Sleep management in posttraumatic stress disorder: a systematic review and meta-analysis

Alicia Ruelaz Maher; Eric A Apaydin; Lara Hilton; Christine Chen; Wendy Troxel; Owen Hall; Gulrez Azhar; Jody Larkin; Aneesa Motala; Susanne Hempel

doi:10.1016/j.sleep.2021.08.016

Sleep management in posttraumatic stress disorder: a systematic review and meta-analysis

Sleep Med. 2021 Nov:87:203-219. doi: 10.1016/j.sleep.2021.08.016. Epub 2021 Aug 19.

Authors

Alicia Ruelaz Maher¹, Eric A Apaydin², Lara Hilton³, Christine Chen⁴, Wendy Troxel⁵, Owen Hall⁴, Gulrez Azhar⁶, Jody Larkin⁷, Aneesa Motala⁸, Susanne Hempel⁸

Affiliations

¹ Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA; Southern California Evidence-based Practice Center, Health Care, RAND Corporation, Santa Monica, CA, USA.
² Southern California Evidence-based Practice Center, Health Care, RAND Corporation, Santa Monica, CA, USA; Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. Electronic address: eapaydin@rand.org.
³ Southern California Evidence-based Practice Center, Health Care, RAND Corporation, Santa Monica, CA, USA; Center for Work & Family Life, University of Southern California, Los Angeles, CA, USA.
⁴ Southern California Evidence-based Practice Center, Health Care, RAND Corporation, Santa Monica, CA, USA.
⁵ Southern California Evidence-based Practice Center, Health Care, RAND Corporation, Pittsburgh, PA, USA; Department of Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
⁶ Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
⁷ Southern California Evidence-based Practice Center, Health Care, RAND Corporation, Pittsburgh, PA, USA.
⁸ Southern California Evidence-based Practice Center, Health Care, RAND Corporation, Santa Monica, CA, USA; Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

PMID: 34634573
DOI: 10.1016/j.sleep.2021.08.016

Abstract

Objective: Post-traumatic stress disorder (PTSD) can lead to many negative secondary outcomes for patients, including sleep disturbances. The objective of this meta-analysis is (1) to evaluate the effect of interventions for adults with PTSD on sleep outcomes, PTSD outcomes, and adverse events, and (2) to evaluate the differential effectiveness of interventions aiming to improve sleep compared to those that do not.

Methods: Nine databases were searched for relevant randomized controlled trials (RCTs) in PTSD from January 1980 to October 2019. Two independent reviewers screened 7176 records, assessed 2139 full-text articles, and included 89 studies in 155 publications for this review. Sleep, PTSD, and adverse event outcomes were abstracted and meta-analyses were performed using the Hartung-Knapp-Sidik-Jonkman method for random effects.

Results: Interventions improved sleep outcomes (standardized mean difference [SMD] -0.56; confidence interval [CI] -0.75 to -0.37; 49 RCTs) and PTSD symptoms (SMD -0.48; CI -0.67 to -0.29; 44 RCTs) across studies. Adverse events were not related to interventions overall (RR 1.17; CI 0.91 to 1.49; 15 RCTs). Interventions targeting sleep improved sleep outcomes more than interventions that did not target sleep (p = 0.03). Improvement in PTSD symptoms did not differ between intervention types.

Conclusions: Interventions for patients with PTSD significantly improve sleep outcomes, especially interventions that specifically target sleep. Treatments for adults with PTSD directed towards sleep improvement may benefit patients who suffer from both ailments.

Keywords: Meta-analysis; PTSD; Sleep; Systematic review.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Adult
Anxiety
Cognitive Behavioral Therapy*
Humans
Sleep
Sleep Wake Disorders* / therapy
Stress Disorders, Post-Traumatic* / complications
Stress Disorders, Post-Traumatic* / therapy