Quality of sleep in patients with posttraumatic stress disorder.

Objective. To assess the characteristics and correlates of sleep problems in patients with lifetime posttraumatic stress disorder and ongoing sleep disturbance not due to obstructive sleep apnea or other diagnosed sleep disorders.Sample. Twenty-six veterans receiving psychiatric care at the Minneapolis Veterans Affairs Medical Center in Minneapolis, Minnesota.Data collection instruments. The Pittsburgh Sleep Quality Index, sleep logs, and actigraph along with three symptom ratings scales-posttraumatic checklist, clinician-administered posttraumatic stress disorder scale, and Beck Depression Inventory-were used.Results. Univariate analysis associated three symptom complexes with poorer sleep quality: posttraumatic avoidance, posttraumatic hypervigilance, and depressive symptoms. Borderline trends also existed between worse sleep quality and more severe clinician-rated posttraumatic stress, more self-reported awakenings from sleep, and greater actigraphy-determined sleep duration. Using linear regression, only posttraumatic hypervigilance symptoms were associated with sleep quality.Conclusion. Sleep quality among posttraumatic stress disorder patients in active treatment is worse in direct relation to more severe posttraumatic hypervigilance symptoms.

Correlates of daytime sleepiness in patients with posttraumatic stress disorder and sleep disturbance.

OBJECTIVE: To assess the correlates of daytime sleepiness in patients with a lifetime diagnosis of posttraumatic stress disorder (PTSD) and ongoing sleep disturbance not due to sleep apnea or other diagnosed sleep disorders. METHOD: The sample consisted of 26 veterans receiving mental health care at the Minneapolis VA Medical Center, Minneapolis, Minnesota. The Epworth Sleepiness Scale was the primary outcome measure. Other sleep-related instruments consisted of the Pittsburgh Sleep Quality Scale, a daily sleep log, and daily sleep actigraphy. In addition, data included 3 symptom ratings (Posttraumatic Stress Disorder Checklist, Clinician Administered PTSD Scale [CAPS], and Beck Depression Inventory). Data were collected from 2003 to 2005. Current and lifetime PTSD diagnoses were based on DSM-IV criteria and were obtained by experienced psychiatrists using the CAPS interview. RESULTS: Univariate analyses showed that daytime sleepiness on the Epworth Sleepiness Scale was associated with daytime dysfunction on the Pittsburgh Sleep Quality Index (P < .001), less use of sleeping medication (P = .02), and more self-rated posttraumatic symptoms (P = .05). Within posttraumatic symptom categories, hypervigilance symptoms were more correlated with daytime sleepiness (P = .03) than were reexperiencing and avoidance symptoms (P = .09 for both). CONCLUSION: In this selected sample, daytime sleepiness was most strongly and independently associated with daytime dysfunction.

Microstructural corpus callosum anomalies in children with prenatal alcohol exposure: an extension of previous diffusion tensor imaging findings.

BACKGROUND: Several studies have now shown corpus callosum abnormalities using diffusion tensor imaging (DTI) in children with fetal alcohol spectrum disorders (FASD) in comparison with nonexposed controls. The data suggest that posterior regions of the callosum may be disproportionately affected. The current study builds on previous efforts, including our own work, and moves beyond midline corpus callosum to probe major inter-hemispheric white matter pathways with an improved DTI tractographic method. This study also expands on our prior work by evaluating a larger sample and by incorporating children with a broader range of clinical effects including full-criteria fetal alcohol syndrome (FAS). METHODS: Participants included 33 children with FASD (8 FAS, 23 partial FAS, 2 static encephalopathy) and 19 nonexposed controls between the ages of 10 and 17 years. Participants underwent DTI scans and intelligence testing. Groups (FASD vs. controls) were compared on fractional anisotropy (FA) and mean diffusivity (MD) in 6 white matter tracts projected through the corpus callosum. Exploratory analyses were also conducted examining the relationships between DTI measures in the corpus callosum and measures of intellectual functioning and facial dysmorphology. RESULTS: In comparison with the control group, the FASD group had significantly lower FA in 3 posterior tracts of the corpus callosum: the posterior mid-body, the isthmus, and the splenium. A trend-level finding also suggested lower FA in the genu. Measures of white matter integrity and cognition were correlated and suggest some regional specificity, in that only posterior regions of the corpus callosum were associated with visual-perceptual skills. Correlations between measures of facial dysmorphology and posterior regions of the corpus callosum were nonsignificant. CONCLUSIONS: Consistent with previous DTI studies, these results suggest that microstructural posterior corpus callosum abnormalities are present in children with prenatal alcohol exposure and cognitive impairment. These abnormalities are clinically relevant because they are associated with cognitive deficits and appear to provide evidence of abnormalities associated with prenatal alcohol exposure independent of dysmorphic features. As such, they may yield important diagnostic and prognostic information not provided by the traditional facial characteristics.

Reliability of sleep log data versus actigraphy in veterans with sleep disturbance and PTSD.

The goal of the study was to assess inter-rater reliability of the daily sleep log (a self-rating) with actigraphy (an objective measure of sleep based on activity) in veterans with Posttraumatic Stress Disorder (PTSD). This analysis focused on time asleep and number of awakenings during bedtime. Study participants consisted of 21 veterans with a lifetime diagnosis of Posttraumatic Stress Disorder and current sleep disturbance symptoms. Data collection included study participants' daily charting of sleep logs and actigraphy (utilizing study participants' activity level). Data analysis included the following: (1) interrater reliability for the tabulation of self-reported sleep logs by two trained raters using 99 nights of sleep from 10 cases; (2) comparison of sleep log data versus actigraphic findings for sleep time during 241 bedtimes; (3) comparison of sleep log data versus actigraphic findings for awakenings during 241 bedtimes. Findings showed that the two raters had intraclass correlation scores of .801 for time spent asleep and .602 for time spent in bed-acceptable scores for tabulation of the sleep logs. Comparison of patients' sleep logs versus actigraphy for 241 nights showed that 10 out of 21 study participants had acceptable intraclass correlations of 0.4 or above for duration of sleep. However, sleep logs and actigraphic data on number of sleep awakenings showed poor intraclass correlation, with only 1 subject having an intraclass correlation greater than .30. In conclusion, these data strongly suggest that sleep logs do not reproduce actigraphic records in patients with PTSD even though the sleep logs were reliably quantified. Sleep logs especially under-count awakenings in PTSD patients with sleep complaints.