CC BY 4.0 · Avicenna J Med 2023; 13(02): 082-088
DOI: 10.1055/s-0043-1768646
Original Article

Relationship between Posttraumatic Stress Disorder and Sleep Disturbances in Syrian Refugees in the United States

1   College of Arts, Sciences, and Letters, Behavioral Sciences, University of Michigan-Dearborn, Dearborn, Michigan, United States
Nancy Wrobel
1   College of Arts, Sciences, and Letters, Behavioral Sciences, University of Michigan-Dearborn, Dearborn, Michigan, United States
Michelle Leonard
1   College of Arts, Sciences, and Letters, Behavioral Sciences, University of Michigan-Dearborn, Dearborn, Michigan, United States
Lana Grasser
2   Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, United States
3   Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States
2   Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, United States
› Author Affiliations
Funding This study was supported in part by the National Institute of Health R01 award #HD099178, F31 award #MH120927, and the Lycaki/Young Foundation (State of Michigan).


Background Posttraumatic stress disorder (PTSD) is associated with disturbed sleep. However, the impact of sleep disturbances and PTSD symptomology in refugee populations is not well known. This study examined how PTSD-related sleep symptoms and overall sleep quality were impacted by previous and current traumatic and stressful experiences.

Methods Adult Syrian refugees living in Southeast Michigan were assessed via scheduled in-home interviews. Overall sleep quality was measured using the Pittsburgh Sleep Quality Index. PTSD-related sleep disturbances were measured using the Pittsburgh Sleep Quality Index Addendum. The presence of PTSD symptomatology was assessed via self-report using the Posttraumatic Stress Disorder Checklist. The Life Events Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition-5 screened for prior traumatic events experienced and the Postmigration Living Difficulties Questionnaire was assessed for postmigration stressors. Correlational analysis was conducted between overall sleep quality, PTSD symptom severity, and previous trauma experienced. A stepwise linear regression analysis was conducted to examine the role of overall sleep quality, PTSD-specific sleep disturbances, current living difficulties, and the number of preimmigration traumatic events directly experienced or witnessed due to the presence of overall PTSD symptomology.

Results A total of 53 adults completed the study. PTSD-disturbed sleep was found to be positively associated with overall poor sleep quality (r = 0.42, p < 0.01), PTSD symptomology (r = 0.65, p < 0.01), and current living difficulties (r = 0.37, p < 0.05). The PTSD-related sleep disturbances (B = 0.66, p < 0.01) and postmigration living difficulties (B = 0.44, p < 0.01) were found to be the strongest predictors of PTSD symptoms.

Conclusion Disturbed sleep is strongly associated with current stressful experiences and PTSD symptomology among Syrian refugees.

Publication History

Article published online:
07 June 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (

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