role in psychiatric comorbidity processes. Constellations of sleep alterations may define distinct disorders better than alterations in one single variable.

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“…Ashworth et al , 2015), PTSD (e.g. Ho, Chan & Tang, 2015), persistent delusions and hallucinations (e.g. Freeman et al , 2015), and cancer (e.g.…”

Section: Discussionmentioning

confidence: 99%

Sleep and mental disorders: A meta-analysis of polysomnographic research.

Baglioni¹,

Nanovska

Regen

et al. 2016

Psychological Bulletin

767

461

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“…Cognitive behavioral therapy targeting sleep has shown promise in treating sleep disturbances in the context of PTSD, with a recent meta-analysis of eleven randomized control trials demonstrating a decrease in PTSD, depressive, and sleep symptoms for individuals given sleepspecific cognitive behavioral therapy. 48 Given the ubiquitous nature of disturbed sleep among OEF/ OIF veterans, addressing other contributing factors is important. This study is one of the first to examine correlates of disturbed sleep, other than demographics and specific psychopathology, in OEF/OIF/OND veterans.…”

Section: Discussionmentioning

confidence: 99%

Sleep Disturbances in OEF/OIF/OND Veterans: Associations with PTSD, Personality, and Coping

Lind

Brown

Farrell-Carnahan

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: Sleep disturbances are well documented in relation to trauma exposure and posttraumatic stress disorder (PTSD), but correlates of such disturbances remain understudied in veteran populations. We conducted a preliminary study of sleep disturbances in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans (n = 133; mean [standard deviation] age = 29.8 [4.7] y). Methods: Veterans were assigned to one of three groups based on responses to the Clinician Administered PTSD Scale: control (no trauma-exposure [TE] or PTSD), TE, and PTSD. Sleep disturbance was assessed using the Pittsburgh Sleep Quality Index (PSQI). Measures of resilience, trauma load, personality, coping, alcohol use, and mild traumatic brain injury were also assessed via self-report. Results: The PTSD group had significantly more disturbed sleep (PSQI global score mean = 8.94, standard deviation = 3.12) than control (mean = 5.27, standard deviation = 3.23) and TE (mean = 5.34, standard deviation = 3.17) groups, but there were no differences between TE and control. The same pattern emerged across most PSQI subscales. Results of linear regression analyses indicated that current smoking, Army (versus other military branches), neuroticism, and using substances to cope were all significant correlates of higher sleep disturbance, whereas post-deployment social support was associated with less sleep disturbance. However, when combined together into a model with PTSD status, only neuroticism and substance use coping remained significant as predictors of more disturbed sleep. Conclusions: These initial findings suggest that TE itself may not be an independent risk factor for disturbed sleep in veterans, and that neurotic personality and a tendency to cope by using substances may partially explain sleep disturbance, above and beyond a diagnosis of PTSD.

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“…Cognitive Behavioral Therapy for Insomnia (CBT-I; a behavioral treatment that addresses the cognitive, physiological, and behavioral maintaining factors of insomnia) is the recommended first line of treatment for sleep issues [48] and has been demonstrated to be effective in college students [49], as well as in populations with co-morbid psychiatric and medical conditions [50]. CBT-I improves sleep-related symptoms in individuals with PTSD and may also have a positive influence on other PTSD symptoms [51]. While CBT-I appears to be effective for individuals with comorbid AUDs [52], there are few studies examining its effects on alcohol symptoms.…”

Section: Discussionmentioning

confidence: 99%

Relationships between potentially traumatic events, sleep disturbances, and symptoms of PTSD and alcohol use disorder in a young adult sample

et al. 2017

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Objective Traumatic events, particularly those interpersonal in nature, are associated with increased risk for co-occurring sequelae, including sleep disturbances, posttraumatic stress disorder (PTSD), and alcohol use disorder (AUD). However, the associations between these phenotypes have not been explored among college students. Methods We examined relationships between type of potentially traumatic event (PTE) exposure (pre-college) and sleep disturbances, as well as mediating effects of lifetime PTSD and AUD symptoms on these relationships, in a large undergraduate sample (N=1599, 64.7% female). Hierarchical linear regressions were conducted, beginning with demographics and adding interpersonal and accidental PTEs in a stepwise regression. Following, mediation analyses were run. Results Within the sample, 33.7% endorsed at least one interpersonal PTE, while 64.4% endorsed at least one accidental PTE. Hierarchical regressions demonstrated that interpersonal (β =0.202, p=0.000), but not accidental, PTE exposure significantly predicted disturbed sleep. Both PTSD and AUD symptoms significantly mediated (p values <0.001) the relationship between interpersonal PTE exposure and sleep, with indirect effects accounting for 61% and 17% of total effects, respectively. In the correlated mediation model, both disorders remained significant mediators (p < 0.001), with indirect effects accounting for 56% (PTSD symptoms) and 14% (AUD symptoms) of total effects on sleep. Conclusions Results suggest that interpersonal PTEs are more potent predictors of sleep problems than accidental PTEs. Further, trauma exposure psychiatric symptom sequelae (PTSD, AUD) account for part of the relationship between interpersonal PTE exposure and disturbed sleep, both independently and jointly, suggesting that treating PTSD and AUD symptoms in college students may also improve sleep.

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Cognitive-behavioral therapy for sleep disturbances in treating posttraumatic stress disorder symptoms: A meta-analysis of randomized controlled trials

Cited by 169 publications

References 58 publications

Sleep and mental disorders: A meta-analysis of polysomnographic research.

Sleep and mental disorders: A meta-analysis of polysomnographic research.

Sleep Disturbances in OEF/OIF/OND Veterans: Associations with PTSD, Personality, and Coping

Relationships between potentially traumatic events, sleep disturbances, and symptoms of PTSD and alcohol use disorder in a young adult sample

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