Abstract Introduction Socioeconomic disadvantage may increase vulnerability to insomnia, possibly due to higher rates of trauma exposure. Comorbid posttraumatic stress disorder (PTSD) and insomnia has been linked to greater sleep impairment relative to insomnia alone. However, evidence comes mainly from Veterans and may not generalize to other trauma-exposed groups. In this study, we examined sleep diary and actigraphy data from socioeconomically marginalized adults enrolled in a comparative effectiveness trial. We hypothesized that those with comorbid PTSD and insomnia would exhibit higher sleep fragmentation than those with insomnia alone. Methods Adult participants with insomnia disorder completed validated surveys, as well as sleep diaries and actigraphy (GENEActiv) for 7 days at baseline. PTSD symptom severity was assessed by the PTSD Symptom Checklist for Civilians (PCL-C). We defined PTSD as a PCL-C score of ≥44. Diary and actigraphy-based metrics of nightly average of total sleep time (TST), sleep maintenance efficiency (SME), and wake after sleep onset (WASO) were compared by PTSD status in a subsample of 40 participants with ≥5 days of diary data and actigraphy. Results Participants were 77.2% female, mean age 47.7 years range 19–83, 68.9% Non-White, and 15.7% had PTSD. Across the entire sample, actigraphy derived TST was 410.4 minutes (81.6), SME 82.9% (11.6), and WASO 95.0 minutes (53.6 minutes). Comorbid PTSD participants, relative to insomnia alone, reported lower actigraphy derived TST (-9.7 minutes, 95% CI: -82.2, 63.6), lower SME (estimate -5.3%, 95% CI: -15.4, 1.2), and longer WASO (estimate 15.1 minutes, 95% CI: -29.6, 48.7). Across the entire sample, sleep-diary derived TST was 398.9 minutes (67.0), SME 82.9% (11.1), and WASO 38.4 minutes (40.4 minutes). Comorbid PTSD participants, relative to insomnia alone, reported longer sleep diary derived TST (estimate 43.5 minutes, 95% CI: -13.6, 104.4), greater SME (estimate 3.0%, 95% CI: -5.6, 12.7), and less WASO (estimate -11.1 minutes, 95% CI: -40.0, 0.9). Conclusion Findings indicate that comorbid PTSD and insomnia are characterized by poorer actigraphy-derived sleep despite more favorable subjective reports relative to insomnia alone. Such discrepancies may reflect trauma-related heterogeneity within insomnia. Integrating subjective and objective measures in future work may help identify clinically relevant sleep phenotypes and guide tailored interventions. Support (if any)
Paquet et al. (Fri,) studied this question.
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