title: Trauma Sequelae are Uniquely Associated with Components of Self-Reported Sleep Dysfunction in OEF/OIF/OND Veterans.
abstract: While the associations between psychological distress (e.g., posttraumatic stress disorder [PTSD], depression) and sleep dysfunction have been demonstrated in trauma-exposed populations, studies have not fully explored the associations between sleep dysfunction and the wide range of common physical and physiological changes that can occur after trauma exposure (e.g., pain, cardiometabolic risk factors). We aimed to clarify the unique associations of psychological and physical trauma sequelae with different aspects of self-reported sleep dysfunction. A comprehensive psychological and physical examination was administered to 283 combat-deployed trauma-exposed Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) veterans. The Pittsburgh Sleep Quality Index (PSQI) and PSQI Addendum for PSTD (PSQI-A) were administered along with measures of PTSD, depression, anxiety, pain, traumatic brain injury, alcohol use, nicotine dependence, and cardiometabolic symptoms. We first performed a confirmatory factor analysis of the PSQI and then conducted regressions with the separate PSQI factors as well as the PSQI-A to identify unique associations between trauma-related measures and the separate aspects of sleep. We found that the PSQI global score was composed of three factors: Sleep Efficiency (sleep efficiency/sleep duration), Perceived Sleep Quality (sleep quality/sleep latency/sleep medication) and Daily Disturbances (sleep disturbances/daytime dysfunction). Linear regressions demonstrated that PTSD symptoms were uniquely associated with the PSQI global score and all three factors, as well as the PSQI-A. For the other psychological distress variables, anxiety was independently associated with PSQI global as well as Sleep Efficiency, Perceived Sleep Quality, and PSQI-A, whereas depression was uniquely associated with Daily Disturbances and PSQI-A. Notably, cardiometabolic symptoms explained independent variance in PSQI global and Sleep Efficiency. These findings help lay the groundwork for further investigations of the mechanisms of sleep dysfunction in trauma-exposed individuals and may help in the development of more effective, individualized treatments.
authors.affiliation: a Boston Attention and Learning Laboratory , Boston Division VA Healthcare System , Boston , Massachusetts , USA.|b Geriatric Research Education and Clinical Center , Boston Division VA Healthcare System , Boston , Massachusetts , USA.|c Department of Medicine , Harvard Medical School , Boston , Massachusetts , USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: DeGutis
authors.affiliation: a Boston Attention and Learning Laboratory , Boston Division VA Healthcare System , Boston , Massachusetts , USA.|b Geriatric Research Education and Clinical Center , Boston Division VA Healthcare System , Boston , Massachusetts , USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Chiu
authors.affiliation: a Boston Attention and Learning Laboratory , Boston Division VA Healthcare System , Boston , Massachusetts , USA.|b Geriatric Research Education and Clinical Center , Boston Division VA Healthcare System , Boston , Massachusetts , USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Thai
authors.affiliation: a Boston Attention and Learning Laboratory , Boston Division VA Healthcare System , Boston , Massachusetts , USA.|b Geriatric Research Education and Clinical Center , Boston Division VA Healthcare System , Boston , Massachusetts , USA.|d Department of Psychiatry , Boston University School of Medicine , Boston , Massachusetts , USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Esterman
authors.affiliation: b Geriatric Research Education and Clinical Center , Boston Division VA Healthcare System , Boston , Massachusetts , USA.|e Translational Research Center for TBI and Stress Disorders (TRACTS) , VA RR&D TBI Center of Excellence, VA Boston Healthcare System , Boston , Massachusetts , USA.
authors.forename: William
authors.identifier: 0000-0002-6078-7066
authors.initials: W
authors.lastname: Milberg
authors.affiliation: b Geriatric Research Education and Clinical Center , Boston Division VA Healthcare System , Boston , Massachusetts , USA.|e Translational Research Center for TBI and Stress Disorders (TRACTS) , VA RR&D TBI Center of Excellence, VA Boston Healthcare System , Boston , Massachusetts , USA.
authors.forename: Regina
authors.initials: R
authors.lastname: McGlinchey
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000523:psychology; D001007:Anxiety / Q000150:complications / Q000523:psychology; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000503:physiopathology / Q000523:psychology; D003863:Depression / Q000150:complications / Q000523:psychology; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D057566:Self Report; D012890:Sleep; D012893:Sleep Wake Disorders / Q000150:complications* / Q000503:physiopathology* / Q000523:psychology; D012907:Smoking / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000523:psychology; D014728:Veterans / Q000523:psychology*