1068 Using Sleep to Avoid Inpatient PTSD Treatment

• Published in: Sleep (New York, N.Y.) N.Y.), 2020-05, Vol.43 (Supplement_1), p.A406-A407
• Main Authors: Woodward, S H, Jamison, A L, Souter, T, Shin, H J, Loew, D E, Armontrout, J A
• Format: Article
• Language: English
• Subjects: Post traumatic stress disorder; Sleep
• ISSN: 0161-8105; 1550-9109
• DOI: 10.1093/sleep/zsaa056.1064

Abstract Introduction During inpatient psychiatric treatment, mattress actigraphy can be used to track nightly sleep in a zero-burden fashion to examine its relationships with other markers of treatment progress. We report here on associations between actigraphic sleep parameters and treatment markers in combat veteran engaged in inpatient treatment for posttraumatic stress disorder. We focus first on sleep scheduling, the best-validated outcome available from actigraphic data. Methods 140 combat veteran inpatients provided between 5 and 164 nights of mattress actigraphy over the course of their inpatient psychiatric hospitalizations. The sample was characterized by multiple traumas and a high prevalence of comorbid mood and substance use disorders. Approximately one-half of the sample had undergone objective screening for OSA and for this subsample AHI < 20 was used as an inclusion criterion. Unscreened participants were required to have a BMI < 35. Inclusion also required mean actigraphic SE > 60%. The PTSD Checklist and Combat Exposure Scale were obtained at admission, from which a trauma load index was created by adding z-scores obtained from standardizing these scales. Results In a multiple regression analysis, after accounting for secular change in LOS, higher trauma loads (p < 0.001) and earlier bed times (p = 0.001) were both significantly associated with shorter lengths of stay (LOS; F(3,137) = 10.4, p < 0.001; adj. R-squared = 0.17). Trauma load and bed time did not interact (p = 0.7). Conclusion Avoidance is a criterial symptom of PTSD. Early bed times and early exits from treatment may both reflect the impact of syndromal avoidance on treatment, limiting its dosage and benefit. If so, prescribing later bed times may have utility in inpatient treatment programming. Support Award W81XWH-15-2-0005 from the Department of Defense, Military Operational Medicine Research Program and the Department of Veterans Affairs. This material is the result of work supported with resources and the use of facilities at the Palo Alto VA Medical Center.