Effects of sleep disturbance on trauma‐focused psychotherapy outcomes in posttraumatic stress disorder: A systematic review

• Published in: Annals of the New York Academy of Sciences Vol. 1526; no. 1; pp. 30 - 49
• Main Authors: Bottari, Sarah A., Trifilio, Erin R., Janicke, David M., Porges, Eric C., Cohen, Ronald A., Jaffee, Michael S., Williamson, John B.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.08.2023
• Subjects: Adult; Bias; cognitive behavioral therapy; Decision making; Humans; Insomnia; nightmares; Post traumatic stress disorder; posttraumatic stress disorder; Psychological stress; Psychotherapy; Psychotherapy - methods; Reviews; Risk assessment; Sleep; sleep apnea; Sleep disorders; Sleep Wake Disorders - complications; Sleep Wake Disorders - therapy; Stress Disorders, Post-Traumatic - therapy; Systematic review; Trauma; Treatment Outcome; cognitive behavioral therapy; sleep; nightmares; psychotherapy; sleep apnea; treatment outcome; posttraumatic stress disorder
• ISSN: 0077-8923; 1749-6632
• DOI: 10.1111/nyas.15029

This study aimed to synthesize existing research on the effects of sleep disturbances on trauma‐focused psychotherapy outcomes in adults with posttraumatic stress disorder (PTSD). A systematic review using PubMed, PsycINFO, Embase, Web of Science, and PTSDpubs was performed up to April 2021. Two independent reviewers screened articles for inclusion, performed data extraction, and assessed risk of bias and certainty of the evidence. Narrative synthesis was conducted based on the type of sleep disorder symptom assessed. Sixteen primary studies were included in this review, the majority of which had a high overall risk of bias. Results suggested that sleep disorder symptoms were associated with higher overall PTSD severity across treatment; however, they did not interfere with treatment effectiveness, with the exception of sleep‐disordered breathing. Improvements in insomnia, sleep duration, and sleep quality during treatment were associated with greater treatment gains. Certainty of the evidence ranged from low to very low. These results suggest that it may not be necessary to address sleep disorder symptoms prior to initiating trauma‐focused psychotherapy. Instead, concurrent treatment of sleep‐ and trauma‐related symptoms may be most beneficial. Continued research is needed to clarify the mechanistic relationship between sleep and treatment outcomes and to guide clinical decision‐making. This systematic review aimed to synthesize existing research on the effects of sleep disturbances on trauma‐focused psychotherapy outcomes in adults with posttraumatic stress disorder (PTSD). Results suggested that sleep disorder symptoms were associated with higher overall PTSD severity across treatment; however, they did not interfere with treatment effectiveness, with the exception of sleep‐disordered breathing.