PTSD AND SLEEP FOLLOWING SEVERE ACCIDENTAL INJURY

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Post-traumatic Stress Disorder or PTSD is a common sequela of life threatening stressors and is associated with significant chronicity and psychosocial morbidity. Severe accidents are common life threatening events yet PTSD related to accidental injury remains under-investigated. Sleep disturbance is an integral feature of PTSD and may have a role in the development and maintenance of the disorder. We propose to study PTSD symptoms and their relationship to sleep phenomena during an acute phase following severe accidental injury. Patients hospitalized for life threatening accidents at a regional Trauma Center will be screened, and if appropriate, PTSD and other psychiatric and medical parameters will be evaluated. Patients' sleep will then be recorded with a portable polysomnographic unit. Associations of sleep measures with PTSD symptom severity will be determined. Attempts will have been made to reduce the impact of medical/surgical factors on sleep through screening procedures. Possible relationships of these factors, as well as that of other psychiatric variables to sleep measures, will be explored in analyses. The final aim of the study is to evaluate the relationship of sleep consolidation and PTSD symptom reduction. Symptomatic patients will be randomly assigned to a 7 day course of hypnotic medication versus placebo while receiving clinical management, during a 2 week treatment phase. Sleep, PTSD, and mood symptoms will be assessed prior to initiating and at the completion of the treatment phase. The final study evaluation for symptom severity and functional adjustment will occur 1 month later (6 weeks from baseline assessments) for all of the original subjects.