Sleep Disorders not Linked to Worse QoL in Veterans with PTSD

The presence of PTSD in veteran patients with insomnia and psychological distress may help to determine discrepancies in treatment-based outcomes, according to new findings.

In research presented at the SLEEP 2024 Annual Meeting in Houston, TX, this weekend, a team of US-based investigators reported that the quality of life (QoL) of veterans with psychological distress and a sleep disorder such as insomnia is influenced by each of those conditions. However, among veterans with each of psychological distress, a sleep disorder and PTSD, QoL is not primarily influenced by the sleep disorder. The new data could help to better determine treatment prioritization in veteran patents presenting with poor sleep and psychological health.

Led by Mason Krueger, of the Bruce W. Carter Department of Veterans Affairs Medical Center, investigators sought to interpret the relationships between obstructive sleep apnea (OSA) severity, insomnia, and psychological distress within the QoL of veterans with and without PTSD. QoL, in the case of their analysis, was interpreted by measures of physical and social functioning.

“OSA, insomnia, and psychological distress have been independently linked to various negative outcomes, including poorer QOL,” the team wrote. “However, prior literature has not investigated differences in QOL outcomes between veterans with and without PTSD that may be influenced by sleep apnea severity, insomnia, and psychological distress.”

Krueger and colleagues assessed veteran patients presenting to the Miami VA Sleep Center who were identified for risk of OSA as part of their study. Patents underwent assessment via the Insomnia Severity Index (ISI) as well as the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29) questionnaire to screen for physical functions, depressive symptoms, social roles and activities, and sleep disturbances, among other outcomes. The team used subscales indicating social and physical functioning status from PROMIS-29 as part of their analysis.

Patients were asked to complete their questionnaires the night prior to at-home sleep apnea testing.

The final patient cohort included 645 participants; 84.5% were male and the mean patient age was 52 years old. Approximately one-third (n = 210) of the cohort was diagnosed with PTSD; Krueger and colleagues used multigroup structural equation modelling to compare the PTSD cohort with non-PTSD patients, controlling for age, gender, race, education and body mass index (BMI).

In their final model, investigators observed that among patients with PTSD, higher psychological distress was associated with both reduced social (β=- .54, P <.001) and physical functioning (β=-.29, P <.001) status per PROMIS-29. However, the team did not observed association with OSA in QoL outcomes among patients with PTSD.

Investigators concluded that for veteran patients without PTSD, both insomnia and psychological distress—but not OSA—were associated with worse QoL per PROMIS-29. But in veteran patients with PTSD as well, only their psychological distress was linked to worsened QoL.

“These results indicate that, in those without PTSD, QoL is influenced by both a sleep disorder (insomnia) and psychological distress,” the team wrote. “However, in those with PTSD, QOL appears to be primarily influenced, not by a sleep disorder, but by psychological distress.”

Krueger and colleagues stressed the findings show the significance of prioritizing treatment for psychological distress among veterans with PTSD in order to positively affect their QoL.

References

Krueger M, Tsai Thomas Romaker E, Wallace D, ert al. THE ROLE OF INSOMNIA, SLEEP APNEA, AND PSYCHOLOGICAL DISTRESS ON QUALITY-OF-LIFE IN VETERANS WITH AND WITHOUT PTSD. Paper presented at: Associated Professional Sleep Societies (SLEEP) 2024 Annual Meeting. Houston, TX. June 1 – 5, 2024.

Hays RD, Spritzer KL, Schalet BD, Cella D. PROMIS®-29 v2.0 profile physical and mental health summary scores. Qual Life Res. 2018;27(7):1885-1891. doi:10.1007/s11136-018-1842-3