The Seattle Trauma and Autonomic Related Sleep Symptoms (STARSS) Scale: A Novel Self-Report Measure of Sleep...

Sleep disruption is a common hallmark of posttraumatic stress disorder (PTSD), causing significant distress and often persisting after remission of other symptoms. Autonomic dysregulation is commonly comorbid and has been implicated in the underlying pathophysiology of both wake- and sleep-related symptoms following trauma. However, existing self-report tools for nightmares and trauma-related sleep disruption place relatively little emphasis on autonomic symptoms such as palpitations and sweating, limiting our ability to gauge these features quantitatively, assess their impact on sleep, and track their response to treatment. Here, we describe the initial validation of a novel exploratory 11-item self-report measure, the Seattle Trauma and Autonomic Related Sleep Symptoms (STARSS) Scale, developed to assess trauma-related sleep disruption including nightmares and autonomic hyperarousal symptoms. Psychometric validation of the STARSS was assessed in a sample of 830 healthcare workers and first responders working during the COVID-19 pandemic. The full scale (STARSS-11) positively correlated with self-report measures of symptom domains often associated with nightmares and commonly elevated following trauma exposure including PTSD (PCL-5; r = 0.76), anxiety (GAD7; r = 0.65), depression (PHQ9; r = 0.63), and insomnia (ISI; r = 0.56), and displayed strong internal consistency (α = 0.89; ω = 0.93). The STARSS-11 is well-fit by a 4-factor model: hyperarousal upon waking, trauma dream intensity, and self- and partner-reported excessive physical activity during sleep. An item-reduced STARSS-9 with 3 factors is also described. These outcomes suggest STARSS is a promising tool for the assessment of sleep disturbance related to trauma and dysautonomia in research settings.