Complex insomnia: insomnia and sleep-disordered breathing in a consecutive series of crime victims with nightmares and PTSD

• Published in: Biological psychiatry (1969) 2001-06, Vol.49 (11), p.948-953
• Main Authors: Krakow, Barry, Melendrez, Dominic, Pedersen, Beth, Johnston, Lisa, Hollifield, Michael, Germain, Anne, Koss, Mary, Warner, Teddy D, Schrader, Ron
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Crime Victims - psychology; Dreams; Female; Humans; insomnia; Male; Medical sciences; Nightmare; Psychology. Psychoanalysis. Psychiatry; Psychometrics; Psychopathology. Psychiatry; PTSD; sleep apnea; Sleep Apnea Syndromes - complications; Sleep Initiation and Maintenance Disorders - complications; Sleep Initiation and Maintenance Disorders - diagnosis; Sleep Initiation and Maintenance Disorders - psychology; Sleep, REM - physiology; sleep-disordered breathing; Stress Disorders, Post-Traumatic - diagnosis; Stress Disorders, Post-Traumatic - etiology; Surveys and Questionnaires; upper airway resistance; Victimology
• ISSN: 0006-3223; 1873-2402
• DOI: 10.1016/S0006-3223(00)01087-8

Background: Sleep disturbance in posttraumatic stress disorder is very common. However, no previous posttraumatic stress disorder studies systematically examined sleep breathing disturbances, which might influence nightmares, insomnia, and posttraumatic stress disorder symptoms. Methods: Forty-four consecutive crime victims with nightmares and insomnia underwent standard polysomnography coupled with a nasal pressure transducer to measure airflow limitation diagnostic of obstructive sleep apnea and upper airway resistance syndrome. Results: Forty of 44 participants tested positive on objective sleep studies based on conservative respiratory disturbance indices of more than 15 events per hour; 22 patients suffered from obstructive sleep apnea and 18 suffered from upper airway resistance syndrome. Conclusions: In an uncontrolled study, insomnia and sleep-disordered breathing were extremely prevalent in this small and select sample of crime victims. Research is needed to study 1) prevalence of sleep-disordered breathing in other posttraumatic stress disorder populations using appropriate controls and nasal pressure transducers and 2) effects of sleep treatment on posttraumatic stress symptoms in trauma survivors with comorbid obstructive sleep apnea or upper airway resistance syndrome. In the interim, some posttraumatic stress disorder patients may benefit from sleep medicine evaluations.