November 10, 2010 (Vancouver, Canada) — Traumatic brain injury (TBI) increases the prevalence of sleep disorders in soldiers with posttraumatic stress disorder (PTSD), according to research presented here at CHEST 2010: American College of Chest Physicians Annual Meeting.
Soldiers with PTSD and recently deployed soldiers often experience poor sleep quality, insomnia, and daytime somnolence.
The researchers set out to determine the prevalence of sleep complaints and disorders among soldiers with PTSD who had been recently deployed. They found that more than three quarters of soldiers with PTSD had symptoms of depression, and nearly all of the study group used psychoactive drugs.
The team examined the records of consecutive soldiers returning from combat who had been diagnosed with PTSD, and they looked at demographic data, psychoactive medication use, psychiatric disorders, and concomitant TBI as potential predictors of sleep complaints or disorders.
Of 80 soldiers studied, 89.6% were men (mean age, 37.7 ± 0.3 years; mean body mass index, 29.0 ± 0.3 kg/m2), 76.1% had depression, and 30.1% had anxiety. TBI had occurred in 50.7% of the participants, equally divided between blast and blunt force injuries. Psychoactive drugs were used by 91% of the participants (average, 3.9 prescriptions/patient). Sleep complaints were reported by 92.5% (46.8% had difficulty falling asleep, 35.8% had nocturnal awakenings), and 52.8% had insomnia. Mean Epworth Sleepiness Scale score was 10.5 ± 0.5.
Polysomnography was conducted on 72% of the participants (mean sleep latency, 17.8 ± 6.6 minutes; mean sleep efficiency, 84.5% ± 9.2%). Many experienced sleep fragmentation (mean arousal index, 27.7 ± 2.6 events/hour), and 61% had obstructive sleep apnea (OSA; mean Apnea/Hypopnea Index, 21.8 ± 3.3 events/hour). Patients with OSA used narcotics and benzodiazepines less often and had a lower prevalence of TBI than participants diagnosed without OSA.
Overall, patients with TBI had more sleep fragmentation and insomnia, but less OSA, sleepiness, and depression. The mechanism of TBI was important, as blast injuries were associated with higher prevalence of insomnia, sleep fragmentation, and anxiety, whereas blunt trauma was associated with more somnolence and OSA.
Most patients with PTSD were taking psychoactive medications that have the potential to disrupt sleep or cause somnolence, but the researchers found that only TBI was associated with an increase in sleep disorders.
"Our research identified a higher prevalence of OSA in patients with PTSD when compared to the accepted number of patients diagnosed with PTSD in the general population," Nick Orr, MD, resident at the Walter Reed Army Medical Center, in Washington, DC, who presented the research, told Medscape Medical News.
"We conclude that there may be a link between the presence of OSA and the ultimate development of PTSD after exposure to a traumatic event. More vigilance towards screening for OSA in the predeployment phase, as well as having a heightened alert for identifying OSA in returning PTSD patients, would seem to be prudent steps to take," Dr. Orr advised.
The findings suggest that OSA is an underrecognized problem in combat veterans. "It's very interesting data. We have to have a higher awareness as physicians that these young combat veterans are at high risk for sleep disorders and sleep apnea," Andreea Antonescu-Turcu, MD, assistant professor of pulmonary critical care at the Medical College of Wisconsin, Milwaukee, who moderated the session, told Medscape Medical News.
The study did not receive commercial support. Dr. Orr and Dr. Antonescu-Turcu have disclosed no relevant financial relationships.
CHEST 2010: American College of Chest Physicians Annual Meeting: Abstract 10975. Presented October 31, 2010.
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Jim Kling
Jim Kling is a freelance writer for Medscape.
