An Evaluation of Insomnia Treatment to Reduce Cardiovascular Risk in Patients With Posttraumatic Stress Disorder

  • End date
    Dec 31, 2024
  • participants needed
  • sponsor
    Duke University
Updated on 6 April 2022
behavior therapy
psychiatric disorder
chronic post-traumatic stress disorder


Posttraumatic stress disorder (PTSD) is a chronic, debilitating psychiatric disorder that is associated with an increased risk of death due to cardiovascular disease (CVD). Most individuals with PTSD also have Insomnia Disorder. Sleep quality is also associated with risk factors for CVD. The objective of this study is to examine how insomnia contributes to CVD risk among people with PTSD. The investigators will also examine whether this risk can be decreased with treatment for Insomnia Disorder.


Posttraumatic stress disorder (PTSD) is a disabling and costly psychiatric disorder that is estimated to occur in 20% of individuals who are exposed to a traumatic event and is chronic in one third of cases. In addition to its negative impact on quality of life, there is substantial evidence that PTSD (even after controlling for depression and other risk factors) is associated with a markedly increased risk of cardiovascular morbidity and mortality. However, the mechanisms for the association between PTSD and cardiovascular disease (CVD) risk are not well understood. Although adverse health behaviors, including cigarette smoking, alcohol abuse and poor medication adherence are common in PTSD, recent prospective studies show that they do not account for the magnitude of CVD risk among individuals with PTSD. The investigators propose to test our central hypothesis by evaluating whether CBT-I results in improved biomarkers of CVD risk among those with PTSD. Well established biomarkers of CVD related morbidity and mortality will be used including measures of vascular endothelial function measured by brachial artery flow-mediated dilation (FMD), nighttime blood pressure (BP) dipping measured using 24-hour ambulatory blood pressure monitoring (ABPM), and sympathetic nervous system (SNS) activity as measured by 24-hour urinary catecholamines. Investigators will also assess lipid profile, which along with BP is a modifiable component with marked impact on the atherosclerotic cardiovascular disease (ASCVD) risk score. The primary sleep parameter of interest is objectively-measured sleep efficiency (through actigraphy), although self-report insomnia measures and sleep related arousal will also be measured. The rationale for the proposed research is that once it is established that insomnia is an important and modifiable symptom conveying increased CVD risk in this population, the development of new and innovative approaches to integrating insomnia treatment with PTSD-focused interventions can be developed. 150 men and women with comorbid PTSD and insomnia disorder will be randomly assigned with a 2:1 ratio to 8-week cognitive behavioral therapy-Insomnia (CBT-I) intervention or a waiting period control condition. Sleep quality parameters and CVD risk biomarkers will be assessed at pre-randomization baseline, post-intervention, and at a 6-month follow-up. The study is designed to evaluate the association between insomnia and CVD risk biomarkers among persons with PTSD, and determine whether improvements in insomnia symptoms are associated with improvements in CVD risk biomarkers.

Condition Insomnia, Posttraumatic Stress Disorder, Cardiovascular Risk Factor
Treatment Cognitive Behavior Therapy for Insomnia, Weekly phone contacts
Clinical Study IdentifierNCT04498754
SponsorDuke University
Last Modified on6 April 2022


Yes No Not Sure

Inclusion Criteria

Is between 40-59 years old
Has a current diagnosis of chronic PTSD (at least 3 months duration) based on the Clinician Administered PTSD Scale DSM-5 version (Weathers et al., 2013)
Has a current diagnosis of ID as defined in the International Classification of Sleep Disorders (ICSD-3; American Academy of Sleep Medicine, 2014)

Exclusion Criteria

Has a history of CVD events, including myocardial infarction, stroke, transient ischemic attack, or coronary revascularization
Has diagnosis of congestive heart failure or coronary artery disease based on results of diagnostic testing
Has a current alcohol use or substance use disorder (those who meet lifetime but not current alcohol or substance use disorder will be included)
Is currently participating in or has recently (past 6 months) participated in an evidence-based trauma focused therapy for PTSD
Has cognitive impairment as evidenced by less than 20 on the Montreal Cognitive Assessment scale (M0CA; Nasreddine et al., 2005)
Meets criteria for a psychotic spectrum disorder or bipolar disorder
Has severely impaired hearing or speech
Is pregnant
Is currently prescribed a benzodiazepine
Is not stable (medications and dose stable for one month) on any other current psychoactive and/or cardiovascular medications or will not be stable on these medications during the course of the study
Works night shift
Is participating in another interventional study to address insomnia
Has prominent suicidal or homicidal ideation (as assessed through a clinical interview)
Has a serious/terminal illness or other health problem that would prohibit participation in the study
Has nonclinically significant or sub-threshold insomnia as indicated by a score of <14 on the Insomnia Severity Index
Has seizures (based on clinical interview and self-report)
Has a body mass index of 45 or greater
Has sleep apnea (based on the overnight assessment described below) or a positive sleep apnea screen; or
Has restless leg syndrome (based on the Duke Structured Interview for Sleep Disorders; Edinger, Wyatt, & Olsen, 2009)
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