Disturbed EEG sleep, paranoid cognition and somatic symptoms identify veterans with post-traumatic stress disorder

Harvey Moldofsky; Lorne Rothman; Robert Kleinman; Shawn G Rhind; J Donald Richardson

doi:10.1192/bjpo.bp.116.003483

Disturbed EEG sleep, paranoid cognition and somatic symptoms identify veterans with post-traumatic stress disorder

BJPsych Open. 2016 Nov 9;2(6):359-365. doi: 10.1192/bjpo.bp.116.003483. eCollection 2016 Nov.

Authors

Harvey Moldofsky¹, Lorne Rothman², Robert Kleinman³, Shawn G Rhind⁴, J Donald Richardson⁵

Affiliations

¹ , MD, Dip. Psych., FRCPC, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
² , PhD, SAS (Canada) Institute, Inc., Toronto, Ontario, Canada.
³ , MD, Department of Ophthalmology, Stanford University, Palo Alto, California, USA.
⁴ , PhD, Individual Behaviour and Performance Section, Toronto Research Centre, Defence Research and Development Canada, Toronto, Ontario, Canada.
⁵ , MD, FRCPC, Operational Stress Injury Clinic, Parkwood Hospital, London, Ontario, Canada; Department of Psychiatry, Western University, London, Ontario, Canada; Department of Psychiatry & Behavioral Neuroscience, McMaster University, Hamilton, Ontario, Canada.

Abstract

Background: Chronic post-traumatic stress disorder (PTSD) behavioural symptoms and medically unexplainable somatic symptoms are reported to occur following the stressful experience of military combatants in war zones.

Aims: To determine the contribution of disordered EEG sleep physiology in those military combatants who have unexplainable physical symptoms and PTSD behavioural difficulties following war-zone exposure.

Method: This case-controlled study compared 59 veterans with chronic sleep disturbance with 39 veterans with DSM-IV and clinician-administered PTSD Scale diagnosed PTSD who were unresponsive to pharmacological and psychological treatments. All had standardised EEG polysomnography, computerised sleep EEG cyclical alternating pattern (CAP) as a measure of sleep stability, self-ratings of combat exposure, paranoid cognition and hostility subscales of Symptom Checklist-90, Beck Depression Inventory and the Wahler Physical Symptom Inventory. Statistical group comparisons employed linear models, logistic regression and chi-square automatic interaction detection (CHAID)-like decision trees.

Results: Veterans with PTSD were more likely than those without PTSD to show disturbances in non-rapid eye movement (REM) and REM sleep including delayed sleep onset, less efficient EEG sleep, less stage 4 (deep) non-REM sleep, reduced REM and delayed onset to REM. There were no group differences in the prevalence of obstructive sleep apnoeas/hypopnoeas and periodic leg movements, but sleep-disturbed, non-PTSD military had more EEG CAP sleep instability. Rank order determinants for the diagnosis of PTSD comprise paranoid thinking, onset to REM sleep, combat history and somatic symptoms. Decision-tree analysis showed that a specific military event (combat), delayed onset to REM sleep, paranoid thinking and medically unexplainable somatic pain and fatigue characterise chronic PTSD. More PTSD veterans reported domestic and social misbehaviour.

Conclusions: Military combat, disturbed REM/non-REM EEG sleep, paranoid ideation and medically unexplained chronic musculoskeletal pain and fatigue are key factors in determining PTSD disability following war-zone exposure.

Declaration of interest: None.

Copyright and usage: © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.