Sleep disturbances in sexual abuse victims: A systematic review - 30/12/11

Doi : 10.1016/j.smrv.2011.01.006

Iris M. Steine ^a,^⁎ , Allison G. Harvey ^b,^c , John H. Krystal ^d,^e , Anne M. Milde ^f,^{^{i
Tel.: +47 55586231; fax: +47 55589872.}} , Janne Grønli ^f,^g,^{^{j
Tel.: +47 55586003.}} , Bjørn Bjorvatn ^g,^h,^{^{k
Tel.: +4755586088.}} , Inger H. Nordhus ^b,^g , Jarle Eid ^a,^{^{l
Tel.: +47 55589188.}} , Ståle Pallesen ^a,^g,^{^{m
Tel.: +47 55588842.}}
^a Department of Psychosocial Science, University of Bergen, Christiesgate 12, 5015 Bergen, Norway
^b Department of Clinical Psychology, University of Bergen, Christiesgate 12, 5015 Bergen, Norway
^c Department of Psychology, University of California, Berkeley, USA
^d Clinical Neuroscience Division, VA National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
^e Department of Psychiatry, Yale University School of Medicine, Suite #901, 300 George St., New Haven, CT 06511, USA
^f Department of Biological and Medical Psychology, University of Bergen, Jonas Liesvei 91, 5009 Bergen, Norway
^g Norwegian Competence Center of Sleep Disorders, Haukeland University Hospital, Jonas Lies vei 91, 5009 Bergen, Norway
^h Department of Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, 5018 Bergen, Norway

Corresponding author. Tel.: +47 98 47 63 72; fax: +47 55 58 98 79.

Summary

An impressive body of research has investigated whether sexual abuse is associated with sleep disturbances. Across studies there are considerable differences in methods and results. The aim of this paper was to conduct the first systematic review of this area, as well as to clarify existing results and to provide guidelines for future research. We conducted searches in the electronic databases PsycINFO and PubMed up until October 2010 for studies on sleep disturbances in sexually abused samples. Thirty-two studies fulfilled the inclusion criteria (reported empirical data, included sexually abused subjects, employed some form of sleep measurement, English language and published in peer reviewed journals). Across the studies included, sleep disturbances were widespread and more prevalent in sexually abused subjects as compared to in non-abused samples. Symptoms reported more frequently by sexually abused samples included nightmare related distress, sleep paralysis, nightly awakenings, restless sleep, and tiredness. Results were divergent with regards to sleep onset difficulties, nightmare frequency, nocturnal activity, sleep efficiency, and concerning the proportion of each sample reporting sleep disturbances as such. Potential sources of these divergences are examined. Several methodological weaknesses were identified in the included studies. In order to overcome limitations, future researchers are advised to use standardized and objective measurements of sleep, follow-up or longitudinal designs, representative population samples, large sample sizes, adequate comparison groups, as well as comparison groups with other trauma experiences.

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Keywords : Sexual abuse, Child sexual abuse, Incest, Sleep disturbance, Insomnia, Nightmare, Sleep paralysis