# Association of Sleep Quality, Sleep Disturbances, and Chronotype with Post-Traumatic Stress Disorder in Earthquake-Exposed Adolescents

## TL;DR

Adolescents with PTSD after earthquakes have worse sleep quality and more sleep problems than those without PTSD, suggesting sleep assessment could help identify and treat those at risk.

## Contribution

This study identifies sleep disturbances as a stronger indicator of PTSD in earthquake-exposed adolescents compared to chronotype.

## Key findings

- Adolescents with PTSD had significantly worse sleep quality and more sleep problems than controls.
- Poor sleep quality and clinically significant sleep problems were independently linked to PTSD status.
- Evening chronotype was more common in PTSD adolescents but not independently associated with PTSD.

## Abstract

What are the main findings?
Adolescents with PTSD after the 2023 Türkiye earthquakes exhibited poorer sleep quality and more pronounced sleep problems than earthquake-exposed controls.Sleep quality impairment and clinically significant sleep problems were independently associated with PTSD status and correlated with symptom severity.Evening chronotype was more frequent in adolescents with PTSD and associated with symptom severity but was not independently linked to PTSD in multivariable analyses.

Adolescents with PTSD after the 2023 Türkiye earthquakes exhibited poorer sleep quality and more pronounced sleep problems than earthquake-exposed controls.

Sleep quality impairment and clinically significant sleep problems were independently associated with PTSD status and correlated with symptom severity.

Evening chronotype was more frequent in adolescents with PTSD and associated with symptom severity but was not independently linked to PTSD in multivariable analyses.

What are the implications of the main findings?
Routine assessment of sleep disturbances may help identify adolescents at risk for persistent PTSD symptoms after disasters.Interventions targeting sleep, including cognitive behavioral therapy for insomnia and nightmare-focused treatments, may improve sleep outcomes and reduce PTSD symptom severity.

Routine assessment of sleep disturbances may help identify adolescents at risk for persistent PTSD symptoms after disasters.

Interventions targeting sleep, including cognitive behavioral therapy for insomnia and nightmare-focused treatments, may improve sleep outcomes and reduce PTSD symptom severity.

Background/Objectives: Post-traumatic stress disorder (PTSD) is a common psychiatric consequence of trauma, and adolescents may be particularly vulnerable after large-scale disasters. Sleep disturbances and circadian preference may play a role in PTSD symptomatology. This study aimed to investigate the associations between PTSD, sleep quality, sleep problems, and chronotype in adolescents exposed to an earthquake. Methods: This cross-sectional study included 201 adolescents aged 12–18 years: 92 diagnosed with PTSD and 109 earthquake-exposed controls without a DSM-5 psychiatric disorder. Participants completed the Children’s Posttraumatic Stress Reaction Index (CPTS-RI), Pittsburgh Sleep Quality Index (PSQI), Children’s Sleep Habits Questionnaire (CSHQ), and Children’s Chronotype Questionnaire (CCTQ). Group differences, correlation analyses, and binary logistic regression analyses were performed. Results: Adolescents with PTSD had significantly higher CPTS-RI, PSQI, CSHQ, and CCTQ scores compared with controls (all p < 0.001), indicating poorer sleep quality, more sleep problems, and a greater tendency toward eveningness. PTSD severity was positively correlated with sleep problems, impaired sleep quality, and eveningness. In logistic regression analysis, poor sleep quality (p < 0.001) and clinically significant sleep problems (p = 0.011) were independently associated with PTSD, whereas chronotype was not. Conclusions: Sleep disturbances are more strongly associated with PTSD than chronotype in earthquake-exposed adolescents. Assessment and treatment of sleep problems may represent an important therapeutic target following large-scale trauma.