Executive dysfunction in military PTSD with ecological sleep assessment: A cross-sectional study

BACKGROUND: Post-Traumatic Stress Disorder (PTSD) is consistently linked to deficits in executive functions, including attention, working memory, and inhibitory control, which impact clinical outcomes. This study examined these cognitive functions in military personnel with PTSD and its associations with clinical symptoms and objective sleep parameters. METHODS: French active-duty and veteran service members with PTSD (n = 130) and healthy military controls (n = 65) completed computerized cognitive tasks: inhibition (Go/No-Go), sustained attention (0-Back), and working memory (2-Back). Sleep was monitored under ecological conditions using a polysomnographic headband. Clinical assessments included PTSD severity (PCL-5) and depression (BDI). Efficiency scores combining accuracy and speed were calculated for each task. Group comparisons, correlations, and multiple regressions were conducted. Executive impairment thresholds were derived from the controls to estimate prevalence in the PTSD group. RESULTS: PTSD participants showed lower performance across the three cognitive tasks. Using normative thresholds, 36.6% met criteria for executive impairment. In the PTSD group, clinical and sleep variables explained only a small proportion of the variance in cognitive performance (R² = 0.12), with REM sleep and PTSD severity showing the largest albeit modest contributions. In contrast, predictors explained a greater proportion of variance in controls (R² = 0.35), suggesting stronger predictive utility. Exploratory analyses indicated that medication burden was the strongest individual predictor of executive performance in PTSD. CONCLUSION: Executive dysfunction is frequent among military personnel with PTSD and only partially explained by standard clinical and sleep measures. Cognitive impairment likely reflects multiple interacting mechanisms not captured by standard assessments, underscoring the need for integrative and multimodal approaches.