Sleep disturbance and intrusive memories after presenting to the emergency department following a traumatic motor vehicle accident: an exploratory analysis

<b>Background</b>: Sleep disturbances are common after traumatic events and have been hypothesized to be a risk factor in the development of psychopathology such as that associated with posttraumatic stress disorder (PTSD). <b>Objective</b>: To assess the association between intrusive memories, a core clinical feature of PTSD, and self-reported sleep disturbance shortly after experiencing or witnessing a motor vehicle accident, and whether a brief behavioural intervention (trauma reminder cue and Tetris gameplay) reduced sleep disturbance post-trauma. <b>Method</b>: The exploratory analyses included 71 participants (mean age 39.66, standard deviation 16.32; 37 women, 52.1%) enrolled in a previously published proof-of-concept randomized controlled trial. Participants were recruited from the emergency department after experiencing or witnessing a traumatic motor vehicle accident. Intrusive memories were assessed with a daily paper-and-pen diary for one week post-trauma, and sleep disturbances with three questions from the Impact of Event Scale-Revised assessing problems initiating sleep, problems maintaining sleep and dreams about the event at one week and one month post-trauma. Missing data were imputed 15 times. <b>Results</b>: The total number of intrusive memories during the first week post-trauma suggested weak to moderate pooled intercorrelations with problems initiating and maintaining sleep. An ordinal regression using imputed data suggested that the intervention had no effect on sleep disturbances, while completers only analyses suggested an improvement in problems maintaining sleep at one week. <b>Conclusions</b>: This exploratory study suggested that experiencing early intrusive memories is related to sleep disturbances. Sleep disturbance might be a particularly important construct to assess in studies involving intrusive memories post-trauma. • Sleep disturbances are common after trauma.• We assessed the association between intrusive memories and sleep, and whether a brief behavioural intervention targeting intrusive memories (trauma reminder cue and Tetris gameplay) affected sleep post-trauma.• More intrusive memories post-trauma are potentially related to a greater severity of sleep disturbances.• The intervention had mixed effects on the experience of sleep disturbances.• Sleep disturbance might be a particularly important construct to assess in studies involving intrusive memories post-trauma.

**背景**：创伤事件后睡眠障碍十分常见，且有假说认为其是创伤后应激障碍（PTSD）等精神病理症状发展的危险因素。**研究目的**：本研究旨在评估创伤后应激障碍（PTSD）的核心临床特征——侵入性记忆（intrusive memories），与经历或目睹机动车事故后短期内自我报告的睡眠障碍之间的关联，并探究简短行为干预（创伤提示线索结合俄罗斯方块（Tetris）游戏）是否能够减轻创伤后睡眠障碍。**研究方法**：本探索性分析纳入了71名参与者，均来自已发表的概念验证随机对照试验，其平均年龄为39.66岁，标准差为16.32；其中女性37名，占比52.1%。参与者均为在经历或目睹创伤性机动车事故后，于急诊科招募的受试者。研究采用每日纸笔日记的方式，在创伤后1周内评估侵入性记忆；同时采用《事件影响量表-修订版》（Impact of Event Scale-Revised）中的3个问题，分别在创伤后1周和1个月评估入睡困难、睡眠维持困难以及与事故相关的梦境这三类睡眠障碍情况。针对缺失数据，我们进行了15次多重插补。**研究结果**：创伤后首周的侵入性记忆总次数，与入睡困难及睡眠维持困难呈现弱至中等程度的合并相关。基于多重插补数据的有序回归分析显示，该干预对睡眠障碍无显著影响；但仅纳入完成试验者的分析则表明，干预可在1周时改善睡眠维持困难的情况。**研究结论**：本探索性研究表明，创伤后早期出现的侵入性记忆与睡眠障碍存在关联。在针对创伤后侵入性记忆的研究中，睡眠障碍或许是一项尤为重要的评估构念。
- 创伤后睡眠障碍十分常见。
- 本研究评估了侵入性记忆与睡眠之间的关联，并探究了针对侵入性记忆的简短行为干预（创伤提示线索结合俄罗斯方块游戏）是否会对创伤后睡眠产生影响。
- 创伤后更多的侵入性记忆，可能与更严重的睡眠障碍相关。
- 该干预对睡眠障碍的影响存在不一致性。
- 在针对创伤后侵入性记忆的研究中，睡眠障碍或许是一项尤为重要的评估构念。