0803 Clinical and Polysomnographic Features of Trauma Associated Sleep Disorder (TASD)
H. Sanchez, Vincent Mysliwiec, R. Froese, Jennifer L Creamer, Panagiotis Matsangas, S. Foster, S. Hansen, Matthew S. Brock
May 27, 2020 DOI: 10.1093/sleep/zsaa056.799 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational cohort study |
|---|---|
| Sample size | 40 |
| Population | Active duty service members with trauma associated sleep disorder |
| Key findings | In 40 active-duty service members with trauma associated sleep disorder, combat-related dream content, trauma-related nightmares, and disruptive nocturnal behaviors were common, as were comorbid insomnia, PTSD, anxiety, depression, and obstructive sleep apnea. Most patients had REM sleep without atonia. PTSD was associated with purposeful disruptive nocturnal behaviors, and those behaviors were associated with less N3 sleep. The authors argue these findings support TASD as a unique REM-related parasomnia. |
Abstract
Trauma associated sleep disorder (TASD) is an emerging parasomnia that develops after trauma with clinical features of trauma related nightmares (TRN), disruptive nocturnal behaviors (DNB), and autonomic disturbances. The purpose of this study is to characterize the clinical and polysomnographic (PSG) features of TASD. Clinical history and detailed video-PSG review, to include post-PSG nightmare reports, of a cohort of patients with TASD. Patients (n=40, 32 men, 8 women) were active duty service members with a median age of 38.9 yrs (range 24-57 yrs). Dream content typically related to combat (n=37, 92.5%), with 75% (n=30) reporting TRN and 60% (n=24) reporting dream enactment at least weekly. Self-reported DNB included vocalizations, violent limb movements, thrashing, defensive posturing, and jumping from bed. There was a high rate of comorbid insomnia (n=35, 87.5%), PTSD (n=23, 63.9%), anxiety (n=25, 62.5%), depression (n=20, 50%), OSA (n=19, 47.5%), chronic pain (n=12, 30%), and TBI (n=13, 32.5%). Most patients had REM sleep without atonia (RSWA) (n=33, 82.5%), though a minority had purposeful DNB (n=11, 27.5%). Vocalizations were present in seven (17.5%) patients. Patients with PTSD were more likely to have purposeful DNB (n=9, 100%) than those without PTSD (n=13, 50%; p=0.013), whereas patients with purposeful DNB had markedly less N3 sleep (1.0±11.4%) than those without purposeful DNB (13.8±16.2%; p=0.002). There was no significant difference in medications between DNB groups. TASD is frequently comorbid with other sleep and behavioral health disorders. Characteristics of TASD are often captured on video-PSG during REM sleep, though DNB may be less pronounced than what patients report in their habitual sleeping environment. Clinical and video-PSG correlations are invaluable in assessing patients with TASD. This study, which is the largest cohort to date, provides a further basis for establishing TASD as a unique REM-related parasomnia. N/A