SLEEP 2011 Abstract Supplement

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B. Clinical Sleep Science IX. Psychiatric and Behavioral Disorders and Sleep 0732 PSYCHIATRIC CO MORBIDITIES IN AFRICAN AMERICAN PATIENTS PRESENTING TO SLEEP DISORDERS CLINIC Khurshid K 1 , Khan RA 2 , Fatima S 3 1 Psychiatry, Howard University Hospital, Washington, DC, USA, 2 Neurology, Howard University Hospital, Washington, DC, USA, 3 Neurology, Georgetown University Hospital, Washington, DC, USA Introduction: Psychiatric disorders are common in patients presenting in primary care clinics and sleep disorders clinics. There is bidirectional relationship between sleep disorders and psychiatric disorders. Investigation of the psychiatric dimension of sleep disorders can provide important information regarding pathophysiology and clinical management of both psychiatric and sleep disorders. There have been numerous studies assessing the psychiatric co morbidities and relationship between sleep disorders and psychiatric disorders. Sleep disorders, particularly sleep disordered breathing, has been found to be commonly prevalent in patients of African-American decent. There is no study in the medical literature evaluating the burden of psychiatric disorders in African-American patients presenting in sleep disorders clinic. This study evaluates psychiatric co-morbidities in patients presenting for evaluation in our sleep disorders clinic Methods: 1.All African-American patients seen in our sleep disorders clinic from January 1,2010 till June 30,2010 were identified through clinic records 2.Chart review of these patients 3.Data were collected regarding their reasons for referral, demographics, medications, and diagnoses of various psychiatric disorders as documented in their charts 4.Review of PSG data of patients who underwent sleep studies Results: All patients who presented to our sleep disorders clinic for evaluation were included in this review. Mean age was 52.6 years. M: F ratio was approximately 1:2. Commonly encountered psychiatric co-morbidities included Major depressive disorder, Anxiety disorders, Substance abuse, Schizophrenia and Schizoaffective disorders. Snoring, excessive daytime somnolence and insomnia were the most common presenting features.Significant number of patients presenting with insomnia had co-morbid psychiatric disorders.Psychiatric diagnoses were less common when the results were compred to other similar studies of general population. Conclusion: This study showed that significant number of patients presenting with insomnia had co-morbid psychiatric disorders and suggested that all patients who present with insomnia should be evaluated for presence of co-morbid or underlying psychiatric disorders.Psychiatric disorders in African American patients presenting to our sleep disorders clinic may be underdiagnosed or less prevelant as comapred to general population. 0733 THE NIGHTTIME CHAOS OF OEF/OIF MILITARY-RELATED POSTTRAUMATIC STRESS DISORDER Nappi CM 1,2 , Salamat J 1 , Anderson D 1 , Norman S 1,2 , Drummond SP 1,2 1 Psychiatry, University of California, San Diego, San Diego, CA, USA, 2 Psychology Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA Introduction: Subjective sleep disturbances are well documented in PTSD, although objective sleep problems are less clear. Little data has been published on sleep characteristics of Operation Enduring Freedom/ Operation Iraqi Freedom (OEF/OIF) Veterans with PTSD. Here, we present baseline sleep data from OEF/OIF Veterans prior to treatment. Methods: To be eligible, subjects must have been deployed at least once to OEF/OIF, experienced a military-related trauma, and meet DSM-IV criteria for PTSD, chronic insomnia, and nightmare disorder. At baseline, subjects completed self report questionnaires of sleep, as well as wore an actigraph and completed sleep diaries for 1 week. We report data from 21 subjects (age=32.6+/-7.6yrs, 19M, 10 with multiple deployments). Results: Subjects reported 6.2+/-4.4 nightmares/week, with moderate levels of associated distress. They scored 9.3+/-3.9 on the PSQI-Addendum, well above the cutoff of 4. On the CAPS, nightmares were the most frequent and intense of the reported intrusive symptoms. Global PSQI scores were significantly elevated (mean=14.2+/-3.2), as were reports of insomnia on the ISI (mean=18.6+/-3.7) and CAPS (frequency of sleep difficulty: 100% reported “daily or almost every day”). Diary data also showed subjectively poor sleep: TST=5.8+/-1.8hrs, SE=77+/- 14%, SL=42+/-8.2min, WASO=68.8+/-56.6min. Actigraphy showed similar data: TST=6.1+/-1.5hrs, SE=78+/-9.4%, WASO=73+/-28.5min. Of note, there was considerable inter- and intra-individual variability in these sleep measures. Conclusion: Both subjective and objective sleep is highly disturbed in OEF/OIF Veterans with PTSD and this is the first study to demonstrate consistency between subjective and objective assessments in this cohort. As with other PTSD cohorts, nightmares occur almost daily, on average. Insomnia-related sleep disruptions are seen at levels roughly equivalent to insomnia patients from our lab and depressed patients in the literature. Night-to-night variability in sleep, at both group and individual levels, was greater in PTSD than the other samples. These marked sleep disruptions may relate to daytime function and/or treatment outcome. 0734 PAP COMPLIANCE IN HISPANIC VETERANS WITH PSYCHIATRIC DISORDERS Kovacevic I 1,3 , Wallace DM 1 , Vargas SS 4 , Shafazand S 2 1 Neurology, University of Miami/Miami VA HealthCare System, Miami, FL, USA, 2 Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL, USA, 3 Psychiatry, University of Miami/Miami VA HealthCare System, Miami, FL, USA, 4 Medicine, University of Miami Miller School of Medicine, Miami, FL, USA Introduction: Psychological symptoms are recognized as contributing factors in PAP treatment compliance for sleep disordered breathing (SDB). We explored PAP compliance rates in Hispanic veterans with and without psychiatric co-morbidities. Methods: Consecutive Hispanic patients were recruited from the Miami VA Sleep clinic as part of a sleep education in Hispanics study. Participants completed questionnaires, screening for SDB, sleep quality (PSQI), health-related quality of life (HRQOL) and for presence of anxiety and depression symptoms (HADS). SDB diagnosis and severity was confirmed by in-lab polysomnography. Patients were categorized in 2 groups (Psychiatric disorders present or not) based on Axis 1 diagnoses obtained from electronic records. One week after PAP distribution compliance data was downloaded from PAP memory card. Means and SDs and frequencies are reported. Group comparisons were made using Chi-square or student t test as appropriate. Results: Sixty-one veterans (2% female) were enrolled with mean age 50± 13, BMI of 34±6 and HRQOL score 59.6±21.5. The mean HADS Depression score was 8±4 and anxiety score 9±5. Axis I diagnosis were found in 64% of the cohort, 30% had mood disorders, 18% with PTSD, 2% substance abuse, 2% psychoses, and 13% with multiple diagnoses. Poor sleep quality was reported by 95% of the cohort with mean PSQI score of 11±4 and 92% screened high risk for SDB and confirmed mean AHI was 41±32 events per hour. At 7 days, mean total hours of PAP usage was 30±18. During this time, 35% of the cohort had used PAP greater than 4 nights, more than 4 hours each night. There was a trend towards less PAP usage in patients with psychiatric disorders although it did not reach statistical significance. Conclusion: Psychiatric disorders may play a role in determining PAP compliance. Longer term compliance data is needed to confirm this trend. SLEEP, Volume 34, Abstract Supplement, 2011 A252
B. Clinical Sleep Science IX. Psychiatric and Behavioral Disorders and Sleep 0735 NARRATIVE EXPOSURE TREATMENT FOR POSTTRAUMATIC STRESS DISORDER DECREASES INSOMNIA SYMPTOMS AND NIGHTMARES Casement MD, Marx BP, Bovin MJ, Sloan DM Behavioral Sciences Division, National Center for PTSD, Boston, MA, USA Introduction: Insomnia and nightmares are core features of PTSD, yet clinically significant sleep disturbance persists in approximately 40% of patients who complete cognitive-behavioral therapy for PTSD. This study examined the extent to which a novel treatment for PTSD improved trauma-related insomnia and nightmares. Methods: Participants were randomized to either a narrative exposure treatment (NET; n = 22) or a waitlist condition (WL, n = 23). All participants completed assessments at baseline, post-treatment (6 weeks for WL), and 3 month follow-up (or 18 weeks for WL). Trauma-related sleep disturbance was examined using two items from the Clinician Administered PTSD Scale. Results: The baseline assessment revealed that the NET and WL groups did not differ significantly in severity of sleep disturbance. At baseline, 80% of the sample reported clinically significant insomnia (sleep onset latency ≥ 30 min several times a week), and 20% reported clinically significant nightmares (severely distressing nightmares with difficulty returning to sleep at least once or twice per week). However, group differences were observed following treatment. Individuals who completed NET had significant decreases in sleep disturbance, with 22% reporting significant insomnia and 4% reporting significant nightmares. These sleep improvements were maintained through 3 month follow-up. In contrast, 65% of the WL group reported significant insomnia and 43% reported significant nightmares at 6 week follow-up. Conclusion: These findings indicate that NET reduces sleep disturbance to sub-clinical levels of severity in a majority of patients. Furthermore, the degree of sleep improvement following NET compares favorably to reported sleep improvements following other cognitive-behavioral treatments for PTSD. Support (If Any): This research was supported by an NIH Clinical Training Grant awarded to Denise Sloan (5R34MH077658) and an NIH Institutional Training Grant awarded to the National Center for PTSD (5T32MH019836). 0736 THE EFFECT OF BRIGHT LIGHT THERAPY ON POSTTRAUMATIC STRESS DISORDER RELATED SLEEP DISTURBANCES Cornelius SK 1,2 , Kline CE 1,2,3 , Ginsberg JP 2 , Youngstedt SD 1,2 1 Exercise Science, University of South Carolina, Columbia, SC, USA, 2 Research and Development, WJB Dorn VA, Columbia, SC, USA, 3 Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA Introduction: Sleep disturbance is perhaps the most common complaint of posttraumatic stress disorder (PTSD) patients, and may play a role in precipitating and/or perpetuating the symptoms of PTSD. Treatment of disturbed sleep could provide an important means of improving mental health in PTSD patients. The objective of our ongoing study is to examine whether bright light therapy will elicit reductions in clinical and self assessment of PTSD symptom severity, and related morbidity, including depression and disturbed sleep. Methods: Following a 1-week baseline, twenty-four veterans of the current conflicts in Iraq and Afghanistan diagnosed with combat-related PTSD were randomized to one of two, 4-week treatments: (1) bright light (daily 10,000 lux for 30 min; n=12) or (2) a placebo inactivated negative ion generator (NIG; n=12). A Clinician-Administered PTSD Scale (CAPS-2) was administered at baseline and within 1-3 days following the intervention. At weekly intervals, depression was assessed with the Beck Depression Inventory (BDI-II), self-reported PTSD symptoms were assessed with the PTSD Checklist-Military Version (PCL-M), and sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), plus addendum for PTSD-related sleep problems. Results: Preliminary results showed a greater reduction in CAPS-2 [Effect Size (ES)=0.89 vs. 0.07] and PCL-M (ES= 0.92 vs.0.27), following bright light vs. NIG, respectively. PTSD-related sleep complaints were also reduced more following bright light (ES=1.14) vs, NIG (ES=- 0.16), partly due to a reduction in frequency of nightmares following bright light (from 2X/wk to < 1x/week), but no change following NIG . A greater reduction in BDI-II (ES=0.83 vs. 0.49) was also observed following bright light vs. NIG. Conclusion: Preliminary results suggest benefits of bright light for PTSD and associated morbidity, including depression and PTSD-related sleep disturbances. Support (If Any): VA Merit Award 0737 EFFICACY OF A COGNITIVE-BEHAVIORAL TREATMENT FOR INSOMNIA AMONG AFGHANISTAN AND IRAQ (OEF/ OIF) VETERANS WITH PTSD Ochsner Margolies S 1,2 , Rybarczyk B 1 , Lynch J 2 , Vrana S 1 1 Virginia Commonwealth University, Richmond, VA, USA, 2 Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA Introduction: High rates of post-traumatic stress disorder (PTSD) are being diagnosed in veterans who served in Afghanistan and/or Iraq in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF). Sleep disturbances are a core and salient feature of PTSD and can maintain or exacerbate associated symptoms. Recent research demonstrates that sleep-focused behavioral interventions with a component for nightmares improve sleep disturbances as well as PTSD symptoms. Studies to date have focused primarily on civilian PTSD participants, with some recent pilot work on older veterans with PTSD. This study examines the efficacy of cognitive behavioral therapy for insomnia (CBT-I) in significantly improving sleep and reducing PTSD severity in younger OEF/ OIF combat veterans. Methods: Participants included 27 (mean age = 36.8, 85% male) OEF/ OIF combat veterans with clinically significant insomnia and PTSD, recruited from the mental health clinic at the McGuire Hunter Holmes VA Medical Center. Participants were randomized to either a treatment group or a wait-list control group. Those in the treatment condition participated in four CBT-I sessions over a six-week period including sleep restriction, stimulus control, cognitive restructuring, sleep education, sleep hygiene and imagery rehearsal therapy to address nightmares. Participants completed measures at baseline and post-treatment. Participants in the treatment condition also provided three-month follow-up data. Outcome measures included: Sleep Diary (sleep efficiency, wake after sleep onset, sleep latency, total sleep time), Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Pittsburgh Sleep Quality Index- Addendum (PSQI-A, a measure assessing PTSD related sleep disturbances), PTSD Symptom Scale, Disbeliefs and Attitudes About Sleep, Profile of Mood States, and Patient Health Questionnaire. Actigraphy was measured for participants in the treatment group at baseline and post treatment. Results: Repeated measures ANOVAs revealed a significant improvement between groups, for the following variables: sleep efficiency, p < .001; sleep latency, p < .05; PSQI, p < .001; PSQI-A, p = .01; ISI, p < .001; PTSDSS, p = .001. Actigraphy data was collected and will be presented at the time of the conference along with remaining outcome measures. Conclusion: CBT-I is an effective treatment for insomnia, nightmares and PTSD symptoms in OEF/OIF veterans with combat related PTSD and should be used as an adjunctive therapy to standard PTSD treatment. Support (If Any): This project was funded by the United States Department of Veterans Affairs Predoctoral Rehabilitation Research Fel- A253 SLEEP, Volume 34, Abstract Supplement, 2011
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