Residual Sleep Problems Predict Reduced Response to Prolonged Exposure among Veterans with PTSD

While evidence-based treatments exist for posttraumatic stress disorder (PTSD), a significant sub-set of veterans continue to meet criteria for PTSD after treatment. Sleep problems may affect treatment retention and predict efficacy for PTSD treatments. The present study used data from a clinical trial of Prolonged Exposure therapy (PE) administered to veterans (N=154) to evaluate whether residual sleep symptoms remained after treatment completion, and if so, whether these residual sleep symptoms were associated with higher levels of PTSD and comorbid depression at the end of treatment. Participants (ages 20 to 75 years old; 35.7% Black; 54.5% married) completed demographic questions, symptom assessments, and engagement-related surveys. Hierarchical multiple linear regression models demonstrated that changes in sleep were significant predictors of PTSD and depression symptom reduction above and beyond the influence of demographic and engagement factors (e.g., therapy satisfaction). Greater residual sleep symptoms were predictive of smaller treatment gains. Findings illustrate the potential significance of sleep during the course of PTSD treatment, leading to several important clinical assessment and treatment implications.