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Residual Sleep Problems Predict Reduced Response to Prolonged Exposure among Veterans with PTSD

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Abstract

While evidence-based treatments exist for posttraumatic stress disorder (PTSD), a significant sub-set of veterans continue to meet criteria for PTSD after treatment. Sleep problems may affect treatment retention and predict efficacy for PTSD treatments. The present study used data from a clinical trial of Prolonged Exposure therapy (PE) administered to veterans (N=154) to evaluate whether residual sleep symptoms remained after treatment completion, and if so, whether these residual sleep symptoms were associated with higher levels of PTSD and comorbid depression at the end of treatment. Participants (ages 20 to 75 years old; 35.7% Black; 54.5% married) completed demographic questions, symptom assessments, and engagement-related surveys. Hierarchical multiple linear regression models demonstrated that changes in sleep were significant predictors of PTSD and depression symptom reduction above and beyond the influence of demographic and engagement factors (e.g., therapy satisfaction). Greater residual sleep symptoms were predictive of smaller treatment gains. Findings illustrate the potential significance of sleep during the course of PTSD treatment, leading to several important clinical assessment and treatment implications.

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Authors and Affiliations

  1. College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, MSC 160, Charleston, SC, 29425, USA

    Cristina M. López & Ron Acierno

  2. Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA

    Cynthia Luethcke Lancaster, Daniel F. Gros & Ron Acierno

  3. Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC, 29425, USA

    Cynthia Luethcke Lancaster & Daniel F. Gros

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  1. Cristina M. López
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  2. Cynthia Luethcke Lancaster
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  3. Daniel F. Gros
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  4. Ron Acierno
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Correspondence to Cristina M. López.

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Funding

This work was supported by grants from Veterans Affairs Health Services Research and Development (NCT01102764), Veterans Affairs Clinical Sciences Research (CX000845), and BIRCWH K12HD055885 from the National Institute of Child Health And Human Development (NICHD) and the Office of Research on Women’s Health (ORWH), as well as by the South Carolina Clinical & Translational Research (SCTR) Institute, with an academic home at the Medical University of South Carolina (NIH - NCATS Grant Number UL1 TR001450). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

Conflict of Interest

Cristina M. López, Cynthia Luethcke Lancaster, Daniel F. Gros, and Ron Acierno declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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López, C.M., Lancaster, C.L., Gros, D.F. et al. Residual Sleep Problems Predict Reduced Response to Prolonged Exposure among Veterans with PTSD. J Psychopathol Behav Assess 39, 755–763 (2017). https://doi.org/10.1007/s10862-017-9618-6

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