The relationship between sleep disturbance and the course of anxiety disorders in primary care patients

Abstract

This study examined the relationship between sleep disturbance and the course of anxiety disorders in primary care patients. Participants were part of the Primary Care Anxiety Project (PCAP), a naturalistic, longitudinal study of anxiety disorders in primary care. Participants completed an intake evaluation and follow-up assessments at 6 months, 12 months, and annually thereafter. Only participants with sleep data at intake were included in the current study (n=533). The majority (74%) reported experiencing sleep disturbance at intake. Those with a diagnosis of generalized anxiety disorder (GAD) or post-traumatic stress disorder (PTSD) were over 2 times more likely to have sleep problems. Sleep disturbance at intake did not relate to the longitudinal course of GAD, social phobia, panic disorder, or obsessive-compulsive disorder. However, it did predict the course of PTSD, controlling for comorbid major depressive disorder (MDD) and having more than one anxiety disorder diagnosis intake, those with sleep disturbance at intake being less likely to remit from PTSD in the 5 years of follow-up. By year 5, only 34% of those with sleep problems at intake remitted from PTSD whereas 56% of those without sleep disturbance remitted from the disorder. The findings suggest that sleep disturbance in PTSD may have prognostic significance and may be important to address in clinical interventions.