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Tijdschrift voor Psychiatrie 49 (2007) 9, 629 - 638

Review article

Sleep disturbances in post-traumatic stress disorder. An overview of the literature

S. van Liempt, E. Vermetten, J.H.M. de Groen, H.G.M. Westenberg

summary
background
Nightmares and insomnia are experienced by 70% of patients suffering from post-traumatic stress disorder (ptsd). These sleep problems are often resistant to treatment and exert a strong negative influence on the quality of life. In the last few decades several studies have reported on the characteristics of sleep disturbances in ptsd.
aim
To provide an overview of objective features of sleep disturbances - as opposed to self-report methods - in patients with ptsd.
method Articles on this topic, published in peer-reviewed journals between 1980 and the present, were retrieved from Medline and Embase, using the search terms 'ptsd', 'sleep', 'nightmares', 'insomnia', 'polysomnography'.
results Studies reported on changes in sleep efficiency, arousal regulation, motor activity during sleep, rem characteristics and delta sleep activity during sleep. Also, correlations were found between nightmares and sleep apnoea in ptsd. In some studies on sleep disturbance no objective sleep disturbances were found in ptsd patients. However, most studies on ptsdrelated sleep disturbances were conducted in small, heterogeneous groups, and results were therefore inconsistent. Even the results of larger and more homogeneous studies were sometimes contradictory.
conclusion There is a discrepancy between the clinical importance of sleep problems in ptsd and unambiguous objective sleep disorders. Future research should try to establish objective criteria for identifying the altered sleep patterns in ptsd. These criteria should help us to understand the neurobiological mechanisms of sleep disturbances in ptsd and develop new treatment strategies.

keywords insomnia, nightmares, polysomnography, post-traumatic stress disorders, sleep