Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Oct 29;10(1):1679964.
doi: 10.1080/20008198.2019.1679964. eCollection 2019.

Sleep disturbance at pre-deployment is a significant predictor of post-deployment re-experiencing symptoms

Dean T Acheson  1   2 , Brian Kwan  3 , Adam X Maihofer  2 , Victoria B Risbrough  1   2 , Caroline M Nievergelt  1   2 , Jacob W Clark  4 , Xin M Tu  3 , Michael R Irwin  5 , Dewleen G Baker  1   2
Affiliations

Sleep disturbance at pre-deployment is a significant predictor of post-deployment re-experiencing symptoms

Dean T Acheson et al. Eur J Psychotraumatol. .

Abstract
in English, Spanish, Chinese

Background: Insomnia is common in service members and associated with many mental and physical health problems. Recently, longitudinal data have been used to assess the impact of disturbed sleep on mental health outcomes. These studies have consistently shown relationships between sleep disturbance and development of mental illness. Objective: The present study examined the longitudinal relationship between sleep disturbance and PTSD symptomatology in a cohort of Marines and Navy Corpsmen deployed to Iraq and Afghanistan (n = 2,404) assessed prior to deployment, as well as at -3 and 6 months post-deployment. Additionally, we aimed to investigate the extent to which these relationships are moderated by combat-stress severity, and to what extent these findings are replicated in a second, separate cohort of Marines and Navy corpsmen (n = 938) assessed with identical measures prior to deployment and within 3 months of return. Method: The present study employed latent variable path models to examine the relationships between pre-deployment sleep disturbance and post-deployment re-experiencing symptoms. Initial cross-lagged path models were conducted on discovery and replication samples to validate the hypothesized predictive relationships. Follow up moderation path models were then conducted to include the effect of combat-stress severity on these relationships. Results: Initial cross-lagged models supported a significant relationship between pre-deployment sleep disturbance and future re-experiencing PTSD symptoms at all time points. Initial moderation models showed a small moderator effect of combat-stress severity, though the main predictive relationship between pre-deployment sleep disturbance and PTSD symptoms remained significant. The moderator effect was not significant in the replication sample. Conclusions: The results of this study support pre-deployment sleep disturbance as a risk factor for development of post-deployment PTSD symptoms. Interventions aimed at normalizing sleep may be important in preventive measures for PTSD.

Antecedentes: El insomnio es común en los miembros del servicio y está asociado con muchos problemas de salud mental y física. Recientemente, se han utilizado datos longitudinales para evaluar el impacto de las alteraciones del sueño en los resultados de salud mental. Estos estudios han demostrado consistentemente las relaciones entre las alteraciones del sueño y el desarrollo de enfermedades mentales.Objetivo: El presente estudio examinó la relación longitudinal entre el trastorno del sueño y la sintomatología del TEPT en una cohorte de infantes y médicos de Marina desplegados en Irak y Afganistán evaluados antes del despliegue, así como a los 3 y 6 meses posteriores al despliegue. Además, nuestro objetivo fue investigar hasta qué punto estas relaciones son moderadas por la gravedad del estrés de combate, y en qué medida estos hallazgos se replican en una segunda cohorte separada de marinos y médicos de la Marina evaluados con medidas idénticas antes del despliegue y dentro de los 3 meses de regreso.Método: El presente estudio empleó modelos de trayectorias de variables latentes para examinar las relaciones entre la alteración del sueño previa al despliegue y los síntomas de reexperimentación posterior al despliegue. Se llevaron a cabo modelos iniciales de trayectorias de retardo cruzadas en muestras de descubrimiento y replicación para validar las relaciones predictivas hipotéticas. Los modelos de seguimiento de las trayectorias de moderación se llevaron a cabo para incluir el efecto de la gravedad del estrés de combate en estas relaciones.Resultados: Los modelos iniciales de retardo cruzado respaldaron una relación significativa entre la alteración del sueño previa al despliegue y los síntomas futuros de TEPT que se vuelven a experimentar en todos los momentos. Los modelos de moderación iniciales mostraron un efecto moderador pequeño de la gravedad del estrés de combate, aunque la principal relación predictiva entre la alteración del sueño previa al despliegue y los síntomas de TEPT se mantuvo significativa. El efecto moderador no fue significativo en la muestra de replicación.Conclusiones: Los resultados de este estudio respaldan que la alteración del sueño previa al despliegue es un factor de riesgo para el desarrollo de síntomas de TEPT posterior al despliegue. Intervenciones dirigidas a normalizar el sueño pueden ser importantes en cuanto a medidas preventivas para el TEPT.

背景：失眠在服役人员中常见且与许多身心健康问题有关。最近，纵向数据被用于评估睡眠障碍对心理健康结果的影响。这些研究一致揭示了睡眠障碍与精神疾病发展的关系。目的：本研究考查了被派遣到伊拉克和阿富汗的海军医护兵在部署前和部署后3个月、6个月的睡眠障碍和创伤后应激障碍症状之间的纵向关系。此外，我们旨在考查这些关系在多大程度上受到战斗应激严重程度的影响。并通过让另一个海军医护兵独立群体在其部署前和在回国后3个月内接受相同测评考查这些结果在多大程度上能够重复。方法：本研究采用潜变量路径模型来考查部署前睡眠障碍与部署后再体验症状之间的关系。在探索样本和重复样本上应用初始交叉滞后路径模型以验证假设的预测关系。随后在调节路径模型中将战斗应激严重程度对这些关系的影响纳入。结果：初始交叉滞后模型在所有时间点都支持了部署前睡眠障碍与未来出现再体验这一PTSD症状之间显著相关。虽然部署前睡眠障碍对创伤后应激障碍症状的主预测关系仍然显著，初始调节模型显示战斗应激严重程度的调节效应较小。调节效应在重复样本中不显著。结论：本研究的结果支持部署前睡眠障碍作为部署后PTSD症状发展的一个风险因子。旨在使睡眠正常化的干预在创伤后应激障碍的预防措施中可能很重要。.

Keywords: PTSD; Sleep; insomnia; longitudinal; re-experiencing.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Standardized coefficients for autoregressive cross-lagged panel model on the initial (MRS I) sample. Observed variables are indicated by rectangular nodes, while latent constructs are indicated by oval-shaped nodes. Observed variables B1-C1 indicate specific items from Clinician Administered PTSD Scale (CAPS), DSM IV version (see PCA results for specific items). Modelled correlated error for repeated measures has been omitted for clarity of presentation (values range .04 – .33). Modelled correlated error between latent constructs at 3 and 6-month time points has likewise been omitted for clarity (values .4 and .33, respectively). * = p < .05, ** = p < .001.
Figure 2.
Figure 2.
Standardized coefficients for the replicated (MRS II) autoregressive cross-lagged panel model. Observed variables are indicated by rectangular nodes, while latent constructs are indicated by oval-shaped nodes. Observed variables B1-C1 indicate specific items from Clinician Administered PTSD Scale (CAPS) DSM IV version (see PCA results for specific items). Modelled correlated error for repeated measures has been omitted for clarity of presentation (values range −.03 – .43). Modelled correlated error between latent constructs at post-deployment has likewise been omitted for clarity (.35). ** = p < .001.
Figure 3.
Figure 3.
Standardized coefficients for the initial (MRS I) moderation model-predicting re-experiencing symptoms at 3-month from re-experiencing symptoms at pre-deployment, sleep disruption at pre-deployment, combat-stress experience, and the interaction between pre-deployment sleep disruption and combat stress. Observed variables are indicated by rectangular nodes, while latent constructs are indicated by oval-shaped nodes. Observed variables B1-C1 indicate specific items from Clinician Administered PTSD Scale (CAPS) DSM IV version (see PCA results for specific items). Indicators of the interaction construct represent the residual of the product of the two items multiply regressed on both individual items in order to isolate variance accounted for by the interaction. * = p < .05, ** = p < .001.
Figure 4.
Figure 4.
Standardized coefficients for the initial (MRS I) moderation model-predicting re-experiencing symptoms at 6-month from re-experiencing symptoms at pre-deployment, sleep disruption at pre-deployment, combat-stress experience, and the interaction between pre-deployment sleep disruption and combat stress. Observed variables are indicated by rectangular nodes, while latent constructs are indicated by oval-shaped nodes. Observed variables B1-C1 indicate specific items from Clinician Administered PTSD Scale (CAPS) DSM IV version (see PCA results for specific items). Indicators of the interaction construct represent the residual of the product of the two items multiply regressed on both individual items in order to isolate variance accounted for by the interaction. * = p < .05, ** = p < .001.
Figure 5.
Figure 5.
Standardized coefficients for the replicated (MRS II) moderation model predicting re-experiencing symptoms at post-deployment from re-experiencing symptoms at pre-deployment, sleep disruption at pre-deployment, combat-stress experience, and the interaction between pre-deployment sleep disruption and combat stress. Observed variables are indicated by rectangular nodes, while latent constructs are indicated by oval-shaped nodes. Observed variables B1-C1 indicate specific items from Clinician Administered PTSD Scale (CAPS) DSM IV version (see PCA results for specific items). Indicators of the interaction construct represent the residual of the product of the two items multiply regressed on both individual items in order to isolate variance accounted for by the interaction. ** = p < .001.
See this image and copyright information in PMC

References

    1. Abel T., Havekes R., Saletin J. M., & Walker M. (2013). Sleep, plasticity and memory from molecules to whole brain networks. Current Biology, 23, 774–12. - PMC - PubMed
    1. Acheson D. T., Geyer M. A., Baker D. G., Nievergelt C. M., Yurgil K., & Risbrough V. B. (2015). Conditioned fear and extinction learning performance and its association with psychiatric symptoms in active duty Marines. Psychoneuroendocrinology, 51, 495–505. - PMC - PubMed
    1. Agorastos A., Nash W. P., Nunnink S., Yurgil K. A., Goldsmith A., Litz B. T., … Baker D. G. (2013). The peritraumatic behavior questionnaire: Development and initial validation of a new measure for combat-related peritraumatic reactions. BMC Psychiatry, 13, 9. - PMC - PubMed
    1. Baker D. G., Nash W. P., Litz B. T., Geyer, M. A., Risbrough, V. B., Niervergelt, C. M., … MRS Team (2012). Predictors of risk and resilience for posttraumatic stress disorder among ground combat marines: Methods of the marine resiliency study. Preventing Chronic Disease, 9, 110134. - PMC - PubMed
    1. Beck A. T., & Steer R. A. (1993). Beck anxiety inventory manual. San Antonio, TX: Harcourt Brace and Company.