Sleep disturbances and psychiatric disorders associated with posttraumaticstress disorder in the general population

The aim of the study was to assess sleep disturbances in subjects with post traumatic stress disorder (PTSD) from an urban general population and to id entify associated psychiatric disorders in these subjects. The study was pe rformed with a representative sample of 1,832 respondents aged 15 to 90 yea rs living in the Metropolitan Toronto area who were surveyed by telephone ( participation rate, 72.8%). Interviewers used Sleep-EVAL, an expert system specifically designed to conduct epidemiologic studies of sleep and mental disorders in the general population. Overall, 11.6% of the sample reported having experienced a traumatic event, with no difference in the proportion of men and women. Approximately 2% (1.8%) of the entire sample were diagnos ed by the system as having PTSD at the time of interview, The rate was high er for women (2.6%) than for men (0.9%), which translated into an odds rati o (OR) of 2.8 (95% confidence interval [CI], 1.3 to 6,1). PTSD was strongly associated with other mental disorders: 75.7% of respondents with PTSD rec eived at least one other diagnosis. Most concurrent disorders (80.7%) appea red after exposure to the traumatic event. Sleep disturbances also affected about 70% of the PTSD subjects. Violent or injurious behaviors during slee p, sleep paralysis, sleep talking, and hypnagogic and hypnopompic hallucina tions were more frequently reported in respondents with PTSD. Considering t he relatively high prevalence of PTSD and its important comorbidity with ot her sleep and psychiatric disorders, an assessment of the history of trauma tic events should be part of a clinician's routine inquiry in order to limi t chronicity and maladjustment following a traumatic exposure. Moreover, co mplaints of rapid eye movement (REM)-related sleep symptoms could be an ind ication of an underlying problem stemming from PTSD. Copyright (C) 2000 by W.B. Saunders Company.