title: Obese Veterans Enrolled in a Veterans Affairs Medical Center Outpatient Weight Loss Clinic Are Likely to Experience Disordered Sleep and Posttraumatic Stress.
abstract: This cross-sectional study aimed to characterize sleep patterns, the quality and duration of sleep, and estimate the prevalence of common sleep disorders and posttraumatic stress disorder (PTSD) in a hospital-based Veterans Affairs MOVE! (Managing Overweight Veterans Everywhere) clinic.
  
  
  
  Participants completed five instruments: the Pittsburgh Sleep Quality Index (PSQI), Smith's Measure of Morningness/Eveningness, Restless Legs Syndrome Rating Scale, the STOP Questionnaire, and the Posttraumatic Stress Disorder (PTSD) Checklist - Civilian Version (PCL-C).
  
  
  
  Enrolled Veterans (n = 96) were mostly male (78%), African American (49%), mean age 58 (standard deviation [SD] 10.6) years, and mean body mass index (BMI) 38.4 kg/m(2) (SD 8.4). By PSQI, 89% rated sleep quality as "poor" (mean = 11.1, SD = 5.1), consistent with severely impaired sleep. Most were at high risk for sleep disorders including restless leg syndrome (53%), obstructive sleep apnea (66%), and circadian sleep disorders (72%). Forty-seven percent endorsed clinically significant symptoms of PTSD. Hypotheses-generating regression models suggest sleep latency (minutes before falling asleep) was associated with BMI (p = 0.018). Bedtime, getting up time, hours of sleep, waking up in the middle of the night or early morning, having to get up to use the bathroom, inability to breathe comfortably, cough or snore loudly, feeling too cold or too hot, having bad dreams, pain, and frequency of having trouble sleeping, were not significantly associated with BMI.
  
  
  
  Our cross-sectional study suggests that sleep difficulties are common among Veterans referred to a weight loss program at a Veterans Affairs Hospital. Controlled studies are needed to investigate whether the results are generalizable and whether obesity among veterans is a risk factor for sleep disorders and PTSD.
  
  
  
  A commentary on this article appears in this issue on page 943.
authors.affiliation: Department of Medicine, Division of Endocrinology, Virginia Commonwealth University, Richmond VA.|Department of Medicine Division of Endocrinology Hunter Holmes McGuire VAMC, Richmond VA.
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Mayer
authors.affiliation: Department of Medicine, Division of Endocrinology, Virginia Commonwealth University, Richmond VA.|Department of Medicine Division of Endocrinology Hunter Holmes McGuire VAMC, Richmond VA.
authors.forename: James R
authors.initials: JR
authors.lastname: Levy
authors.affiliation: Mental Health Service Line, Psychology Section, Hunter Holmes McGuire VAMC.
authors.forename: Leah
authors.initials: L
authors.lastname: Farrell-Carnahan
authors.affiliation: Department of Research, Hunter Holmes McGuire VAMC, Richmond VA.|College of Nursing, Medical University of South Carolina, Charleston, SC.
authors.forename: Michelle G
authors.initials: MG
authors.lastname: Nichols
authors.affiliation: Department of Neurology Hunter Holmes McGuire VAMC, Richmond VA.
authors.forename: Shekar
authors.initials: S
authors.lastname: Raman
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000628:therapy*; D010045:Outpatients / Q000706:statistics & numerical data*; D012893:Sleep Wake Disorders / Q000150:complications*; D013313:Stress Disorders, Post-Traumatic / Q000150:complications*; D014481:United States; D014493:United States Department of Veterans Affairs; D014505:Urban Population; D014728:Veterans / Q000706:statistics & numerical data*; D061217:Weight Reduction Programs / Q000379:methods*
keywords: insomnia; obesity; obstructive sleep apnea; sleep; survey; veterans