title: Placebo-controlled comparison of prazosin and cognitive-behavioral treatments for sleep disturbances in US Military Veterans.
abstract: OBJECTIVE
  Pharmacological and cognitive-behavioral treatments targeting insomnia and nightmares have been shown to be effective in the treatment of military veterans with sleep complaints comorbid with symptoms of stress-related disorders, including Post-Traumatic Stress Disorder (PTSD), but the two approaches have not been directly compared. This randomized controlled trial compared the effects of prazosin vs. a behavioral sleep intervention (BSI), targeting nightmares and insomnia against a placebo pill control condition on sleep and daytime symptoms.
  
  
  METHODS
  Fifty United States military veterans (mean age 40.9years, SD=13.2years) with chronic sleep disturbances were randomized to prazosin (n=18), BSI (n=17), or placebo (n=15). Each intervention lasted 8weeks. Participants completed self-report measures of insomnia severity, sleep quality, and sleep disturbances. All kept a sleep diary throughout the intervention period. Polysomnographic studies were conducted pre- and post-intervention.
  
  
  RESULTS
  Both active treatment groups showed greater reductions in insomnia severity and daytime PTSD symptom severity. Sleep improvements were found in 61.9% of those who completed the active treatments and 25% of those randomized to placebo.
  
  
  CONCLUSIONS
  BSI and prazosin were both associated with significant sleep improvements and reductions in daytime PTSD symptoms in this sample of military veterans. Sleep-focused treatments may enhance the benefits of first-line PTSD treatments.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. germax@upmc.edu
authors.forename: Anne
authors.initials: A
authors.lastname: Germain
authors.forename: Robin
authors.initials: R
authors.lastname: Richardson
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Moul
authors.forename: Oommen
authors.initials: O
authors.lastname: Mammen
authors.forename: Gretchen
authors.initials: G
authors.lastname: Haas
authors.forename: Steven D
authors.initials: SD
authors.lastname: Forman
authors.forename: Noelle
authors.initials: N
authors.lastname: Rode
authors.forename: Amy
authors.initials: A
authors.lastname: Begley
authors.forename: Eric A
authors.initials: EA
authors.lastname: Nofzinger
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D000328:Adult; D015928:Cognitive Behavioral Therapy; D003130:Combat Disorders / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D004311:Double-Blind Method; D004325:Dreams / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011224:Prazosin / Q000494:pharmacology / Q000627:therapeutic use*; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome; D014728:Veterans / Q000523:psychology
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D011224:Prazosin