title: The Manifestations of Sleep Disturbances 16 Years Post-Trauma.
abstract: Limited data exist on the association between trauma and sleep across developmental stages, particularly trauma experienced in childhood and sleep in adulthood. We assessed sleep quality across the developmental spectrum among avalanche survivors 16 years after exposure as compared to a matched comparison cohort.
  
  
  
  Participants were survivors of two avalanche-affected towns (n = 286) and inhabitants of non-exposed towns (n = 357). Symptoms were assessed with respect to the survivors' developmental stage at the time of the disaster: childhood (2-12), adolescence (13-19), young adult (20-39), and adult (≥ 40). The Posttraumatic Diagnostic Scale, Pittsburgh Sleep Quality Index and Pittsburgh Sleep Quality Index PTSD Addendum were used.
  
  
  
  Overall PTSD symptoms were not associated with avalanche exposure in any age groups under study. However, survivors who were children at the time of the disaster were 2.58 times (95% CI 1.33-5.01) more likely to have PTSD-related sleep disturbances (PSQI-A score ≥ 4) in adulthood than their non-exposed peers, especially symptoms of acting out dreams (aRR = 3.54; 95% CI 1.15-10.87). Those who were adults at time of the exposure had increased risk of trauma-related nightmares (aRR = 2.69; 95% CI 1.07-6.79 for young adults aRR = 3.07; 95% CI 1.51-6.24 for adults) compared to their non-exposed peers.
  
  
  
  Our data indicate a chronicity of PTSD-related sleep disturbances, particularly among childhood trauma survivors. REM sleep disturbances may have different manifestations depending on the developmental stage at the time of trauma exposure.
authors.affiliation: Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
authors.forename: Edda Bjork
authors.initials: EB
authors.lastname: Thordardottir
authors.affiliation: Faculty of Psychology, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
authors.forename: Ingunn
authors.initials: I
authors.lastname: Hansdottir
authors.affiliation: Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.|Department of Epidemiology, Harvard School of Public Health, Boston, MA.|Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
authors.forename: Unnur Anna
authors.initials: UA
authors.lastname: Valdimarsdottir
authors.affiliation: National Center for PTSD, VA Boston Healthcare System, Boston, MA.|Department of Psychiatry, Boston University School of Medicine, Boston, MA.
authors.forename: Jillian C
authors.initials: JC
authors.lastname: Shipherd
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC.
authors.forename: Heidi
authors.initials: H
authors.lastname: Resnick
authors.affiliation: Mental Health Services, The National University Hospital of Iceland, Reykjavik, Iceland.|Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
authors.forename: Berglind
authors.initials: B
authors.lastname: Gudmundsdottir
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004190:Disasters; D004325:Dreams / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D012893:Sleep Wake Disorders / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D012895:Sleep, REM; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D017741:Survivors / Q000523:psychology; D013997:Time Factors; D055815:Young Adult
keywords: children; development; posttraumatic stress; sleep; trauma