Sleep Quality, Sleep Problems, Chronotype, and PTSD in Earthquake-Exposed Adolescents

In earthquake-exposed adolescents evaluated after the 2023 Kahramanmaraş earthquakes, a study reports that sleep quality and sleep problems were strongly associated with PTSD when adolescents meeting DSM-5 criteria were compared with exposed controls. They also report that while eveningness differed between groups, chronotype was not independently associated with PTSD status after multivariable adjustment. The report focuses on questionnaire-based measures and how those measures related to PTSD diagnosis and symptom burden.

The article describes a cross-sectional case–control study of 201 adolescents (ages 12–18 years) who presented for psychiatric evaluation at a child and adolescent psychiatry outpatient clinic after the earthquake sequence. Based on face-to-face clinical interviews using DSM-5 criteria, 92 participants were assigned to a PTSD group and 109 to an earthquake-exposed control group without a DSM-5 psychiatric disorder. Post-traumatic stress symptoms were assessed with the Children’s Posttraumatic Stress Reaction Index (CPTS-RI), alongside sleep quality (Pittsburgh Sleep Quality Index [PSQI]) and parent-reported sleep habits and chronotype (Children’s Sleep Habits Questionnaire [CSHQ] and Children’s Chronotype Questionnaire [CCTQ]). These measures frame the paper’s comparisons of questionnaire profiles between PTSD cases and exposed controls.

Across instruments and informants, the authors report consistent between-group differences reflecting worse sleep-related scores in adolescents with PTSD. The PTSD group had poorer self-reported sleep quality on the PSQI, more parent-reported sleep problems on the CSHQ, and higher CCTQ morningness–eveningness scores indicating greater eveningness (all p < 0.001 in the reported comparisons). The paper defines poor sleep quality as PSQI > 5 and clinically significant sleep problems as a CSHQ total score > 41. Overall, the reported comparisons indicate that multiple sleep-related measures—and chronotype scoring—varied between PTSD cases and exposed controls.

Beyond diagnostic grouping, the authors describe how symptom burden tracked with sleep- and chronotype-related scores. CPTS-RI PTSD severity was reported as positively correlated with PSQI, CSHQ, and CCTQ scores, aligning greater symptom severity with worse sleep quality, more sleep problems, and greater eveningness. The article also describes the use of CPTS-RI severity categories to report symptom distributions, without positioning those categories as primary endpoints for modeling. These correlation patterns are presented as a rationale for examining whether sleep and chronotype measures retain associations with PTSD status after adjustment.

In multivariable binary logistic regression, the paper reports that questionnaire-defined sleep measures—not chronotype—were independently associated with PTSD status. Using poor sleep quality as defined by the study’s PSQI threshold and clinically significant sleep problems as defined by its CSHQ cutoff, both remained associated with PTSD in adjusted analyses, whereas chronotype did not. In a sensitivity analysis that added out-of-province accommodation (the only sociodemographic variable reported as differing between groups) to the model, the authors report adjusted odds ratios of OR = 9.378 for poor sleep quality and OR = 2.716 for clinically significant sleep problems. Overall, the adjusted pattern described in the article emphasizes sleep quality impairment and sleep problems as independently associated with PTSD status, while chronotype differences did not persist as independent correlates.

Key Takeaways:

• The authors report that adolescents with PTSD had worse PSQI sleep quality, more CSHQ sleep problems, and greater CCTQ eveningness compared with earthquake-exposed controls in between-group comparisons.
• CPTS-RI PTSD severity was reported as positively correlated with PSQI, CSHQ, and CCTQ scores in the study’s correlation analyses.
• In adjusted models, the authors report independent associations of questionnaire-defined poor sleep quality and clinically significant sleep problems with PTSD status, while chronotype was not independently associated.