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:
1250 N Arcadia Ave, Traumatic Brain Injury/Geriatrics, Extended Care, and Rehabilitation Service Line, Atlanta VA Medical Center, Decatur, GA 30030. whuang4@emory.edu.
2Atlanta Veterans Affairs Medical Center, Traumatic Brain Injury/Geriatrics, Extended Care, and Rehabilitation Service Line, Decatur, Georgia, USA.
3Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
4Birmingham/Atlanta Veterans Affairs GRECC, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA.
5Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
6Emory Prevention Research Center, Rollins School of Public Health Emory University, Atlanta, Georgia, USA.
7Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
8Department 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

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