BACKGROUND Complicated grief (CG) is characterized by persistent, impairing grief after losing a loved one. Little is known about sleep disturbance in CG. Baseline prevalence of subjective sleep disturbance, impact of treatment on sleep, and impact of mid-treatment sleep on CG and quality of life outcomes were examined in adults with CG in secondary analyses of a clinical trial. METHODS Patients with CG (n = 395, mean age =53.0; 78% female) were randomized to CGT+placebo, CGT+citalopram (CIT), CIT, or placebo. Subjective sleep disturbance was assessed by a grief-anchored sleep item (Pittsburgh Sleep Quality Index: PSQI-1) and a four-item sleep subscale of the Quick Inventory of Depressive Symptomatology (QIDS-4). Sleep disturbance was quantified as at least one QIDS-4 item with severity ≥2 or grief-related sleep disturbance ≥3 days a week for PSQI-1. Outcomes included the Inventory of Complicated Grief (ICG), Work and Social Adjustment Scale (WSAS), and Clinical Global Impressions Scale. RESULTS Baseline sleep disturbance prevalence was 91% on the QIDS-4 and 46% for the grief-anchored PSQI-1. Baseline CG severity was significantly associated with sleep disturbance (QIDS-4: p = .015; PSQI-1: p = .001) after controlling for comorbid depression and PTSD. Sleep improved with treatment; those receiving CGT+CIT versus CIT evidenced better endpoint sleep (p = .027). Mid-treatment QIDS-4 significantly predicted improvement on outcome measures (all p < .01), though only WSAS remained significant after adjustment for mid-treatment ICG (p = .02). CONCLUSIONS Greater CG severity is associated with poorer sleep beyond PTSD and depression comorbidity. Additional research including objective sleep measurement is needed to optimally elucidate and address sleep impairment associated with CG.

中文翻译：

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睡眠对复杂悲伤严重程度和结果的影响。

背景 复杂性悲伤（CG）的特点是失去亲人后持续的、损害性的悲伤。对于 CG 中的睡眠障碍知之甚少。在一项临床试验的二次分析中，对成人 CG 患者主观睡眠障碍的基线患病率、治疗对睡眠的影响以及治疗中期睡眠对 CG 和生活质量结果的影响进行了检查。方法 CG 患者（n = 395，平均年龄 = 53.0；78% 女性）被随机分配至 CGT + 安慰剂、CGT + 西酞普兰 (CIT)、CIT 或安慰剂。主观睡眠障碍通过悲伤锚定睡眠项目（匹兹堡睡眠质量指数：PSQI-1）和抑郁症状快速清单（QIDS-4）的四项睡眠分量表进行评估。睡眠障碍被量化为至少一项 QIDS-4 项目的严重程度≥2 或 PSQI-1 中与悲伤相关的睡眠障碍每周≥3 天。结果包括复杂悲伤量表 (ICG)、工作和社会适应量表 (WSAS) 和临床总体印象量表。结果 QIDS-4 的基线睡眠障碍患病率为 91%，悲伤锚定的 PSQI-1 的基线睡眠障碍患病率为 46%。在控制共病抑郁症和 PTSD 后，基线 CG 严重程度与睡眠障碍显着相关（QIDS-4：p = .015；PSQI-1：p = .001）。治疗后睡眠得到改善；与 CIT 相比，接受 CGT+CIT 的患者终点睡眠质量更好 (p = .027)。治疗中期 QIDS-4 显着预测结果指标的改善（所有 p < .01），但在治疗中期 ICG 调整后只有 WSAS 仍然显着（p = .02）。结论 除 PTSD 和抑郁症合并症外，CG 严重程度与睡眠质量较差相关。需要进行包括客观睡眠测量在内的更多研究，以最佳地阐明和解决与 CG 相关的睡眠障碍。