1186 Change in Global and Trauma-Related Sleep Difficulties Among Adults Receiving Treatment for Posttraumatic Stress Disorder

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Abstract Introduction Sleep difficulties are prevalent among individuals with posttraumatic stress disorder (PTSD). While sleep often improves following psychotherapy for PTSD, residual sleep difficulties are common. Most studies assessing sleep in the context of PTSD treatment have relied on single-item scores. This study evaluated associations between sleep difficulties and psychopathology prior to treatment and predictors of change in global and trauma-related sleep problems following PTSD treatment. Methods Participants (N=146, 75.3% Female, M Age=36) enrolled in a randomized trial of prolonged exposure (PE) and PE plus sertraline completed the Pittsburgh Sleep Quality Index (PSQI), PSQI PTSD Addendum (PSQI-PTSD), PTSD Symptom Scale Self-Report for DSM-IV (PSS-SR; re-experiencing, avoidance, and arousal subscales), and Quick Inventory of Depressive Symptomatology (QIDS-SR) at baseline, post-treatment, and 3-month follow-up. Sleep-related items were removed from PSS-SR and QIDS-SR scales. Correlations examined associations between baseline self-report measures. For treatment-completers, paired t-tests compared PSQI and PSQI-PTSD scores between baseline and post-treatment and between post-treatment and follow-up. Multivariate linear regression models assessed predictors of change in sleep from baseline to post-treatment. Results At baseline, global sleep difficulties (PSQI) were clinically elevated (M=11.77, SD=3.26) and associated with moderately higher PSS-SR avoidance (r=.26, p=.002), arousal (r=.32, p<.001), and QIDS-SR severity (r=.30, p<.001), but not PSS-SR re-experiencing. PTSD-related sleep difficulties (PSQI-PTSD) were associated with greater PSS-SR re-experiencing (r=.48, p<.001), avoidance (r=.35, p<.001), and arousal (r=.29, p<.001) and QIDS-SR severity (r=.44, p<.001). Among treatment-completers, sleep problems decreased substantially between baseline and post-treatment (PSQI: p<.001, d=1.09; PSQI-PTSD: p<.001, d=0.96); however, mean global sleep difficulty scores remained above the clinical-cutoff of 5 (M=7.90, SD=3.87). Change from post-treatment to follow-up was non-significant, suggesting maintenance of gains. When predicting change in PTSD-related, but not global, sleep difficulties, higher baseline re-experiencing symptoms (β=.38, p=.002) was the strongest predictor of improvement in trauma-related sleep difficulties (PSQI-PTSD, R-squared=.20, F(4,84)=5.18, p<.001). Conclusion On average, sleep difficulties decreased substantially following trauma-focused intervention, but global sleep difficulties remained elevated. This builds upon research suggesting sleep disturbance may be better conceptualized and treated as comorbid with PTSD rather than secondary. Research identifying mechanisms mediating improved sleep can inform targeted use of adjunctive, sleep-specific interventions for patients receiving trauma-focused therapy. Support (if any) R01MH066347, R01MH066348

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