Probable trauma associated sleep disorder in post-9/11 US Veterans


<jats:title>Abstract</jats:title><jats:sec><jats:title>Study Objectives</jats:title><jats:p>The purpose of this study was to (1) estimate trauma associated sleep disorder (TASD) prevalence among post-9/11 era veterans and to describe differences in service and comorbid mental health clinical characteristics among individuals with and without probable TASD, and (2) estimate TASD prevalence and characteristics of reported traumatic experiences stratified by sex.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We used cross-sectional data from the post-deployment mental health study of post-9/11 veterans, which enrolled and collected baseline data from 2005 to 2018. We classified veterans as having probable TASD using self-reported measures: traumatic experiences from the traumatic life events questionnaire (TLEQ) and items from the Pittsburgh sleep quality index with Addendum for posttraumatic stress disorder (PTSD) mapped to TASD diagnostic criteria and ascertained mental health diagnoses (PTSD, major depressive disorder [MDD]) via Structured Clinical Interview for DSM-IV. We calculated effect sizes as prevalence ratios (PR) for categorical variables and Hedges’ g for continuous variables.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Our final sample included 3618 veterans (22.7% female). TASD prevalence was 12.1% (95% CI: 11.1% to 13.2%) and sex-stratified prevalence was similar for female and male veterans. Veterans with TASD had a much higher comorbid prevalence of PTSD (PR: 3.72, 95% CI: 3.41 to 4.06) and MDD (PR: 3.93, 95% CI: 3.48 to 4.43). Combat was the highest reported most distressing traumatic experience among veterans with TASD (62.6%). When stratifying by sex, female veterans with TASD had a wider variety of traumatic experiences.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Our results support the need for improved screening and evaluation for TASD in veterans, which is currently not performed in routine clinical practice.</jats:p></jats:sec>






Published Version (Please cite this version)


Publication Info

Taylor, Kenneth A, Vincent Mysliwiec, Nathan A Kimbrel, Ann V Augustine, undefined VA Mid-Atlantic MIRECC Registry Workgroup and Christi S Ulmer (2023). Probable trauma associated sleep disorder in post-9/11 US Veterans. SLEEP Advances, 4(1). 10.1093/sleepadvances/zpad001 Retrieved from

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.



Nathan Andrew Kimbrel

Associate Professor in Psychiatry and Behavioral Sciences

My primary areas of interest include the etiology, assessment, and treatment of PTSD, depression, suicide, and non-suicidal self-injury. I primarily work with veterans, firefighters, and emergency medical personnel due to their high levels of occupational exposure to traumatic stress. I also have long-standing interests in genetics, epigenetics, GxE research, personality, smoking, comorbidity, and statistical modeling procedures, such as CFA, SEM, and mixture modeling.


Christi S Ulmer

Associate Professor in Psychiatry and Behavioral Sciences

I am an Associate Professor at Duke University School of Medicine and clinical research psychologist at the Durham VA Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT). My research is focused on increasing our understanding of the health correlates of sleep disorders, increasing patient access to behavioral sleep medicine, and developing and disseminating behaviorally-based treatments for sleep disorders. I am a Behavioral Sleep Medicine Diplomate who has been treating patients with sleep disturbances for the past 17 years. I serve as faculty on the Durham VA Health Psychology fellowship training program; the first accredited BSM training program in the VA healthcare system. I served as a VA Co-Chair for the development of VA/DOD Clinical Practice Guidelines for insomnia and sleep apnea, and served as a consultant on the VA Dissemination of training in Cognitive Behavioral Therapy for Insomnia for more than 8 years. I am committed to expanding patient access to and provider knowledge of effective behavioral sleep medicine interventions, and increasing the recognition of sleep’s role in patient health.     

Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.