Prior sleep problems and adverse post-traumatic neuropsychiatric sequelae (APNS) of motor vehicle collision in the AURORA study
Department of Emergency Medicine
Emergency Medicine | Mental and Social Health | Psychiatry and Psychology
STUDY OBJECTIVES: Many patients in Emergency Departments (ED) after motor vehicle collisions (MVC) develop posttraumatic stress disorder (PTSD) or major depressive episodes (MDE). This report from the AURORA study focuses on associations of pre-MVC sleep problems with these outcomes 8 weeks after MVC mediated through peritraumatic distress and dissociation and 2-week outcomes.
METHODS: 666 AURORA patients completed self-report assessments in the ED and at 2 and 8 weeks after MVC. Peritraumatic distress, peritraumatic dissociation and pre-MVC sleep characteristics (insomnia, nightmares, daytime sleepiness and sleep duration in the 30 days before the MVC, trait sleep stress reactivity) were assessed retrospectively in the ED. The survey assessed acute stress disorder (ASD) and MDE at 2 weeks and at 8 weeks assessed PTSD and MDE (past 30 days). Control variables included demographics, MVC characteristics, and retrospective reports about PTSD and MDE in the 30 days before the MVC.
RESULTS: Prevalence estimates were 41.0% for 2-week ASD, 42.0% for 8-week PTSD, 30.5% for 2-week MDE, and 27.2% for 8-week MDE. Pre-MVC nightmares and sleep stress reactivity predicted 8-week PTSD (mediated through 2-week ASD) and MDE (mediated through the transition between 2-week and 8-week MDE). Pre-MVC insomnia predicted 8-week PTSD (mediated through 2-week ASD). Estimates of population attributable risk suggest that blocking effects of sleep disturbance might reduce prevalence of 8-week PTSD and MDE by as much as one-third.
CONCLUSIONS: Targeting disturbed sleep in the immediate aftermath of MVC might be one effective way of reducing MVC-related PTSD and MDE.
Insomnia, Major Depressive Episode, Motor Vehicle Collision, Nightmares, Posttraumatic Stress Disorder, Prospective Design, Sleep Stress Reactivity
DOI of Published Version
Neylan TC, Kessler RC, Ressler KJ, Clifford G, Beaudoin FL, An X, Stevens JS, Zeng D, Linnstaedt SD, Germine LT, Sheikh S, Storrow AB, Punches BE, Mohiuddin K, Gentile NT, McGrath ME, van Rooij SJH, Haran JP, Peak DA, Domeier RM, Pearson C, Sanchez LD, Rathlev NK, Peacock WF, Bruce SE, Joormann J, Barch DM, Pizzagalli DA, Sheridan JF, Harte SE, Elliott JM, Hwang I, Petukhova MV, Sampson NA, Koenen KC, McLean SA. Prior sleep problems and adverse post-traumatic neuropsychiatric sequelae (APNS) of motor vehicle collision in the AURORA study. Sleep. 2020 Sep 25:zsaa200. doi: 10.1093/sleep/zsaa200. Epub ahead of print. PMID: 32975289. Link to article on publisher's site
Neylan TC, Kessler RC, Haran JP. (2020). Prior sleep problems and adverse post-traumatic neuropsychiatric sequelae (APNS) of motor vehicle collision in the AURORA study. University of Massachusetts Medical School Faculty Publications. https://doi.org/10.1093/sleep/zsaa200. Retrieved from https://escholarship.umassmed.edu/faculty_pubs/1906