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BackgroundAdverse childhood experiences (ACEs) increase the risk of mental health difficulties in general, but the link to panic disorder (PD) has received comparatively little attention. There are no data for the magnitudes between ACEs and PD. This systematic review and meta-analysis estimated the overall, as well as the subgroups, odds ratio of having PD in adults who report ACEs, compared to adults who do not.MethodsThe study was pre-registered on PROSPERO [CRD42018111506] and the database was searched in June 2021. In order to overcome the violation of independent assumptions due to multiple estimations from the same samples, we utilized a robust variance estimation model that supports meta-analysis for clustered estimations. Accordingly, an advanced method relaxing the distributional and asymptotic assumptions was used to assess publication bias and sensitivity.ResultsThe literature search and screening returned 34 final studies, comprising 192,182 participants. Ninety-six estimations of 20 types of ACEs were extracted. Pooled ORs are: overall 2.2, CI (1.82–2.58), sexual abuse 1.92, CI (1.37–2.46), physical abuse 1.71, CI (1.37–2.05), emotional abuse 1.61, CI (0.868–2.35), emotional neglect 1.53, CI (0.756–2.31), parental alcoholism 1.83, CI (1.24–2.43), and parental separation/loss 1.82, CI (1.14–2.50). No between-group difference was identified by either sociolegal classification (abuse, neglect, household dysfunction) or threat-deprivation dimensions (high on threat, high on deprivation and mixed).ConclusionsThere are links of mild to medium strength between overall ACEs and PD as well as individual ACEs. The homogeneous effect sizes across ACEs either suggest the effects of ACEs on PD are comparable, or raised the question whether the categorical or dimensional approaches to classifying ACEs are the definitive ways to conceptualize the impact of ACEs on later mental health.

Introduction In this study we assess sleep complaints and objective sleep parameters in a cohort of patients with post-traumatic stress disorder (PTSD) admitted to a sleep laboratory. Methods Retrospective study of patients with a diagnosis of PTSD who were referred for full polysomnography (PSG) in a sleep service as part of the investigation of a sleep disturbance. Demographic data, presenting complaints, PSG parameters, subjective levels of sleepiness, sleep diary, medication and diagnoses were recorded. Result The sample included 30 patients, 46.7% female 53.3% male, mean age 45 years, (SD 15), mean BMI 28 (SD 4.7) kg/m. 13 patients presented with excess daytime sleepiness or fatigue, 11 with parasomnia, 5 with poor sleep and 1 patient with nightmare disorder. 21 had a diagnosis of depression, 12 reported insomnia and 20 nightmares. 63.3% received antidepressants. Mean total sleep time (TST) in sleep diary was 6.5 hours. Mean Epworth score was 10 (SD 6.5). PSG parameters (expressed as mean and SD) were: Sleep latency (SL) 26.3 (35.8) min, TST 390 (130) min, sleep efficiency (SE) for time in bed 77.6 (16.2)%, SE for sleep period of time 80.5 (16.7)%, stages 1 and 2: 48 (13.5)%, REM 17 (15.5)% slow wave sleep 13 (9.5)%, apnoea hypopnea index 7.6 (9.2)/h, periodic limb movement (PLM) index 19.5 (29.9)/h. Parasomnias were recorded in 7 cases. After PSG, 8 patients were diagnosed with PLM disorder, 9 with parasomnia, 6 with sleep apnoea, 3 with insomnia. 5 had no sleep disorder identified. The presence of PLM during sleep did not correlate with the usage of antidepressants. Discussion Both sleep onset and sleep maintenance insomnia were reported. Nightmares were frequent. The presence of PLMD was higher than expected, raising the possibility that it may be a contributor to sleep disturbances in PTSD. A case controlled study would be of value.