Abstract
Introduction Nightmares are a frequent concern among US veterans, often linked to prevalent mental health conditions like depression and PTSD. Antidepressant medications are commonly used to manage these conditions, yet the association between their usage and the frequency of nightmares remains unclear. Methods The sample consisted of veterans at risk for sleep apnea at the Miami VA Sleep Center evaluated over one year. Veterans underwent home polysomnography (PSG) and completed questionnaires including demographics and the Munich Parasomnia Screening (MUPS). The frequency of nightmares was assessed using the nightmare item in MUPS. Electronic Medical Records were reviewed to obtain active medical and psychiatric diagnoses and active medication orders (including most common antidepressants: SSRIs, SNRIs, mirtazapine and bupropion) contemporaneous with the sleep evaluation. Results The study involved 649 veterans, predominantly male (84%) with mean age of 50 ± 14 years. Within this cohort, 49% were diagnosed with depression and 33% with PTSD. Regarding reported nightmare frequency, 16% indicated nightmares “never”, 9% “less than once a year”, 22% “once or several times a year”, 22% “once or several times a month”, 21% “once or several times a week” and 8% “almost every night.” Multiple regression was used to predict nightmares. In model 1, depression was positively associated with nightmares (p=0.001), independent of PTSD and AHI. In model 2, using an antidepressant versus not was positively associated with nightmares (p=0.05). However, depression was no longer significant (p=0.102). In model 3, type of antidepressants was evaluated, but only SSRIs were significant (p=0.04) while depression remained non-significant. Conclusion The findings highlight the prevalence of nightmares among veterans. Although depression was initially associated with increased nightmare frequency, when treatment for depression was considered, depression no longer predicted nightmares. Instead, antidepressants and specifically SSRIs predicted nightmares. Considering the type of antidepressant may be crucial when patients report nightmares. Further research is needed to investigate the impact of mental health conditions and medication effects on nightmares in this population. Support (if any)