Dimensions of trauma: The relationship between daytime PTSD cluster symptomology and sleep measures

The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) characterizes posttraumatic stress disorder (PTSD) by intrusion, avoidance, negative cognition, and hyperarousal symptom clusters. These clusters may reflect distinct underlying pathologies. There is a strong bidirectional relationship between PTSD and sleep disturbances, but sleep's associations with individual symptom clusters remain unclear. This study examines these relationships and may be the first relating sleep architecture to the negative cognition cluster. We investigated subjective and physiological sleep measures across the spectrum of PTSD symptom cluster severities.

This Research Domain Criteria-design study included participants (N = 133) who experienced a Criterion-A trauma within the past 2 years but not the previous month; 68 met PTSD criteria and 65 qualified as resilient or subthreshold PTSD using the Clinician-Administered PTSD Scale for DSM-5. Sleep was assessed via 14-days of sleep diaries and one night of ambulatory polysomnography following an acclimation night. Multiple linear regression models analyzed sleep quality measures (sleep onset latency, total sleep time, sleep midpoint, and wake after sleep onset), while stepwise regression models explored sleep architecture (sleep macroarchitecture, rapid eye movement sleep, and slow-wave sleep microarchitecture).

Sleep quality measures had varying relationships with total PTSD Checklist for DSM-5 and symptom cluster scores. Sleep architecture and rapid eye movement sleep-specific and slow-wave sleep-specific features demonstrated unique relationships with PTSD symptom clusters.

Findings suggest the utility of dimensional approaches, potential symptom-specific intervention targets, and highlight possible distinct contributions of sleep in PTSD cluster pathophysiology. (PsycInfo Database Record (c) 2026 APA, all rights reserved).