0938 Fear of Sleep (FS) in Posttraumatic Stress Disorder (PTSD) Patients Correlates Directly with Indices of Hyperarousal During Wakefulness and Sleep. (27th April 2018)

• Record Type: Journal Article
• Authors: Gupta, M A; Sheridan, A D
• Is Part Of: Sleep. Volume 41(2018)Supplement 1
• Page Start: A348
• Page End: A348
• Publication Date: 2018-04-27
• Subjects: Sleep -- Physiological aspects -- Periodicals; Sleep disorders -- Periodicals; Sommeil -- Aspect physiologique -- Périodiques; Sommeil, Troubles du -- Périodiques; Sleep disorders; Sleep -- Physiological aspects; Sleep -- physiological aspects; Sleep Wake Disorders; Psychophysiology; Electronic journals; Periodicals; 616.8498
• DOI: 10.1093/sleep/zsy061.937
• Languages: English
• ISSNs: 0161-8105

Abstract

Abstract: Introduction: Fear of sleep (FS) can be a significant factor in the sleep disturbances encountered in PTSD. PTSD patients may experience FS due to several reasons including fear of losing vigilance, fear of experiencing traumatic nightmares and a conditioned association of bedtime with traumatic experiences (eg., sexual abuse). We examined some psychologic and sleep physiologic correlates of FS. Methods: 40 consenting civilians with PTSD (38 female, mean±SD age: 44.60 ± 12.73) underwent ≥1 nights of Level 3 home sleep testing (WatchPAT200; Itamar Medical, Israel)(average scores from 3 nights of sleep data from 33/40 patients are presented in this report) and completed a battery of instruments including the Fear of Sleep Inventory (FOSI))(Zayfert et al., 2006), a 23-item instrument where participants rate trauma-related sleep disturbances involving fear of sleep, Insomnia Severity Index (ISI) and PTSD Checklist for DSM-5 (PCL-5). Results: The mean±SD PCL-5 score was 40.40 ± 18.81 (cutoff for PTSD at 33). FOSI scores were directly correlated with total PCL-5 (Pearson r=0.639, p<0.001) score and its symptom subscales of Cluster B(intrusive symptoms) (r=0.605, p<0.001), Cluster C (avoidance) (r=0.577, p<0.001), Cluster D(negative cognitions) (r=0.493, p=0.002) and Cluster E(hyperarousal) (r=0.654, p<0.001), and the ISI (r=0.548, p<0.001). Multiple regression analysis using FOSI score as dependent variable and all PCL5 subscales and ISI as independent variables, revealed that only PCL-5 Cluster E (β =0.648, t=4.959, p<0.001) remained a significant predictor of FOSL in the regression model (adjusted R 2 =0.403 for this model). The FOSI correlated with several sleep physiological measures as follows: sleep latency (r=0.620, p<0.001), mean pulse rate during sleep (r=0.492, p=0.004), sleep efficiency (r=-0.547, p=0.001), no. wakenings/hour (r=0.353, p=0.044), respiratory disturbance index (r=0.480, p=0.003) and oxygen desaturation index (r=0.593, p<0.001). Conclusion: FS may be an index of the underlying drive for vigilance and sympathetic activation in PTSD patients both during wakefulness and sleep. The previously unreported finding of a direct correlation of FS with indices of sleep-disordered breathing and heart rate during sleep, in addition to measures of sleep fragmentation, further supports this. Support (If Any): None.