title: Effects of Blast Exposure on Subjective and Objective Sleep Measures in Combat Veterans with and without PTSD.
abstract: OBJECTIVE
  This study examined the extent to which self-reported exposure to blast during deployment to Iraq and Afghanistan affects subjective and objective sleep measures in service members and veterans with and without posttraumatic stress disorder (PTSD).
  
  
  METHODS
  Seventy-one medication-free service members and veterans (mean age = 29.47 ± 5.76 years old; 85% men) completed self-report sleep measures and overnight polysomnographic studies. Four multivariate analyses of variance (MANOVAs) were conducted to examine the impact of blast exposure and PTSD on subjective sleep measures, measures of sleep continuity, non-rapid eye movement (NREM) sleep parameters, and rapid eye movement (REM) sleep parameters.
  
  
  RESULTS
  There was no significant Blast × PTSD interaction on subjective sleep measures. Rather, PTSD had a main effect on insomnia severity, sleep quality, and disruptive nocturnal behaviors. There was no significant Blast × PTSD interaction, nor were there main effects of PTSD or Blast on measures of sleep continuity and NREM sleep. A significant PTSD × Blast interaction effect was found for REM fragmentation.
  
  
  CONCLUSIONS
  The results suggest that, although persistent concussive symptoms following blast exposure are associated with sleep disturbances, self-reported blast exposure without concurrent symptoms does not appear to contribute to poor sleep quality, insomnia, and disruptive nocturnal disturbances beyond the effects of PTSD. Reduced REM sleep fragmentation may be a sensitive index of the synergetic effects of both psychological and physical insults.
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, PA.|University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA.
authors.forename: Ryan P J
authors.initials: RP
authors.lastname: Stocker
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Benjamin T E
authors.initials: BT
authors.lastname: Paul
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, PA.|University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA.
authors.forename: Oommen
authors.initials: O
authors.lastname: Mammen
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Hassen
authors.initials: H
authors.lastname: Khan
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Marissa A
authors.initials: MA
authors.lastname: Cieply
authors.affiliation: University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA.
authors.forename: Anne
authors.initials: A
authors.lastname: Germain
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D054042:Bombs / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D017286:Polysomnography; D012890:Sleep; D012893:Sleep Wake Disorders / Q000150:complications*; D013313:Stress Disorders, Post-Traumatic / Q000150:complications*; D014728:Veterans / Q000706:statistics & numerical data*
keywords: PTSD; REM sleep; blast exposure; mild traumatic brain injury (mTBI); sleep; veterans