The Impact of Sustained Attention Training on Aspects of Sleep in Returning Veterans

Abstract

Purpose: Post-traumatic stress disorder (PTSD) and Traumatic Brain Injury (TBI) are major causes of morbidity in veterans returning from wars in Iraq and Afghanistan. Both sleep disruptions and attention impairments are linked to PTSD and TBI and adversely affect the daily lives of these individuals. This project followed returning veterans who took part in a sustained attention training program and monitored the effects on their sleep patterns. We hypothesized that sustained attention training would improve the subjects’ quality and quantity of sleep. Methods: To test this hypothesis, participants’ (n=54) sleep was measured at home using actigraphy, a commercially available personal EEG, a sleep diary, and a global measure of sleep quality (Pittsburgh Sleep Quality Index, PSQI). The actigraphy, EEG, diary, and PSQI data were combined into a single data set for comparison. Exploratory analyses were performed to confirm the validity of the actigraphy, EEG, and diary as sleep measures as compared to the PSQI. The sleep data was then combined with the attention training database for comparison. Results: On preliminary analysis, the PSQI was highly correlated with PTSD, as was expected. However the more quantitative actigraphy, EEG, and diary data failed to correlate with the PSQI or PTSD. As these measures were not able to accurately capture the quality of the participants’ sleep, they could not be used to determine if their sleep quality was affected by the attention training program. That said, it was found that sustained attention training was associated with a trend towards improvement in sleep quality on the PSQI, suggesting that training may have had a positive impact on sleep. Conclusions: There is a known, repeatable, strong correlation between PTSD and sleep quality. In this project, at home quantitative measures of sleep were unable to reliably assess subjects’ sleep. No correlation was found between these measures and PTSD. It is suspected that this was due to the already disturbed nature of their sleep patterns. Sustained attention training did demonstrate slight improvements in sleep as measured by the PSQI.