Acupuncture for Treatment of Persistent Disturbed Sleep: A Randomized Clinical Trial in Veterans With Mild Traumatic Brain Injury and Posttraumatic Stress Disorder.


Author: Huang W1,2,3, Johnson TM4,5, Kutner NG3, Halpin SN6, Weiss P7, Griffiths PC4, Bliwise DL8

Affiliation: <sup>1</sup>250 N Arcadia Ave, Traumatic Brain Injury/Geriatrics, Extended Care, and Rehabilitation Service Line, Atlanta VA Medical Center, Decatur, GA 30030. whuang4@emory.edu.

<sup>2</sup>Atlanta Veterans Affairs Medical Center, Traumatic Brain Injury/Geriatrics, Extended Care, and Rehabilitation Service Line, Decatur, Georgia, USA.

<sup>3</sup>Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.

<sup>4</sup>Birmingham/Atlanta Veterans Affairs GRECC, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA.

<sup>5</sup>Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, Georgia, USA.

<sup>6</sup>Emory Prevention Research Center, Rollins School of Public Health Emory University, Atlanta, Georgia, USA.

<sup>7</sup>Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.

<sup>8</sup>Department of Neurology, Emory Sleep Center, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.
Conference/Journal: J Clin Psychiatry.
Date published: 2018 Dec 11
Other:
 Volume ID: 80   ,  Issue ID: 1   ,  Special Notes: doi: 10.4088/JCP.18m12235.   ,  Word Count: 277  
    OBJECTIVE: To evaluate real, as compared with sham, acupuncture in improving persistent sleep disturbance in veterans with mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD).



METHODS: This sham-controlled randomized clinical trial at a US Department of Veterans Affairs Medical Center (2010-2015) included 60 veterans aged 24-55 years (mean of 40 years) with history of mTBI of at least 3 months and refractory sleep disturbance. Most of these participants (66.7%) carried a concurrent DSM-IV clinical diagnosis of PTSD. For the present study, they were randomized into 2 groups and stratified by PTSD status using the PTSD Checklist-Military Version. Each participant received up to 10 treatment sessions. The primary outcome measure was change in baseline-adjusted global Pittsburgh Sleep Quality Index (PSQI) score following intervention. Secondary outcomes were wrist-actigraphy-assessed objective sleep measurements. Comorbid PTSD was analyzed as a covariate.



RESULTS: Mean (SD) preintervention global PSQI score was 14.3 (3.2). Those receiving real acupuncture had a global PSQI score improvement of 4.4 points (relative to 2.4 points in sham, P = .04) and actigraphically measured sleep efficiency (absolute) improvement of 2.7% (relative to a decrement of 5.3% in sham, P = .0016). Effective blinding for active treatment was maintained in the study. PTSD participants presented with more clinically significant sleep difficulties at baseline; acupuncture was effective for both those with and without PTSD.



CONCLUSIONS: Real acupuncture, compared with a sham needling procedure, resulted in a significant improvement in sleep measures for veterans with mTBI and disturbed sleep, even in the presence of PTSD. These results indicate that an alternative-medicine treatment modality like acupuncture can provide clinically significant relief for a particularly recalcitrant problem affecting large segments of the veteran population.



TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01162317.



© Copyright 2018 Physicians Postgraduate Press, Inc.



PMID: 30549498  DOI: 10.4088/JCP.18m12235