Sleep after treatment for panic disorder in emergency department patients consulting for chest pain

Objective A significant number of patients with unexplained chest pain (UCP) have panic disorder (PD), and most individuals with panic disorder (PD) report poor sleep, including insomnia and nocturnal panic attacks (NPA). The objective of the study was to examine the impact of treatment for PD on sleep problems and to assess the influence of pre-treatment insomnia on post-treatment persistence of PD diagnosis and pain severity. Methods Secondary analyses were conducted on sleep data collected from 42 PD patients consulting emergency departments (ED) for UCP. In this quasi-experimental design, cohorts of participants were randomly assigned to one of four conditions: (1) seven sessions of cognitive-behavior therapy (CBT) for PD, (2) a one-session panic management intervention, (3) pharmacotherapy, or (4) usual care. Data from clinical interviews performed by trained assistants and from self-report questionnaires were collected before and after treatment. Results after treatment, 35 percent of participants still met the diagnostic criteria for insomnia, and 20 percent of the sample still reported NPA. The presence of insomnia was a predictor of post-treatment pain severity (B = 1.336, SE B = .483, p = .009), regardless of the severity of pre-treatment anxiety and depressive symptoms or of assignation to an active PD treatment. Conclusions Treatment for PD had a small effect on sleep, and residual sleep difficulties persisted after treatment. More importantly, the presence of insomnia was a significant predictor of persistent pain after treatment. The results highlight the importance of careful assessment of sleep before and during treatment for PD in UCP patients.