1 Sleep disturbances associated with post-traumatic stress disorder: presentation and polysomnographic features in a population of patients admitted to a sleep laboratory

Introduction In this study we assess sleep complaints and objective sleep parameters in a cohort of patients with post-traumatic stress disorder (PTSD) admitted to a sleep laboratory. Methods Retrospective study of patients with a diagnosis of PTSD who were referred for full polysomnography (PSG) in a sleep service as part of the investigation of a sleep disturbance. Demographic data, presenting complaints, PSG parameters, subjective levels of sleepiness, sleep diary, medication and diagnoses were recorded. Result The sample included 30 patients, 46.7% female 53.3% male, mean age 45 years, (SD 15), mean BMI 28 (SD 4.7) kg/m. 13 patients presented with excess daytime sleepiness or fatigue, 11 with parasomnia, 5 with poor sleep and 1 patient with nightmare disorder. 21 had a diagnosis of depression, 12 reported insomnia and 20 nightmares. 63.3% received antidepressants. Mean total sleep time (TST) in sleep diary was 6.5 hours. Mean Epworth score was 10 (SD 6.5). PSG parameters (expressed as mean and SD) were: Sleep latency (SL) 26.3 (35.8) min, TST 390 (130) min, sleep efficiency (SE) for time in bed 77.6 (16.2)%, SE for sleep period of time 80.5 (16.7)%, stages 1 and 2: 48 (13.5)%, REM 17 (15.5)% slow wave sleep 13 (9.5)%, apnoea hypopnea index 7.6 (9.2)/h, periodic limb movement (PLM) index 19.5 (29.9)/h. Parasomnias were recorded in 7 cases. After PSG, 8 patients were diagnosed with PLM disorder, 9 with parasomnia, 6 with sleep apnoea, 3 with insomnia. 5 had no sleep disorder identified. The presence of PLM during sleep did not correlate with the usage of antidepressants. Discussion Both sleep onset and sleep maintenance insomnia were reported. Nightmares were frequent. The presence of PLMD was higher than expected, raising the possibility that it may be a contributor to sleep disturbances in PTSD. A case controlled study would be of value.