1078 Sleep Problems In Posttraumatic Stress Disorder (PTSD) In A Nationally Representative Us Sample Before And After Controlling For Comorbid Depression: Results From A Nationally Representative US Sample. (27th May 2020)

• Record Type: Journal Article
• Authors: Gupta, M A; Vujcic, B
• Is Part Of: Sleep. Volume 43(2020)Supplement 1
• Page Start: A410
• Page End: A411
• Publication Date: 2020-05-27
• 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/zsaa056.1074
• Languages: English
• ISSNs: 0161-8105

Abstract

Abstract: Introduction: The impact of psychiatric comorbidities on sleep disturbances in PTSD have been studied in the National Comorbidity Survey (NCS)(Leskin GA, 2002) and the NCS-replication (Lauterbach D, 2011) studies. We examined sleep problems in PTSD before and after controlling for comorbid depressive disease, in the National Ambulatory Medical Care Survey(NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) which use a multi-stage probability design to collect nationally representative data on health care visits. Methods: We examined patient visits(1995-2015) from NAMCS/NHAMCS with a PTSD diagnosis (ICD-9-CM 309.81). Both NAMCS/NHAMCS allow ≥3 reasons for visit(RFV) and ≥3 physician-assigned diagnoses (using ICD9-CM codes). The following variables were created: 'Insomnia': ICD9-CM codes 307.41, 307.42, 780.51, RFV 11351; 'Sleep Disturbance'(SD): ICD-9CM codes 780.5, 780.50, 780.59; 'Nightmares': ICD9-CM code 307.4, RFV 11353; Obstructive sleep apnea (OSA): ICD-CM codes 327.23, 780.57, RFV 11355, checklist; and 'Depression': ICD9-CM codes 296.2, 296.3, 296.82, 311, 296.20-296.36, 300.4. Results: There were an estimated 37, 262, 245±3, 203, 047 (unweighted count or UWC=3, 995; 66.4%±1.8% female;.mean±age: 40.39 ± 0.56 years; 'Depression' was comorbid with 37.7%±1.5% cases) PTSD patients visits. All sleep variables accounted for 11.2%±1.2% (UWC=303) of PTSD visits with their individual frequencies as follows: 'Insomnia'6.5%±1.1%(UWC=153); 'Nightmares': 1.9%±0.4%(UWC=74); 'SD': 2.0%±0.3%(UWC=67); OSA: 1.3%±0.3%(UWC=27). Logistic regression analysis using PTSD versus all other patient visits as dependent variable revealed the following sleep predictors of PTSD after controlling for age and sex and: (i) before controlling for 'Depression': 'Insomnia': OR=7.16, (95%CI 4.78-10.73); 'SD': OR=4.43(95%CI 2.55-7.71); 'Nightmares':OR=104.29 (95%CI56.65-192.02); 'OSA': OR=1.71(95%CI 0.94-3.12); and (ii) after controlling for 'Depression': 'Insomnia': OR=2.88 (95%CI 1.87-4.42); 'SD': OR=2.84 (95%CI 1.73-4.67); and 'Nightmares': OR=58.33(95%CI 26.39-128.94); and 'OSA': OR=2.02(95%CI 1.14-3.57). Conclusion: In a nationally representative sample, the association of PTSD with insomnia, sleep disturbance and nightmares remained significant, albeit decreased, after controlling for the confounding effect of comorbid depression; however the association of PTSD with OSA emerged only after the effect of depression was controlled for. Support: None