Enhancing sleep health in urban American Indian/Alaska Native adolescents: Implications for culturally tailored interventions.

BACKGROUND: Urban American Indian/Alaska Native (AI/AN) adolescents are vulnerable to sleep and other health-related disparities due to numerous social drivers, including historical trauma and relocation to urban areas. This study aims to identify strategies to increase protective factors and culturally tailor sleep health interventions for this population. METHODS: Using community-based participatory research, the NAYSHAW study conducted in-depth interviews with urban AI/AN adolescents aged 12-19 years to understand critical components needed for developing a culturally sensitive sleep health intervention. Data from two qualitative subsamples (N = 46) and parent surveys (N = 110) were analyzed, focusing on factors that affect sleep health behaviors, including parental involvement, technology, and traditional practices. RESULTS: Key findings include the detrimental impact of electronics use at night and protective effects of traditional practices on sleep. Parental involvement in sleep routines varied by adolescent's age. Adolescents desired sleep health education in interactive formats, whereas parents preferred workshops and digital applications for sleep health strategies. Findings suggest that interventions need to address electronics use and should also be culturally tailored to address the unique experiences of urban AI/AN adolescents. CONCLUSIONS: Results underscore the importance of utilizing community-based strategies to develop culturally tailored sleep interventions for underserved populations, specifically urban AI/AN adolescents. Integrating traditional practices with evidence-based sleep health strategies can provide a holistic approach to improving sleep and overall well-being. Parental education and involvement will be critical to the success of such interventions.

Development of the Couples' Sleep Conflict Scale: A new tool to assess conflict around sleep in romantic relationships.

OBJECTIVE: The purpose of this study was to evaluate the psychometric properties of the Couples' Sleep Conflict Scale, a new measure designed to identify the extent of conflict around sleep in romantic relationships. METHODS: Data from an individual sample (N = 158) and dyadic sample (N = 143 mixed-gender couples) in romantic relationships were used to examine the psychometric properties of the Couples' Sleep Conflict Scale, including internal consistency, convergent and divergent validity, and whether the factor structure differed between couples with concordant and discordant chronotypes. RESULTS: Results revealed that the Couples' Sleep Conflict Scale fit a 1-factor solution of 5 items, a summed or mean score can be used, and that it is reliable for both men and women. In addition, more relational sleep conflict was associated with both their own and their partners' poorer sleep hygiene, worse sleep quality, and more daytime sleepiness as well as more general relationship conflict, lower relationship satisfaction, and higher anxious and avoidant attachment. Finally, we found partial measurement invariance for factor loadings, intercepts, and latent variable variances between couples with concordant vs. discordant chronotypes. CONCLUSION: The Couples' Sleep Conflict Scale is a brief measure that can be used in both research and in health care settings to examine how sleep-related conflict can affect both sleep and relationship quality among couples.

Bidirectional Associations Between Daily Sleep and Wake Behaviors in Urban American Indian/Alaska Native Youth.

PURPOSE: This is the first study to examine daily, bidirectional associations between sleep and wake behaviors/mood in urban American Indian/Alaska Native (AI/AN) adolescents. METHODS: Participants were 142 urban AI/AN adolescents (mean age = 14 years, 58% female). Sleep was measured with actigraphy (total sleep time [TST] and sleep efficiency) and daily diary (bedtime, wakeup time, and sleep quality) over seven consecutive days. Wake behaviors (caffeine consumption, physical activity, participation in cultural activities, and electronic use after 8p.m.) and mood upon awakening (higher rating indicates greater happiness) were measured via daily diary for seven consecutive days. Multilevel models examined the degree to which nightly sleep predicted next day's wake behaviors and, conversely, wake behaviors and mood predicted nightly sleep, controlling for age, gender, and weekday/weekend. RESULTS: Earlier bedtime and wakeup times predicted greater participation in physical activity the following day. Later bedtime and wakeup time, worse sleep quality, and shorter TST predicted greater electronic use the following night. Earlier bedtime and wakeup time and better sleep quality predicted higher mood ratings. Conversely, greater caffeine consumption during the day predicted both later bedtime and wakeup time. Participation in cultural activities is predicted later bedtime. More nighttime electronic use predicted both later bedtime and wakeup time, poorer sleep quality, and worse TST and sleep efficiency. Higher mood ratings in the morning predicted earlier bedtime and later wakeup time. DISCUSSION: Findings highlight dynamic associations between sleep and wake behaviors and mood in AI/AN adolescents and may elucidate novel pathways for intervention and future research.

Neighborhood determinants of sleep and the moderating role of cultural factors among native adolescents.

OBJECTIVE: This study examined the association between neighborhood social environment and sleep among urban American Indian and Alaska Native (AI/AN) adolescents as well as the moderating role of cultural factors in this association. METHOD: The analytic sample included 133 urban AI/AN adolescents (age 12-16, 57.1% female, Mage = 14.03, SDage = 1.35). Perceived neighborhood social environment included safety and cohesion. Cultural factors included AI/AN cultural identification and historical loss. Sleep duration, efficiency, and wake after sleep onset (WASO) were measured via actigraphy. Sleep disturbance was measured via a questionnaire. RESULTS: Greater neighborhood safety was significantly associated with lower sleep disturbance (b = -2.17, SE = 0.8, p = .008), higher sleep efficiency (b = 1.75, SE = 0.64, p = .006), and lower WASO (b = -8.60, SE = 3.34, p = .01). Neighborhood cohesion was not associated with any sleep outcomes. Cultural factors moderated the association between neighborhood social environment and sleep outcomes (p < .05). Specifically, both neighborhood safety and cohesion were associated with lower sleep disturbance, only among individuals reporting higher levels of AI/AN cultural identification. Further, neighborhood safety was associated with greater sleep efficiency and lower WASO (i.e., better sleep) only among adolescents with higher contemplation of historical loss. CONCLUSIONS: Findings highlight the importance of considering cultural factors in addressing sleep and health disparities. AI/AN cultural identification and a sense of historical loss may be important targets for identifying adolescents who might benefit the most from policies and interventions focused on improving the social environment in order to improve sleep and other health outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Yours, mine, or ours? Dyadic sleep hygiene and associations with sleep quality, emotional distress, and conflict frequency in mixed-gender, bed-sharing couples.

Although prior research demonstrates the interdependence of sleep quality within couples (i.e., the sleep of one partner affects the sleep of the other), little is known about the degree to which couples' sleep hygiene behaviours are concordant or discordant, and if one's own sleep hygiene or their report of their partners' sleep hygiene is related to worse relational, psychological, and sleep outcomes. In a sample of 143 mixed-gender, bed-sharing couples, each partner completed an online questionnaire consisting of the Sleep Hygiene Index (for themselves and their partner), PROMIS sleep disturbance scale, conflict frequency, PHQ-4 for anxiety and depressive symptoms, and the Perceived Stress Scale. Paired samples t-tests between partners were conducted using total and individual-item Sleep Hygiene Index scores to examine similarities and differences. Intraclass correlation coefficient (ICC) scores of dyadic reports were conducted to examine the level of agreement between each partner's sleep hygiene. Finally, we examined associations between one's own sleep hygiene and their report of their partner's sleep hygiene with both partner's sleep quality, emotional distress, and conflict frequency in a dyadic structural equation model with important covariates and alternative model tests. The results revealed a significant difference between men's (M = 14.45, SD = 7.41) and women's total score self-report sleep hygiene ([M = 17.67, SD = 8.27]; t(142) = -5.06, p < 0.001) and partners only had similar sleep hygiene for 5 out of the 13 items. Examining dyadic reports of sleep hygiene revealed that partners had moderate agreement on their partners' sleep hygiene (0.69-0.856). The results from the dyadic structural equation model revealed that poorer sleep hygiene was associated with one's own poor sleep quality, higher emotional distress, and more frequent relational conflict. For both men and women a poorer report of a partner's sleep hygiene was associated with one's own report of higher relationship conflict. Finally, men's poorer report of a partner's sleep hygiene was related better to their own sleep quality but was related to poorer sleep quality for their partners. These results have implications for sleep promotion and intervention efforts as well as for couple relationship functioning.

Positive airway pressure adherence among patients with obstructive sleep apnea and cognitive impairment: A narrative review.

Adults with Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD) have increased rates of Obstructive Sleep Apnea (OSA). Positive Airway Pressure (PAP) is the first-line treatment for OSA and may have potential benefits for slowing cognitive decline in these individuals. However, adherence is low in PAP users overall and those with cognitive impairment may have unique challenges. Furthermore, there has been little systematic study of the use of PAP or strategies to enhance PAP adherence among those with AD or MCI. The aim of this review is to examine existing observational, quasi-experimental and experimental studies of the effects of PAP on cognitive function. In addition, our goal was to gather evidence about the adherence rates, and support for PAP among adults with MCI and mild to moderate AD. Through searches of electronic databases (University of Utah Library, SAGE Publishing, PubMed, Wiley, EBSCO, Science Direct, ProQuest, and NCBI), we identified 11 articles that fit our study inclusion criteria. Synthesis of data was performed with a focus on cognitive outcomes of PAP interventions and adherence. Findings from the studies showed that multiple indices of memory improved with PAP use. Adherence in MCI and AD populations was largely comparable to adherence reported in general adult populations, but more research is needed to optimize systems for providing support for PAP users and caregivers. Results support PAP as a promising intervention in this population but more research is needed to make definitive conclusions about the relationship between PAP use and improved cognitive function. Furthermore, research is needed to determine if additional interventions are needed to support patients and caregivers.

Design of the think PHRESH longitudinal cohort study: Neighborhood disadvantage, cognitive aging, and alzheimer's disease risk in disinvested, black neighborhoods.

BACKGROUND: Black Americans have disproportionately higher rates and earlier onset of Alzheimer's disease and related dementias (ADRD) relative to White Americans. We currently lack a comprehensive understanding of how the lived experience and broader societal factors, including cumulative exposure to structural racism and the mechanisms underlying the risks, may contribute to elevated ADRD risk in Black Americans. METHODS: The Think PHRESH study builds on existing, community-based research infrastructure, from the ongoing Pittsburgh Hill/Homewood Research on Neighborhood Change and Health (PHRESH) studies, to examine the contributions of dynamic neighborhood socioeconomic conditions across the lifecourse to cognitive outcomes in mid- and late-life adults living in two historically disinvested, predominantly Black communities (anticipated n = 1133). This longitudinal, mixed-methods study rests on the premise that neighborhood racial segregation and subsequent disinvestment contributes to poor cognitive outcomes via factors including (a) low access to educational opportunities and (b) high exposure to race- and socioeconomically-relevant stressors, such as discrimination, trauma, and adverse childhood events. In turn, these cumulative exposures foster psychological vigilance in residents, leading to cardiometabolic dysregulation and sleep disruption, which may mediate associations between neighborhood disadvantage and ADRD risk. This premise recognizes the importance of potential protective factors that may promote cognitive health, including neighborhood social cohesion, safety, and satisfaction. The proposed study will leverage our existing longitudinal data on risk/protective factors and biobehavioral mediators and will include: (1) up to three waves of cognitive assessments in participants ages 50 years + and one assessment in participants ages 35-49 years; clinical adjudication of ADRD will be completed in participants who are 50+, (2) extensive surveys of risk and protective factors, (3) two assessments of blood pressure and objectively measured sleep, (4) a comprehensive assessment of life and residential history; and (5) two rounds of in-depth qualitative interviews to reveal lifecourse opportunities and barriers experienced by Black Americans in achieving optimal cognitive health in late life. DISCUSSION: Understanding how structural racism has influenced the lived experience of Black Americans, including dynamic changes in neighborhood conditions over time, is critical to inform multi-level intervention and policy efforts to reduce pervasive racial and socioeconomic disparities in ADRD.

Differential item functioning of the Acculturation, Habits, and Interests Multicultural Scale for Adolescents (AHIMSA) by race/ethnicity.

Background: Acculturation is a complex multidimensional construct that plays in important role in various outcomes across many domains (e.g., psychological, behavioral, social, and developmental). While there are many acculturation measures for specific racial/ethnic groups, few multigroup measures exists. Even fewer have been psychometrically evaluated for differential item functioning (DIF; e.g., measurement invariance). This is a critical step in determining whether item properties are equivalent across groups and thus, whether scores obtained from different groups are in fact comparable. Methods: The Acculturation, Habits, and Interests, Multicultural Scale for Adolescents (AHIMSA) was completed by first and second generation participants identifying as White, Hispanic, or Asian (n = 1,399). The scale can be used to compute scores on four acculturation orientation subscales: Assimilated, Separated, Integrated, and Marginalized. Racial/ethnic DIF was evaluated for the Assimilation, Integration, and Separation subscales. Results: Analyses revealed racial/ethnic DIF was present for two items on the Separation scale based on McFadden's pseudo R2. No DIF was identified for the Assimilation and Integration scales. Supplemental analyses revealed no evidence of longitudinal DIF or by generation status and some DIF by sex for Assimilation and Integration. Based on evaluation of test characteristic curves and DIF plots, it was determined that DIF was trivial and could likely be ignored. Conclusions: Psychometric properties were generally equivalent across the three racial/ethnic groups for each of the subscales evaluated. This indicates that scores obtained from each subscale could be compared across racial/ethnic groups. By establishing cross-group usability of the scale, racial/ethnic differences in acculturation orientation can be examined, and, more importantly, used in the context of research on related mental, physical, and behavioral health outcomes.

Examining the Cross-sectional Association Between Neighborhood Conditions, Discrimination, and Telomere Length in a Predominantly African American Sample.

Disproportionate exposure to adverse neighborhood conditions and greater discrimination may contribute to health disparities among African Americans (AAs). We examined whether adverse neighborhood conditions, alone or in conjunction with discrimination, associate with shorter leukocyte telomere length among a predominantly AA cohort. The sample included 200 residents from two low-income neighborhoods (96% AA; mean age = 67 years). Perceived neighborhood conditions and discrimination were surveyed in 2018, and objective neighborhood conditions (total crime rate, neighborhood walkability, ambient air pollution (PM2.5, black carbon)) were collected in 2017/2018. Relative telomere length (T/S; ratio of telomeric DNA to a single-gene copy) was assessed from blood samples. Linear regression models estimated the main effects of each neighborhood condition and discrimination and their interactions on the T/S ratio. Less walkable neighborhoods were associated with shorter telomeres. Higher air pollution (PM2.5) was associated with shorter telomeres among those experiencing greater discrimination. Findings highlight the importance of understanding the intersecting influences of historic and contemporary sources of systemic racism and how they contribute to accelerated aging among adults.

Neighborhood Built Environment and Sleep Health: A Longitudinal Study in Low-Income and Predominantly African-American Neighborhoods.

In the present study, we examined the associations between physical characteristics of neighborhoods and sleep health outcomes and assessed the mediating role of physical activity in these associations. A longitudinal study (the Pittsburgh Hill/Homewood Research on Eating, Shopping, and Health (PHRESH) Zzz Study; n = 1,051) was conducted in 2 low-income, predominately African-American neighborhoods in Pittsburgh, Pennsylvania, with repeated measures of neighborhood characteristics and sleep health outcomes from 2013 to 2018. Built environment measures of walkability, urban design, and neighborhood disorder were captured from systematic field observations. Sleep health outcomes included insufficient sleep, sleep duration, wakefulness after sleep onset, and sleep efficiency measured from 7-day actigraphy data. G-computations based on structural nested mean models were used to examine the total effects of each built environment feature, and causal mediation analyses were used to evaluate direct and indirect effects operating through physical activity. Urban design features were associated with decreased wakefulness after sleep onset (risk difference (RD) = -1.26, 95% confidence interval (CI): -4.31, -0.33). Neighborhood disorder (RD = -0.46, 95% CI: -0.86, -0.07) and crime rate (RD = -0.54, 95% CI: -0.93, -0.08) were negatively associated with sleep efficiency. Neighborhood walkability was not associated with sleep outcomes. We did not find a strong and consistent mediating role of physical activity. Interventions to improve sleep should target modifiable factors, including urban design and neighborhood disorder.

Food insecurity, sleep, and cardiometabolic risks in urban American Indian/Alaska Native youth.

OBJECTIVES: Food insecurity contributes to racial/ethnic disparities in health. This is the first study to examine associations among food insecurity, sleep, and cardiometabolic outcomes in urban American Indian/Alaska Native (AI/AN) youth. DESIGN: Participants were 142 urban AI/AN youth (mean age = 14 years, 58% female). Food insecurity and self-reported sleep disturbance were measured using validated surveys. A multi-dimensional sleep health composite was derived using questionnaires (ie, satisfaction, alertness) and actigraphy-derived indices (ie, duration, efficiency, regularity, timing). Cardiometabolic measures included body mass index, blood pressure, glycosylated hemoglobin, waist circumference, cholesterol, and triglycerides. Covariates were sex, age, and single-parent household. RESULTS: Greater food insecurity was significantly associated with greater body mass index (b = 0.12, p = .015), higher systolic blood pressure (b = 0.93, p = .03), and greater sleep disturbance (b = 1.49, p < .001), and marginally associated with lower sleep health composite scores (b = -0.09, p = .08). There was a significant indirect path from greater food insecurity to greater waist circumference through poorer sleep health (0.11, 95% bootstrapping CI: [0.01, 0.30]). CONCLUSION: Food insecurity is an important correlate of sleep and cardiometabolic health among urban AI/AN youth and should be addressed to reduce emerging health risks during this important developmental period. Policies to reduce food insecurity and increase access to healthy foods as well as sleep interventions for these youth could help, as preliminary findings suggest that sleep health may mediate the negative impact of food insecurity on cardiometabolic risks.

Longitudinal associations between sleep and BMI in a low-income, predominantly Black American sample.

OBJECTIVE: Black individuals and those experiencing socioeconomic disadvantage are at increased risk for sleep problems and obesity. This study adds to the limited extant literature examining longitudinal associations between objectively measured sleep and changes in body mass index (BMI) in Black Americans. DESIGN: We focused on individuals with at least 1 observation of sleep and BMI at 1 of 3 study time points (2013, 2016, and 2018). We modeled longitudinal trends in BMI as a function of time, average of each sleep variable across assessments, and within-person deviations in each sleep variable over time. SETTING: Data were collected via interviewer-administered at-home surveys and actigraphy in Pittsburgh, PA. PARTICIPANTS: Our sample comprised 1115 low-income, primarily Black adults, including 862 women and 253 men. MEASUREMENTS: Sleep measures included actigraphy-measured total sleep time, sleep efficiency, and wakefulness after sleep onset, as well as self-reported sleep quality. We also included objectively measured BMI. RESULTS: In models adjusted for age, gender, and other sociodemographic covariates (eg, income, marital status), there were no significant longitudinal associations between total sleep time, sleep efficiency, wakefulness after sleep onset, or subjective sleep quality and changes in BMI. CONCLUSIONS: This study provides further evidence that, among a sample of low-income Black adults, sleep problems are not longitudinally predictive of BMI. Although ample cross-sectional evidence demonstrates that sleep problems and obesity commonly co-occur, longitudinal evidence is mixed. Better understanding the overlap of sleep and obesity over time may contribute to prevention and intervention efforts.

Multi-dimensional Profiles of Risk and Their Association with Obesity-Severity in Low-Income Black Women.

Multi-level risk factors underlie disproportionate obesity rates among Black women. Latent class analysis of multi-level risk and protective factors among low-income Black women (n = 917) in 2011 (Pittsburgh, PA). Data were collected via in-person survey, interviewer-assisted online dietary recalls, and from 2011 crime records. Multinomial logistic regression estimated cross-sectional associations between latent classes and obesity severity derived from measured anthropometry. Latent class analysis identified four groups of women according to their motivations and intentions to be healthy, socioeconomic and health burden, and neighborhood risk: Class 1 = Very high burden (n = 283), Class 2 = Health motivated, low burden, low neighborhood risk (n = 231), Class 3 = High burden and high neighborhood risk (n = 106), and Class 4 = Low burden and low neighborhood risk (n = 297). Class 3 = High burden and high neighborhood risk women had the highest severe obesity risk. Multi-level strategies may support low-income Black women women's resilience to obesity who face neighborhood-level and socioeconomic stressors.

Couples-based interventions to promote PAP adherence among older adults: a qualitative study of patients, partners, and providers.

STUDY OBJECTIVES: Bed partners play a critical role in the treatment of obstructive sleep apnea and are affected by the treatment (or lack thereof) of their partner's obstructive sleep apnea, but few studies have included partners formally in treatment. In this qualitative study, we examine key stakeholder perspectives (patient, bedpartner, and sleep medicine provider) to inform the development of a novel, couples-based intervention to promote adherence to positive airway pressure (PAP) and sleep health among older adult couples. METHODS: We conducted 3 focus group discussions with patients with obstructive sleep apnea/using PAP and their partners and 3 focus group discussions with sleep medicine providers. A standard interview guide was used to gather stakeholder input: (1) to understand interdependence of sleep among couples with sleep apnea; (2) to understand collaborative strategies that couples are currently using to address their sleep health challenges, including their perceptions of what is helpful vs not helpful; and (3) feasibility of the intervention design and delivery. Interviews were transcribed and thematically analyzed. RESULTS: Participants (n = 25) included 9 patients, 7 partners, and 9 providers. Analysis of the discussion identified themes within the 3 topics addressed in the focus group discussions: (1) interdependence of sleep health among couples, (2) collaboration and other dyadic strategies for increasing PAP use, and (3) facilitators and barriers to a couples-based PAP adherence intervention. Results of the focus group discussions provided new insights into collaborative strategies that could be used to enhance the sleep health of both patients and partners. Patient/partners reported that a couples-based treatment could reduce common frustrations experienced by new PAP users, thereby benefiting their relationship. However, barriers to couples-based treatment included patients and partners feeling overwhelmed and reluctance to discuss intimacy. Providers recognized the benefits of involving partners but reported concern about exacerbating conflict in the couple. CONCLUSIONS: Results indicate that couples and providers are enthusiastic about couples-based treatment that addresses their individual and dyadic sleep health challenges and identified important barriers that will need to be addressed to enhance uptake by clinicians and participation/retention of couples. CITATION: Baron KG, Troxel WM, Galway S, et al. Couples-based interventions to promote PAP adherence among older adults: a qualitative study of patients, partners, and providers. J Clin Sleep Med. 2022;18(11):2627-2634.

A latent class approach to understanding longitudinal sleep health and the association with alcohol and cannabis use during late adolescence and emerging adulthood.

OBJECTIVE: Sleep is a multi-dimensional health behavior associated with elevated risk of substance use. This is the first study to utilize a latent class approach to characterize sleep health across multiple dimensions and across time from late adolescence to emerging adulthood, and to examine associations with alcohol and cannabis use trajectories. METHODS: The sample included 2995 emerging adults (mean ages = 18 to 24 years across six waves of data collection; 54% female) who provided data on sleep dimensions (quality, duration, and social jetlag) and frequency and consequences of alcohol and cannabis use. Longitudinal latent class analysis (LLCA) models characterized participants according to the three sleep dimensions. Latent growth models examined trajectories of frequency and consequences of alcohol or cannabis use over time among emergent sleep classes, with and without controlling for covariates. RESULTS: LLCA models identified four sleep classes: good sleepers (n = 451; 15.2%); untroubled poor sleepers (n = 1024; 34.2%); troubled, moderately good sleepers (n = 1056; 35.3%); and suboptimal sleepers (n = 460; 15.4%). Good sleepers reported significantly lower levels of alcohol or cannabis use and consequences, and less of an increase in alcohol consequences as compared to suboptimal sleepers. CONCLUSIONS: Persistent poor sleep health was associated with higher levels of alcohol and cannabis use and consequences, and greater increases in alcohol-related consequences during the transition from late adolescence to emerging adulthood. Findings have important clinical implications, highlighting that addressing multi-dimensional sleep health may be an important, novel target of intervention to reduce substance use frequency and consequences.

Sleep Management in Posttraumatic Stress Disorder (PTSD): A Systematic Review.

Posttraumatic stress disorder (PTSD) is a condition that can emerge after exposure to a traumatic event. It involves several symptoms, including distressing memories or dreams and/or dissociative reactions; psychological distress at exposure to trauma cues; physiologic reactions to cues; avoidance of stimuli associated with the event; negative alterations in cognitions and mood associated with the trauma; and alterations in arousal and reactivity, including sleep disturbance. The purpose of this systematic review is to synthesize the evidence from randomized controlled trials on the effects that interventions for adults with PTSD have on sleep outcomes. The authors searched research databases and bibliographies of existing systematic reviews to identify pertinent trials published in English; literature was identified by the searches using predetermined eligibility criteria. The primary outcome domain included sleep quality, insomnia, and nightmares. Secondary outcomes were PTSD symptoms and adverse events. Risk of bias and the quality of evidence were assessed for each outcome. The identified interventions addressed pharmacological, psychological, behavioral, complementary, and integrative medicine treatments aimed at improving sleep or lessening other PTSD symptoms. Interventions in general showed an effect on sleep. Interventions explicitly targeting sleep-particularly psychotherapy targeting sleep-showed larger effects on sleep than did interventions not targeting sleep. Heterogeneity was considerable, but sleep effect estimates were not systematically affected by trauma type, setting, or modality. Comparative effectiveness studies are needed to support the findings.