Abstract Introduction Traumatic events are common and frequently followed by persistent sleep disruption, which can include repetitive nightmares, dream enactment behaviors, and nighttime autonomic dysregulation in addition to insomnia. These symptoms are included in the proposed diagnosis of trauma-associated sleep disorder (TASD), though overlap substantially with post-traumatic stress disorder (PTSD), rapid eye movement sleep behavior disorder (RBD) and obstructive sleep apnea (OSA). As autonomic disturbances may help differentiate TASD from related diagnoses, more research into autonomic dysfunction is warranted. Methods VA electronic medical record data for individuals who have undergone polysomnography (N= 1,036,904, 92% male, mean SD age 65.6 13.8) was used to examine relationships between autonomic disorders, preliminary TASD variable, and related diagnoses (i.e., OSA, RBD, and PTSD), as well as outpatient prescriptions of prazosin and clonidine. ICD-10 codes were used to obtain sleep, psychiatric, and autonomic diagnoses, and the preliminary TASD variable was created using full text search of clinical note data for TASD-related terms. Results Autonomic diagnoses (i.e., orthostatic hypotension, fibromyalgia, chronic fatigue, postural orthostatic tachycardia syndrome, inappropriate sinus tachycardia, unspecified autonomic disorder; presented in aggregate for power) were more common across all TASD-related diagnoses and preliminary TASD variable: PTSD (10.5% vs. 6.0%; p 2.2e-16); RBD (20% vs. 7.5%; p 2.2e-16); OSA (8.9% vs. 4.7%; p 2.2e-16); other parasomnias (14.7% vs. 7.5%; p 2.2e-16), TASD (16.2% vs. 7.6%; p=2.2e-15). Individual results for orthostatic hypotension and fibromyalgia were similar. Rates of prazosin prescription were highest for individuals with preliminary TASD diagnosis (67%), though also common in PTSD (43%) compared to RBD/other parasomnias and OSA (14-15% and 4% after removing individuals with PTSD). Clonidine was prescribed at lower rates (8-12%). Conclusion High rates of autonomic disorder comorbidity were seen across all diagnoses containing overlap with TASD symptoms, including OSA. A more detailed understanding of autonomic changes, particularly at night, is needed to identify potential patterns unique to TASD. High rates of prazosin prescription in TASD suggest this preliminary variable captures individuals with significant trauma-related sleep disturbances. Ongoing work is incorporating specific autonomic parameters, polysomnography data, and additional chart note data into TASD diagnosis. Support (if any) VA CSRDS Award IK2CX001774 (RCH), VA Northwest MIRECC (RCH, MJL)
Lind et al. (Fri,) studied this question.