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Sleep disorders in combat-related PTSD

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Abstract

Purpose

We sought to assess the rate of sleep complaints and sleep disorders among active duty soldiers with deployment-related PTSD and to determine whether any clinical features differentiated those with sleep disorders.

Methods

Retrospective review of consecutive soldiers diagnosed with PTSD. We recorded subjective measures of sleep and polysomnographic data. We compared clinical and demographic variables including psychoactive medication use, psychiatric comorbidity, and combat-related traumatic injury with the presence of sleep disorders.

Results

One hundred thirty patients were included (91.5 % male, mean age of 35.1 ± 10.6 years, mean body mass index (BMI) 28.9 ± 4.4 Kg/m2). About 88.5 % had comorbid depression, with the majority (96.2 %) taking psychoactive medications (mean 3.4 ± 1.6 medications per patient). Over half of the cohort suffered combat-related traumatic physical injuries (54.6 %). The obstructive sleep apnea syndrome (OSAS) was diagnosed in 67.3 % (80 % of the cohort underwent polysomnography), with a mean apnea hypopnea index of 24.1 ± 22.8 events/hour and a mean oxygen saturation nadir of 84.2 ± 5.7 %. OSAS was significantly more common in the non-injured soldiers (72.9 vs. 38.0 %, p < 0.001). In multivariate analysis, absence of physical injury showed a trend towards predicting OSAS.

Conclusions

Sleep complaints are common among soldiers with PTSD. We observed significantly higher rates of OSAS among those without physical injuries, raising the possibility that underlying sleep-disordered breathing is a risk factor for the development of PTSD. This potential association requires further validation.

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Abbreviations

AASM:

American Academy of Sleep Medicine

DSM-IV-TR:

Diagnostic and statistical manual of mental disorders, 4th ed, text revision

ESS:

Epworth sleepiness scale

OEF:

Operation enduring freedom

OIF:

Operation Iraqi freedom

PCL-M:

PTSD checklist-military version

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Acknowledgments

All of the authors listed participated in the production of this manuscript. Dr. Williams participated in data analysis and manuscript writing. Dr. Collen participated in protocol development, data collection, and manuscript writing. Dr. Orr participated in the data collection, project, and protocol design. Dr. Holley participated in statistical data analysis. Dr. Lettieri participated in protocol development, study design, data collection, data analysis, and manuscript revisions. Dr. Williams is the guarantor of the material contained within this manuscript.

Conflict of interest

The authors have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Pulmonary, Critical Care, and Sleep Medicine, Womack Army Medical Center, Fort Bragg, NC, USA

    Scott G. Williams

  2. Pulmonary, Critical Care, and Sleep Medicine, Pulmonary Diseases Service, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam, Houston, TX, 78234, USA

    Jacob Collen

  3. Department of Cardiology, Walter Reed National Military Medical Center, Bethesda, MD, USA

    Nicholas Orr

  4. Pulmonary, Critical Care, and Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA

    Aaron B. Holley & Christopher J. Lettieri

  5. Department of Medicine, Uniformed Services University, Bethesda, MD, USA

    Scott G. Williams, Aaron B. Holley & Christopher J. Lettieri

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  1. Scott G. Williams
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  2. Jacob Collen
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  4. Aaron B. Holley
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  5. Christopher J. Lettieri
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Corresponding author

Correspondence to Jacob Collen.

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The views expressed in this paper are those of the authors and do not reflect the official policy of the Department of the Army Department of Defense, or the US Government.

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Williams, S.G., Collen, J., Orr, N. et al. Sleep disorders in combat-related PTSD. Sleep Breath 19, 175–182 (2015). https://doi.org/10.1007/s11325-014-0984-y

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