0923 Prospective Bidirectional Relationship Between Sleep Duration and PTSD Symptoms Following Acute Coronary Syndrome

Abstract Introduction Sleep disturbance is a “hallmark” symptom of posttraumatic stress disorder (PTSD). Poor sleep (including short sleep) after combat-related trauma can also predict subsequent PTSD. Less is known about the association between sleep duration and PTSD when PTSD is induced by an acute health-related event. We examined the bidirectional relationship between sleep duration and PTSD symptoms over the year following hospital evaluation for acute coronary syndrome (ACS). Methods Participants were enrolled in this observational study after emergency department evaluation for ACS. Sleep duration (“During the past month, how many hours of actual sleep did you get at night?”) and PTSD symptoms related to the cardiac event/hospitalization (PTSD Checklist; PCL) were assessed at 1-, 6-, and 12 months after hospital discharge. Cross-lagged path analysis was used to model the effects of sleep duration and PTSD symptoms on each other. Covariates included age, sex, race/ethnicity, cardiac severity, baseline depression symptoms, and early acute stress disorder symptoms. Results The sample included 1,145 participants. Mean (SD) age was 61.4 (12.6) y and 46.5% were female. Mean sleep duration was ~6.1 hours, with ~57% of participants reporting short sleep duration (i.e., 7 hours). Mean PCL score was ~24.19, with ~16% of participants screening positive for probable PTSD related to the cardiac event/hospitalization (PCL score ≥33) at each assessment (17.2%, 16.3%, and 15.7% at 1-, 6-, and 12 months). Higher PTSD symptoms predicted shorter sleep duration at the next timepoint (i.e., 1 to 6 months and 6 to 12 months), B=-0.14 hours/10-point difference, se=0.03, p.001. Shorter sleep duration was associated with higher PTSD symptoms at the next timepoint, B=-0.25 points/hour, se=0.12, p=.04. Results were similar when insomnia and nightmare items were removed from the PCL. Higher dream-related PTSD symptoms (i.e., nightmares) had a marginally significant association with shorter sleep at the following assessment, B=-0.09 hours/point, se=0.05, p=.057. Shorter sleep was significantly associated with higher dream-related PTSD symptoms at the next timepoint, B= 0.03 points/hour, se=0.01, p=.001. Conclusion Short sleep duration and PTSD symptoms are mutually reinforcing across the year following ACS evaluation. Findings suggest that sleep, PTSD symptoms, and their relationship should be considered in the post-ACS period. Support (if any)