...sleep disturbances
BALTIMORE, June 10 -- Veterans returning from
the Iraq war can suffer sleep disturbances as
severe as those among chronic insomniacs,
researchers said here.
Combat vets reporting adjustment difficulties
after they come home simply "do not sleep like
good sleepers," said Anne Germain, Ph.D., of the
University of Pittsburgh.
Both subjective reports of sleep disturbances
and objective measurements in a sleep lab show a
pattern that more closely resembles people with
chronic insomnia, Dr. Germain and a colleague
reported in two presentations at the Associated
Professional Sleep Societies meeting.
Their findings arise from preliminary data from
a study of combat vets that will eventually
include 90 patients whose war experience comes
mainly from the recent Middle East conflicts,
Dr. Germain said.Dr. Germain presented data
from the sleep lab and Colleen Walsh, B.S.,
reported on how the vets themselves reported
their sleep disturbances.
In the sleep lab, Dr. Germain said, she tested
11 medication-free veterans, of whom nine met
full criteria for current moderate-to-severe
posttraumatic stress disorder (PTSD).
She also tested 11 medication-free and
healthy volunteers who were good sleepers, using
Cohen's d-values to assess group differences
with small, medium, and large effect sizes
indicated by d-values of 0.20, 0.50, and 0.80,
respectively.
Analysis found that the vets:
Had lower sleep efficiency (d=0.81), related to
moderate increases in sleep latency (d=0.35),
duration and number of nocturnal awakenings
(d=0.49 and d=0.62, respectively), and reduced
total sleep time (d=0.34). Sleep efficiency was
significantly and negatively correlated with
PTSD severity, at P<0.001.
The sleep lab findings were paralleled by
subjective measures in a group that included
three more veterans, for a total of 14,
according to Walsh. Their subjective views were
contrasted with 14 healthy volunteers who were
good sleepers and 14 who were chronic
insomniacs, Walsh said, using electronic sleep
diaries and the Pittsburgh Sleep Quality Index (PSQI)
questionnaire.
Disruptive nocturnal behaviors -- such as
kicking or screaming during sleep -- were
assessed using the PSQI addendum for PTSD, she
said.
Analysis showed that -- compared with the good
sleepers -- the veterans had significantly worse
sleep quality and sleep efficiency, took longer
to go to sleep, woke up more often after they
fell asleep, and were awake longer when they
did. The differences were all significant at
P<0.001.
On the other hand, there were no significant
differences between the veterans and the
insomniacs, she said, except in disruptive
nocturnal behaviors, where the difference was
significant at P<0.001.
For example, Walsh said, veterans took an
average of 32.5 minutes to fall asleep, compared
with 8.6 minutes for the good sleepers and 42.1
minutes for the insomniacs.
The findings are not entirely surprising,
said Jack Edinger, Ph.D., of the VA Medical
Center and Duke University in Durham, N.C., who
moderated the session at which Walsh presented
her data.
"It has been a constant factor in every
cohort of war veterans," said Dr. Edinger, who
was not involved in the study. "The change is
there's more focus on recognizing sleep
disorders as the lynchpin in the experience of
disturbances," he said. "If you can get these
guys sleeping better, you can start to make some
progress" with other co-morbid disorders.
He noted that sleep medicine is a relatively
new discipline that can now be applied to recent
vets. |
