title: Insecure attachment is an independent correlate of objective sleep disturbances in military veterans.
abstract: BACKGROUND
  Sleep disturbances and interpersonal problems are highly prevalent in military veterans with post-traumatic stress disorder (PTSD) and are associated with substantial comorbidities and increased healthcare costs. This study examines the association between interpersonal attachment styles and sleep in a high-risk cohort of military veterans with PTSD symptoms.
  
  
  METHODS
  Participants were 49 military veterans (85% male) enrolled in a treatment study of combat-related sleep disturbances. Data were collected at pre-treatment baseline. Attachment anxiety and avoidance, clinical characteristics, and subjective sleep quality were characterised via self-report. Polysomnographic sleep measures were averaged from two nights of in-laboratory sleep studies and included: visually scored duration and continuity, the percentage of stage 3+4 sleep and rapid eye movement (REM) sleep, and quantitative electroencephalographic (QEEG) measures of delta and beta power during NREM and REM sleep. Linear regressions evaluated the relationship between attachment styles and sleep with adjustment for demographics, and PTSD and depressive symptoms.
  
  
  RESULTS
  Greater attachment anxiety was associated with reduced percentage of stage 3+4 sleep, (β=-0.36, p<0.05) and increased relative beta power during NREM sleep (β=0.40, p<0.05). By contrast, greater attachment avoidance was positively associated with delta power during NREM and REM sleep (β=0.35 and 0.38, respectively, p<0.05).
  
  
  CONCLUSIONS
  These findings suggest specific effects of interpersonal styles on physiological sleep measures. Elucidating both the neurobiological and psychological correlates of PTSD-related sleep disturbances is critical for developing future targeted intervention efforts aimed at reducing the burden of PTSD.
authors.affiliation: University of Pittsburgh, Department of Psychiatry and Psychology, Pittsburgh, PA, USA. troxelw@upmc.edu
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Troxel
authors.forename: Anne
authors.initials: A
authors.lastname: Germain
mesh_terms: D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology*; D001362:Avoidance Learning; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009769:Object Attachment; D017286:Polysomnography; D015995:Prevalence; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult