Clinical Characterization of Insomnia among Veterans with PTSD: Identifying Risk Factors for Diagnosis and Treatment with Sedative-Hypnotics
Clinical Characterization of Insomnia among Veterans with PTSD: Identifying Risk Factors for Diagnosis and Treatment with Sedative-Hypnotics
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DOI：
10.1080/10242694.2017.1349633
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发表时间：
2018-01-01
影响因子：
1.6
通讯作者：
Germain, Anne
中科院分区：
文献类型：
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作者：
Bramoweth, Adam D.;Luther, James;Germain, Anne
失眠在患有创伤后应激障碍（PTSD）的退伍军人中很普遍，它加剧了创伤后应激障碍的症状，并导致功能和生活质量受损。为了改善治疗效果，重要的是确定失眠和镇静催眠使用的危险因素。分类、回归树和逻辑回归模型用于识别与失眠或镇静催眠药物使用相关的变量。主要发现包括低失眠诊断率（3.5-5.6%）和高镇静催眠率（44.2-49.0%）。年轻的退伍军人和那些没有呼吸相关睡眠障碍（BRSD）的人更有可能被诊断为失眠。有更多服务联系的退伍军人和那些有酒精/物质使用障碍的退伍军人更有可能被开镇静催眠药。相互作用条件可能已经确定了失眠诊断不足的潜在风险群体（即患有精神合并症的非黑人退伍军人，没有精神合并症的黑人退伍军人）以及使用镇静催眠药物的风险群体（即没有BRSD的年轻退伍军人）。总之，患有创伤后应激障碍的退伍军人使用镇静催眠药的比例很高，尽管很少有证据表明它们有效。这与表明行为干预是第一线治疗的建议相反。需要改变政策，以减少镇静催眠药物的使用，并增加获得行为失眠症干预的机会。
Insomnia is prevalent among Veterans with post-traumatic stress disorder (PTSD), it exacerbates PTSD symptoms, and it contributes to impaired functioning and quality of life. To improve treatment outcomes, it is important to identify risk factors for insomnia and sedative-hypnotic use. Classification and regression trees and logistic regression models were used to identify variables associated with insomnia or sedative-hypnotic use. Key findings include low insomnia diagnosis rates (3.5-5.6%) and high rates of sedative-hypnotics (44.2-49.0%). Younger Veterans and those without a breathing-related sleep disorder (BRSD) were more likely to receive an insomnia diagnosis. Veterans with greater service connection and those with an alcohol/substance use disorder were more likely to be prescribed sedative-hypnotics. Interaction terms may have identified potential groups at risk of being under-diagnosed with insomnia (i.e. non-black Veterans with psychiatric co-morbidity, black Veterans without psychiatric co-morbidity) as well as groups at risk for sedative-hypnotic use (i.e. younger Veterans without BRSD). In sum, Veterans with PTSD have high rates of sedative-hypnotic use despite minimal evidence they are effective. This is counter to recommendations indicating behavioral interventions are the first-line treatment. Policy changes are needed to reduce use of sedative-hypnotics and increase access to behavioral insomnia interventions.