MONTREAL – Sleep problems are very common among individuals exposed to terrorist attacks, and new evidence suggests that sleep deficits are contributing to obesity in this traumatized population, researchers reported at the annual meeting of the International Society for Traumatic Stress Studies.
Disturbed sleep and traumatic nightmares are hallmark features of posttraumatic stress disorder (PTSD), said Brian Hall, a doctoral candidate at Kent (Ohio) State University and a clinical psychology intern at the Medical University of South Carolina, Charleston. "Sleep is a treatment-refractory target in PTSD. In folks who respond well to treatments for PTSD, sleep problems tend to be a residual issue."
In a study of 501 Israeli Jews living along the Gaza strip, Mr. Hall and his colleagues found that 47% had had at least one direct terrorist exposure involving the death of a relative, personal injury, the injury of a relative or close friend, or witnessing a rocket or terrorist attack with injuries or fatalities.
PTSD was present in 5.5% of this highly exposed cohort, and depression, in an additional 3.8%. Clinical sleep disturbance, assessed using the 18-item Pittsburgh Sleep Quality Index (PSQI), was present in 37.4% of the cohort, but reached 82% among those identified with PTSD, and 79% among those who were depressed. Overweight, assessed by body mass index (BMI), was present in 45% of the entire cohort, with 11% of the overweight group meeting criteria for obesity, he said at the meeting, cosponsored by Boston University.
Statistical analysis showed that although there was no direct effect of PTSD on BMI, sleep mediated this effect.
Further analysis of the same data revealed that females in the cohort were more prone to sleep problems than males (odds ratio, 1.45), as were individuals aged 50-64 years (OR, 2.07) and those older than age 65 years (OR, 4.45), reported Stevan Hobfoll, Ph.D., of Rush University Medical Center in Chicago, in a separate presentation about the same data.
Sleep problems can worsen the symptoms of PTSD and might exacerbate physical health problems such as cardiovascular disease, stroke, and diabetes, said Mr. Hall in an interview. "What I am trying to emphasize from a public health perspective is that interventions targeting sleep problems are important in PTSD."
Asked to comment on the findings, Jeffrey Knight, Ph.D., raised questions about them. "These things are all related, but to what degree and in what order? What do you do with the person in front of you?" said Dr. Knight, a clinical neuropsychologist at the National Center for PTSD, VA Boston Healthcare System, and Boston University. "What you have is a ball of symptoms traveling together as a unit – it’s like a soccer ball – and at any particular time it rolls over and you see certain facets, but the other parts are still operative. Sleep is a piece of the protocol, but whether it’s driven by anxiety or depression or nightmares, you need to address it differently."
None of the presenters reported having conflicts of interest.