Prospective Bidirectional Relationship Between Sleep Duration and Posttraumatic Stress Disorder Symptoms After Suspected Acute Coronary Syndrome

Abstract

Objective Sleep disturbance is a “hallmark” symptom of posttraumatic stress disorder (PTSD). Poor sleep (including short sleep) after combat-related trauma can also predict subsequent PTSD. Less is known about the association between sleep duration and PTSD symptoms when PTSD is induced by acute coronary syndrome (ACS). We examined the bidirectional relationship between sleep duration and PTSD symptoms over the year after hospital evaluation for ACS. Methods Participants were enrolled in this observational study after emergency department evaluation for ACS. Sleep duration (“During the past month, how many hours of actual sleep did you get at night?”) and cardiac event or hospitalization-induced PTSD symptoms (PTSD Checklist) were assessed at 1, 6, and 12 months after hospital discharge. Cross-lagged path analysis was used to model the effects of sleep duration and PTSD symptoms on each other. Covariates included age, sex, race/ethnicity, cardiac severity, baseline depression symptoms, and early acute stress disorder symptoms. Results The sample included 1145 participants; 16% screened positive for probable PTSD (PTSD Checklist score ≥33). Mean sleep duration across time points was 6.1 hours. Higher PTSD symptoms predicted shorter sleep duration at the next time point (i.e., 1–6 and 6–12 months; B = −0.14 hours/10-point difference, SE = 0.03, p < .001). Shorter sleep duration was associated with higher PTSD symptoms at the next time point (B = −0.25 points/hour, SE = 0.12, p = .04). Conclusions Short sleep duration and PTSD symptoms are mutually reinforcing across the first year after ACS evaluation. Findings suggest that sleep, PTSD symptoms, and their relationship should be considered in the post-ACS period.

Exploring the Interplay Between Stress, Sleep, and Health: A Special Issue Commemorating the Contributions of Dr. Martica Hall

“…These articles cover a wide range of topics, methodologies, and populations that collectively demonstrate the widespread impact of stress and sleep on health. We believe Tica would have been pleased to see a single issue addressing topics as diverse as the impact of sleep on cardiovascular health in physicians experiencing burnout (1); the role of biobehavioral rhythm stability in predicting the metabolic syndrome (2); dyadic sleep influences on posttraumatic symptoms among cancer patients and their caregivers (3); and prospective, often bidirectional associations between sleep and psychosocial factors (4–6) and mental health (7,8). Several articles also highlight the dynamic nature of sleep during critical periods across the life span (9) and multidimensional conceptualizations of sleep health (10), ideas and methodologies championed by Tica.…”