The Impact of Anxiety on Subjective and Objective Wakefulness in Warfighters With Insomnia
Rayomand Kapadia1, Amanda Studnicki3, Elizabeth Metzger3, Claire Akard2, Ethan Cheraghpour3, J. Kent Werner2
1School of Medicine, Uniformed Services University, 2Uniformed Services University, 3The Geneva Foundation
Background:
Insomnia and anxiety are highly prevalent among the warfighter population. The unique stressors of military service often lead to a state of sustained hyper-arousal that persists long after missions are complete. Chronic anxiety may cause a perceptual distortion of sleep (i.e., someone’s subjective experience of wakefulness diverges from their objective sleep data), and a discrepancy in sleep quality measures poses a challenge for doctors to adequately treat patients. We hypothesized that warfighters with higher anxiety scores on the State Trait Anxiety Inventory (STAI) will report poorer sleep quality in daily sleep diaries (even on nights of objectively good sleep as measured by Fitbit) due to anxiety-driven emotional retrospective distortion.
Design/Methods:
We selected N=35 participants from a larger clinical trial (N=52) who completed the State-Trait Anxiety Inventory (STAI) and had at least five nights of Fitbit data (total awake time) and self-reported amount of time they believed they were awake the night prior in a sleep diary. We first used Bland Altman plots on discrete anxiety groups (High-Medium = ≥ 38-44, Low = ≤37 STAI Trait Value), and then used a linear mixed-effects model on the difference in subjective (sleep diary) and objective (Fitbit) wakefulness with the continuous STAI and night as covariates and a random intercept for subject ID.
Results:
The low anxiety group (N=17) reported less wakefulness in the sleep diary than recorded by FitBit (-14.05 minutes). The medium-high (N=18) anxiety groups reported more wakefulness in the sleep diary than recorded by FitBit (6.15 minutes). The linear mixed-effects model showed a trend towards significance (p=0.092).
Conclusions:
Warfighter anxiety may impact their perception of wakefulness. The positive mean bias for higher anxiety participants indicates an overestimation of self-reported wakefulness (subjective metric) vs. as shown in the Fitbit data (objective metric), providing insights for targeted sleep intervention design.
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