Anxiety as Modulator of Life

**95**

**Chapter 7**

**Abstract**

disturbances, meta-analysis

**1.1 Insomnia in patients with PD**

**1. Introduction**

A Meta-Analysis of Sleep

*Geneviève Belleville and Alenka Potočnik*

Disturbances in Panic Disorder

The nature and prevalence of sleep disturbances in panic disorder (PD) have been often discussed but remain unclear. The objective of this systematic review and meta-analysis is to document sleep disturbances in PD. Systematic database search and standardized extraction were conducted. Meta-analysis was computed on self-report (subjective) and polysomnographic (PSG) (objective) data and on prevalence rates of nocturnal panic attacks (NPA). Of the 1262 publications retrieved, 31 were included. PD patients were compared to healthy controls on subjective and objective measures. Patients had higher Pittsburgh sleep quality index (PSQI) global scores (hedges' g = 1.306, 95% CI [0.532, 2.081]), longer PSG sleep latency (hedges' g = 0.81, 95% CI [0.576, 1.035]), poorer PSG sleep efficiency (hedges' g = −0.79, 95% CI [−1.124, −0.432]), and shorter stage 2 (hedges' g = 0.70, 95% CI [−1.231, −0.120]) and total sleep time (hedges' g = −0.739, 95% CI [−1.127, −0.351]). Among patients, 52.1% (95% CI [0.464, 0.577]) reported NPA (≥1/lifetime). Patients with PD demonstrate subjective and objective sleep alterations. More than half have experienced NPA. These sleep

disturbances could have a significant role in maintaining PD symptoms.

**Keywords:** panic disorder, nocturnal panic attacks, insomnia, sleep, sleep

Panic disorder (PD) is a common anxiety disorder, with a prevalence rate of 3.7% in the general population [1]. It is characterized by sudden and recurrent surges of anxiety known as panic attacks, apprehensiveness about panic, and avoidance of potential future panic attacks [2]. In PD, as in many anxiety disorders [3], sleep may be affected. The existing literature describes two primary types of sleep problems in patients with PD: insomnia and nocturnal panic attacks (NPA).

DSM-IV-TR defines insomnia as difficulty initiating or maintaining sleep, early awakening, or non-restorative sleep [4]. Symptoms must be present at least three times per week for at least 1 month and must be the source of significant distress or dysfunction [4]. Compared to DSM-IV-TR, DSM-5 added new criteria for insomnia, including early awakening and dissatisfaction with sleep quality [2]. Furthermore, the minimum duration of symptoms was increased to 3 months [2]. Insomnia is assessed using a wide variety of measures that can be generally classified as subjective or objective. The former uses self-report questionnaires and diaries or

**Chapter 7**
