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Objective and Subjective Sleep Characteristics Among Patients Diagnosed with Post-traumatic Stress Disorders: A Systematic Review and Meta-analysis

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Abstract

Purpose

People with post-traumatic stress disorders are more likely to have trouble sleeping than the general population. In this study, we aim to investigate the impact of traumatic events on sleep in patients diagnosed with post-traumatic stress disorders patients and identify the sleep characteristics in these patients using both objectives including polysomnography and actigraph, and subjective measurements including Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and sleep diaries.

Methods

PubMed, Academia, USW Library, Cochrane, Embase, and Google Scholar were searched for relevant studies according to the inclusion criteria. We included all case–control studies that compare participants with current trauma and stress-related disorders to healthy control. The primary sleep parameters of interest were as follows: total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency. Data were meta-analyzed as mean differences (MDs) using RevMan 5.4.

Results

Twenty-three studies were finally included (3669 participants). There was evidence of a statistically significant difference between trauma and stress-related disorders to healthy control in both objective and subjective sleep parameters, with a significant reduction in the patient group other than healthy control in TST (MD = − 17.55 min, 95% CI [ − 31.03, -4.06], P = 0.01); WASO (MD = 14.44, 95% CI: [7.20, 2169], P < 0.0001); SOL (MD = 1.25 min, 95% CI [− 4.48, 6.99], P = 0.67).

Conclusion

Significant differences were found in sleep characteristics between patients diagnosed with trauma and stress disorders and healthy control. A remarkable decrease in three of sleep characteristics including TST, SOL, and WASO either subjective or objective in patients group compared to healthy control.

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Availability of Data and Materials

All data generated or analyzed during this study are included in this published article. Raw data used for analysis are available upon reasonable request from the corresponding author.

Abbreviations

AASM:

American Association of Sleep Medicine

APA:

American Psychiatric Association

ICD:

International Classification of Diseases

SOL:

Sleep onset latency

PTSD:

Post-traumatic stress disorders

DSM5:

Diagnostic and Statistical Manual of Mental Disorders (5th ed.)

RSL:

REM sleep latency

TST:

Total sleep time

WASO:

Wake after sleep onset

REM:

Rapid eye movement

PSG:

Polysomnography

ACT:

Actigraphy

SD:

Sleep dairy

PSQI:

Pittsburgh Sleep Quality Index

ISI:

Insomnia Severity Index

SE:

Sleep efficiency

HC:

Healthy control

AHRQ:

Agency for Healthcare Research and Quality

MD:

Mean difference

CBT-I:

Cognitive behavioral therapy for insomnia

EMDR:

Eye movement desensitization and reprocessing

OSA:

Obstructive sleep apnea

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  1. Nermin Hani and Mohamed Ibrahim Gbreel have contributed equally to this work.

Authors and Affiliations

  1. Department of Psychology, University of South Wales, South Wales, UK

    Nermin Hani & Katerina Pavlou

  2. Faculty of Medicine, October 6 University, Giza Governorate, 15545, Egypt

    Mohamed Ibrahim Gbreel

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  1. Nermin Hani
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Correspondence to Mohamed Ibrahim Gbreel.

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Hani, N., Gbreel, M.I. & Pavlou, K. Objective and Subjective Sleep Characteristics Among Patients Diagnosed with Post-traumatic Stress Disorders: A Systematic Review and Meta-analysis. Sleep Vigilance (2023). https://doi.org/10.1007/s41782-023-00253-4

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