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Table S1 Ovid MEDLINE(R) Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily, Ovid MEDLINE and Versions(R) (up to Mar 2, 2019)

# Searches Results

1. exp Stress Disorders, Post-Traumatic/ 29471

2. (post-traumatic stress or posttraumatic stress or PTSD).ab,ti. 31943

3. 1 or 2 40666

4. exp POLYSOMNOGRAPHY/ 19203

5. (polysomnogra* or PSG or sleep architect* or sleep monit* or sleep stage*).ab,ti. 21938

6. exp Electroencephalography/ 146287

7. (electroencephalogra* or EEG).ab,ti. 93562

8. 4 or 5 or 6 or 7 193615

9. 3 and 8 550

10

.exp animal/ not human/ 4551777

11. 9 not 10 529

12

.limit 11 to English language 488

Table S2 EMBASE via OVID (up to Mar 2, 2019)

# Searches Results

1 exp posttraumatic stress disorder/ 53012

2 (post-traumatic stress or posttraumatic stress or PTSD).ab,ti. 40419

3 exp polysomnography/ 34226

4 (polysomnogra* or PSG or sleep architect* or sleep monit* or sleep stage*).ab,ti. 38797

5 exp electroencephalogram/ 119143

6 (electroencephalogra* or EEG).ab,ti. 123968

7 1 or 2 57888

8 3 or 4 or 5 or 6 216076

9 7 and 8 1218

1

0exp animal/ not human/ 4528116

11 9 not 10 1172

1

2limit 11 to English language 1112

1

Table S3 All EBM databases via OVID (including Cochrane Database of Systematic Reviews; ACP Journal Club; Database of Abstracts of Reviews of Effects; Cochrane Clinical Answers; Cochrane Central Register of Controlled Trials; Cochrane Methodology Register; Health Technology Assessment) (up to Mar 2, 2019)

# Searches Results

1

.

(post-traumatic stress or posttraumatic stress or PTSD).ab,ti.4060

2

.

(polysomnogra* or PSG or sleep architect* or sleep monit* or sleep stage*).ab,ti.3449

3

.

(electroencephalogra* or EEG).ab,ti.6115

4

.

2 or 39204

5

.

1 and 457

2

Table S4 PsycIFNO via EBSCOhost (up to Mar 2, 2019)

# Search Options Actions Results

S21 S17 AND S18 Limiters - English; Population Group: Human

Search modes - Boolean/Phrase

406

S20 S17 AND S18 Limiters - Population Group: Human


420

S19 S17 AND S18 Search modes - Boolean/Phrase 442

S18 S6 OR S7 OR S8 OR S9 OR S10 OR S11 OR S12 OR

S13 OR S14 OR S15 OR S16

Search modes - Boolean/Phrase 70,648

S17 S1 OR S2 OR S3 OR S4 OR S5 Search modes - Boolean/Phrase 44,160

S16 TI EEG OR AB EEG Search modes - Boolean/Phrase 34,907

S15 TI electroencephalogra* OR AB electroencephalogra* Search modes - Boolean/Phrase 16,322

S14 MA Electroencephalography Search modes - Boolean/Phrase 36,766

S13 DE "Electroencephalography" OR DE "Alpha Rhythm"

OR DE "Beta Rhythm" OR DE "Delta Rhythm" OR DE

"Gamma Rhythm" OR DE "Theta Rhythm"

Search modes - Boolean/Phrase 51,957

S12 TI sleep stage* OR AB sleep stage* Search modes - Boolean/Phrase 3,410

S11 TI sleep monit* OR AB sleep monit* Search modes - Boolean/Phrase 1,101

S10 TI sleep architect* OR AB sleep architect* Search modes - Boolean/Phrase 1,112

S9 TI PSG OR AB PSG Search modes - Boolean/Phrase 1,050

S8 TI polysomnogra* OR AB polysomnogra* Search modes - Boolean/Phrase 4,790

S7 MA POLYSOMNOGRAPHY Search modes - Boolean/Phrase 4,462

S6 DE "Polysomnography" Search modes - Boolean/Phrase 5,154

S5 TI PTSD OR AB PTSD Search modes - Boolean/Phrase 29,108

S4 TI posttraumatic stress OR AB posttraumatic stress Search modes - Boolean/Phrase 26,708

S3 TI post-traumatic stress OR AB post-traumatic stress Search modes - Boolean/Phrase 10,513

3

S2 MA Stress Disorders, Post-Traumatic Search modes - Boolean/Phrase 16,896

S1 DE "Post-Traumatic Stress" Search modes - Boolean/Phrase 339

Table S5 CINAHL via EBSCOhost (up to Mar 2, 2019)

# Search Options Actions Results

S18 S5 AND S15 Limiters - English Language; Human


67

S17 S5 AND S15 Limiters - Human


67

S16 S5 AND S15 Search modes - Boolean/Phrase 142

S15 S6 OR S7 OR S8 OR S9 OR S10 OR S11 OR S12 OR S13 OR S14 Search modes - Boolean/Phrase 25,191

S14 TI EEG OR AB EEG Search modes - Boolean/Phrase 6,153

S13 TI electroencephalogra* OR AB electroencephalogra* Search modes - Boolean/Phrase 5,066

S12 (MH "Electroencephalography") Search modes - Boolean/Phrase 13,517

S11 TI sleep stage* OR AB sleep stage* Search modes - Boolean/Phrase 967

S10 TI sleep monit* OR AB sleep monit* Search modes - Boolean/Phrase 676

S9 TI sleep architect* OR AB sleep architect* Search modes - Boolean/Phrase 520

S8 TI PSG OR AB PSG Search modes - Boolean/Phrase 966

S7 TI polysomnogra* OR AB polysomnogra* Search modes - Boolean/Phrase 4,384

S6 (MH "Polysomnography") Search modes - Boolean/Phrase 7,635

S5 S1 OR S2 OR S3 OR S4 Search modes - Boolean/Phrase 22,532

S4 TI PTSD OR AB PTSD Search modes - Boolean/Phrase 8,866

S3 TI posttraumatic stress OR AB posttraumatic stress Search modes - Boolean/Phrase 8,055

S2 TI post-traumatic stress OR AB post-traumatic stress Search modes - Boolean/Phrase 4,881

S1 (MH "Stress Disorders, Post-Traumatic+") Search modes - Boolean/Phrase 18,911

4

Table S6 Studies excluded (N=43) with reasons

Studies excluded ReasonsBreslau et al., 2004 [1] Not the target patients (Including past PTSD patients)Brown et al., 1996 [2] Not the target controls (No control group)Capaldi II et al., 2011 [3] Not the target controls (Traumatic brain injury and other clinical conditions as

controls)Capener et al., 2018 [4] Not the target patients (Women with insomnia, OSA or other sleep disorders)Colvonen et al., 2015 [5] No target outcomes (No PSG data)Creamer et al., 2018 [6] Not the target patients (Military personnel who underwent PSG)Dagan et al., 1991 [7] No target outcomes (No sleep architecture data)El-Solh et al., 2010 [8] No target outcomes (No PSG data)El-Solh et al., 2017 [9] Not the target controls (No control group)Germain et al., 2012 [10] Not the target patients (Veterans with chronic sleep disturbances)Gillin et al., 2001 [11] Not the target controls (No control group)Habukawa et al., 2018 [12] Not the target controls (Major depressive disorder as control group)Insana et al., 2012 [13] Not the target patients (Veterans with chronic sleep disturbances)Kinoshita et al., 2012 [14] Not the target controls (No control group)Kinzie et al., 1994 [15] Not the target controls (No control group)Klein et al., 2003 [16] No target outcomes (No PSG data)Kobayashi et al., 2012a [17] Overlapped sampleKobayashi et al., 2012b [18] Not the target patients (It was unclear whether the participants had PTSD when

performing PSG )Krakow et al., 2000 [19] No target outcomes (No PSG data)Krakow et al., 2006 [20] Not the target patients (Crime victims with sleep disordered breathing)Mellman et al., 1995 [21] Not the target patients (Not all participants in Hurricane victim group had PTSD)Mellman et al., 2002 [22] Not the target patients (It was unclear whether the participants had PTSD when

performing PSG )Mellman et al., 2004 [23] Not the target patients (It was unclear whether the participants had PTSD when

performing PSG)

5

Mellman et al., 1997 [24] Overlapped sampleMellman et al., 2007 [25] Not the target patients (It was unclear whether the participants had PTSD when

performing PSG)Mysliwiec et al., 2013 [26] Not the target patients (OSA and insomnia patients)Mysliwiec et al., 2015 [27] Not the target controls (All participants in control group were OSA patients)Neylan et al., 2003 [28] Not the target controls (No control group)Onton et al., 2018 [29] No target outcomes (No PSG data)Phelps et al., 2018 [30] Not the target controls (No control group)Rezaeitalab et al., 2018 [31] Not the target controls (All participants in this study were OSA patients)Robert et al., 2005 [32] No target outcomes (no PSG data)Ross et al., 1999 [33] Overlapped sampleStout et al., 2017 [34] No target outcomes (Actigraphy, no PSG data)Van Liempt et al., 2011a [35] Overlapped sampleVan Liempt et al., 2011b [36] No target outcomes (Rate of OSA in PTSD, and no sleep architecture data)van Wyk et al., 2016 [37] Overlapped sampleWoodward et al., 2000 [38] Not the target controls (No control group)Woodward et al., 1996a [39] Not the target controls (No control group)Woodward et al., 1996b [40] Not the target controls (Major depressive disorder as control group)Woodward et al., 2003 [41] Overlapped sampleYesavage et al., 2014 [42] Not the target controls (No control group)Lavie et al., 1979 [43] Not the target patients (It was unclear whether the participants had PTSD)

References of excluded studies

1 Breslau N, Roth T, Burduvali E, Kapke A, Schultz L, Roehrs T. Sleep in lifetime posttraumatic stress disorder: A community-based polysomnographic study. Archives of General Psychiatry. 2004; 61(5): 508-516.

2 Brown TM, Boudewyns PA. Periodic limb movements of sleep in combat veterans with posttraumatic stress disorder. Journal of Traumatic Stress. 1996; 9(1): 129-136.

3 Capaldi VF, 2nd, Guerrero ML, Killgore WDS. Sleep disruptions among returning combat veterans from Iraq and Afghanistan. Military medicine. 2011; 176(8): 879-888.

4 Capener DC, Brock MS, Hansen SL, Matsangas P, Mysliwiec V. An initial report of sleep disorders in women in the U.S. military. Military medicine. 2018; in press.

5 Colvonen PJ, Masino T, Drummond SPA, Myers US, Angkaw AC, Norman SB. Obstructive sleep apnea and posttraumatic stress disorder among OEF/OIF/OND veterans. Journal of Clinical Sleep Medicine. 2015; 11(5): 513-518.

6 Creamer JL, Brock MS, Matsangas P, Motamedi V, Mysliwiec V. Nightmares in united states military personnel with sleep disturbances. Journal of Clinical Sleep Medicine. 2018; 14(3):

6

419-426.7 Dagan Y, Lavie P, Bleich A. Elevated awakening thresholds in sleep stage 3-4 in war-related

post-traumatic stress disorder. Biological Psychiatry. 1991; 30(6): 618-622.8 El-Solh AA, Ayyar L, Akinnusi M, Relia S, Akinnusi O. Positive airway pressure adherence in

veterans with posttraumatic stress disorder. Sleep. 2010; 33(11): 1495-1500.9 El-Solh AA, Vermont L, Homish GG, Kufel T. The effect of continuous positive airway

pressure on post-traumatic stress disorder symptoms in veterans with post-traumatic stress disorder and obstructive sleep apnea: a prospective study. Sleep Medicine. 2017; 33: 145-150.

10 Germain A, Richardson R, Moul DE, Mammen O, Haas G, Forman SD, et al. Placebo-controlled comparison of prazosin and cognitive-behavioral treatments for sleep disturbances in US Military Veterans. Journal of psychosomatic research. 2012; 72(2): 89-96.

11 Gillin JC, Smith-Vaniz A, Schnierow B, Rapaport MH, Kelsoe J, Raimo E, et al. An open-label, 12-week clinical and sleep EEG study of nefazodone in chronic combat-related posttraumatic stress disorder. Journal of Clinical Psychiatry. 2001; 62(10): 789-796.

12 Habukawa M, Uchimura N, Maeda M, Ogi K, Hiejima H, Kakuma T. Differences in rapid eye movement (REM) sleep abnormalities between posttraumatic stress disorder (PTSD) and major depressive disorder patients: REM interruption correlated with nightmare complaints in PTSD. Sleep Medicine. 2018; 43: 34-39.

13 Insana SP, Kolko DJ, Germain A. Early-life trauma is associated with rapid eye movement sleep fragmentation among military veterans. Biological psychology. 2012; 89(3): 570-579.

14 Kinoshita LM, Yesavage JA, Noda A, Jo B, Hernandez B, Taylor J, et al. Modeling the effects of obstructive sleep apnea and hypertension in Vietnam veterans with PTSD . Sleep & breathing = Schlaf & Atmung. 2012; 16(4): 1201-1209.

15 Kinzie JD, Sack RL, Riley CM. The polysomnographic effects of clonidine on sleep disorders in posttraumatic stress disorder: A pilot study with Cambodian patients. Journal of Nervous and Mental Disease. 1994; 182(10): 585-587.

16 Klein E, Koren D, Arnon I, Lavie P. Sleep complaints are not corroborated by objective sleep measures in post-traumatic stress disorder: A 1-year prospective study in survivors of motor vehicle crashes. Journal of Sleep Research. 2003; 12(1): 35-41.

17 Kobayashi I, Huntley E, Lavela J, Mellman TA. Subjectively and objectively measured sleep with and without posttraumatic stress disorder and trauma exposure. Sleep. 2012; 35(7): 957-965.

18 Kobayashi I, Mellman TA. Gender differences in sleep during the aftermath of trauma and the development of posttraumatic stress disorder. Behavioral Sleep Medicine. 2012; 10(3): 180-190.

19 Krakow B, Lowry C, Germain A, Gaddy L, Hollifield M, Koss M, et al. A retrospective study on improvements in nightmares and post-traumatic stress disorder following treatment for co-morbid sleep-disordered breathing. Journal of psychosomatic research. 2000; 49(5): 291-298.

20 Krakow B, Melendrez D, Warner TD, Clark JO, Sisley BN, Dorin R, et al. Signs and symptoms of sleep-disordered breathing in trauma survivors: a matched comparison with classic sleep apnea patients. Journal of Nervous & Mental Disease. 2006; 194(6): 433-439.

21 Mellman TA, David D, Kulick-Bell R, Hebding J, Nolan B. Sleep disturbance and its relationship to psychiatric morbidity after Hurricane Andrew. Am J Psychiatry. 1995; 152(11): 1659-1663.

7

22 Mellman TA, Bustamante V, Fins AI, Pigeon WR, Nolan B. REM sleep and the early development of posttraumatic stress disorder. American Journal of Psychiatry. 2002; 159(10): 1696-1701.

23 Mellman TA, Knorr BR, Pigeon WR, Leiter JC, Akay M. Heart rate variability during sleep and the early development of posttraumatic stress disorder. Biological Psychiatry. 2004; 55(9): 953-956.

24 Mellman TA, Nolan B, Hebding J, Kulick-Bell R. A polysomnographic comparison of veterans with combat-related PTSD, depressed men, and non-ill controls. Sleep: Journal of Sleep Research & Sleep Medicine. 1997; 20(1): 46-51.

25 Mellman TA, Pigeon WR, Nowell PD, Nolan B. Relationships between REM sleep findings and PTSD symptoms during the early aftermath of trauma. Journal of Traumatic Stress. 2007; 20(5): 893-901.

26 Mysliwiec V, Gill J, Lee H, Baxter T, Pierce R, Barr TL, et al. Sleep disorders in US military personnel: a high rate of comorbid insomnia and obstructive sleep apnea . CHEST. 2013; 144(2): 549-557.

27 Mysliwiec V, Matsangas P, Gill J, Baxter T, O'Reilly B, Collen JF, et al. A comparative analysis of sleep disordered breathing in Active Duty Service Members with and without combat-related Posttraumatic stress disorder. Journal of Clinical Sleep Medicine. 2015; 11(12): 1393-1401.

28 Neylan TC, Lenoci M, Maglione ML, Rosenlicht NZ, Leykin Y, Metzler TJ, et al. The effect of nefazodone on subjective and objective sleep quality in posttraumatic disorder. The Journal of Clinical Psychiatry. 2003; 64(4): 445-450.

29 Onton JA, Matthews SC, Kang DY, Coleman TP. In-home sleep recordings in military veterans with posttraumatic stress disorder reveal less REM and deep sleep <1 Hz. Frontiers in Human Neuroscience. 2018; 12: 196.

30 Phelps AJ, Kanaan RAA, Worsnop C, Redston S, Ralph N, Forbes D. An ambulatory polysomnography study of the post-traumatic nightmares of post-traumatic stress disorder. Sleep. 2018; in press.

31 Rezaeitalab F, Mokhber N, Ravanshad Y, Saberi S, Rezaeetalab F. Different polysomnographic patterns in military veterans with obstructive sleep apnea in those with and without post-traumatic stress disorder. Sleep and Breathing. 2018; 22(1): 17-22.

32 Robert S, Hamner MB, Kose S, Ulmer HG, Deitsch SE, Lorberbaum JP. Quetiapine improves sleep disturbances in combat veterans with PTSD: Sleep data from a prospective, open-label study. Journal of Clinical Psychopharmacology. 2005; 25(4): 387-388.

33 Ross RJ, Ball WA, Sanford LD, Morrison AR, Dinges DF, Silver SM, et al. Rapid eye movement sleep changes during the adaptation night in combat veterans with posttraumatic stress disorder. Biological Psychiatry. 1999; 45(7): 938-941.

34 Stout JW, Beidel DC, Alfano CA, Mesa F, Trachik B, Neer SM. Sleep disturbances among combat military veterans: A comparative study using subjective and objective sleep assessments. Military Psychology. 2017; 29(3): 189-201.

35 Van Liempt S, Vermetten E, Lentjes E, Arends J, Westenberg H. Decreased nocturnal growth hormone secretion and sleep fragmentation in combat-related posttraumatic stress disorder; potential predictors of impaired memory consolidation. Psychoneuroendocrinology. 2011; 36(9): 1361-1369.

8

36 van Liempt S, Westenberg HGM, Arends J, Vermetten E. Obstructive sleep apnea in combat-related posttraumatic stress disorder: a controlled polysomnography study. European journal of psychotraumatology. 2011; 2.

37 van Wyk M, Thomas KGF, Solms M, Lipinska G. Prominence of hyperarousal symptoms explains variability of sleep disruption in posttraumatic stress disorder. Psychological trauma : theory, research, practice and policy. 2016; 8(6): 688-696.

38 Woodward SH, Arsenault NJ, Murray C, Bliwise DL. Laboratory sleep correlates of nightmare complaint in PTSD inpatients. Biological Psychiatry. 2000; 48(11): 1081-1087.

39 Woodward SH, Bliwise DL, Friedman MJ, Gusman DF. Subjective versus objective sleep in Vietnam combat veterans hospitalized for PTSD. Journal of Traumatic Stress. 1996; 9(1): 137-143.

40 Woodward SH, Friedman MJ, Bliwise DL. Sleep and depression in combat-related PTSD inpatients. Biological Psychiatry. 1996; 39(3): 182-192.

41 Woodward SH, Leskin GA, Sheikh JI. Sleep respiratory concomitants of comorbid panic and nightmare complaint in post-traumatic stress disorder. Depression and Anxiety. 2003; 18(4): 198-204.

42 Yesavage JA, Kinoshita LM, Noda A, Lazzeroni LC, Fairchild JK, Friedman L, et al. Longitudinal assessment of sleep disordered breathing in Vietnam veterans with post-traumatic stress disorder. Nature and science of sleep. 2014; 6: 123-127.

43 Lavie P, Hefez A, Halperin G, Enoch D. Long-term effects of traumatic war-related events on sleep. Am J Psychiatry. 1979; 136(2): 175-178.

9

Note: the references numbers in Table S7 and Figure S1-S60 are consistent with those in manuscript body.

Table S7 Description of healthy controls across studies.

Author(s), date Criteria of healthy controls

Lipinska et al., 2017 [33]

Without any DSM-IV axis I disorders; without history of alcohol or other substance abuse; excluding those taking sedative medication and psychoactive medication to regulate sleeping patterns at the time of recruitment; without trauma experiences more than 5 years or fewer than 6 months prior to screening; without neurological conditions (e.g., epilepsy, traumatic brain injury).

Mellman et al., 2014 [20]

Excluding those who were found to have a body mass index≥40, chronic medical conditions or psychotic disorders, bipolar disorder, severe recurrent depression, daily use of any medication, excessive use of caffeine (more than five cups of coffee per day or its equivalent), heavy smoking (more than 20 cigarettes per day) and drinking (more than 14 drinks/w in men, more than seven drinks/w in women), and regular night shift work or unusual sleep-wake schedules. Excluding those with sleep, breathing, and movement disorders, current alcohol or drug abuse or dependence, and positive urine toxicology for illicit drugs.

Lipinska et al., 2014 [35]

Without a primary DSM-IV-TR Axis I disorder; without a previous history of alcohol or other substance abuse; excluding those taking sedative medication and psychoactive medication to regulate sleeping patterns at the time of recruitment; without trauma experiences more than 5 years or fewer than 6 months prior to screening; without childhood or adolescent trauma; without neurological conditions (e.g., epilepsy, traumatic brain injury) with the potential to influence study outcomes;

Richards et al., 2013 [14]

Without a history of traumatic brain injury, presence of neurological disorders or systemic illness; excluding those who use psychiatric, anticonvulsant, antihypertensive or sympathomimetic, steroidal, statin or other prescription medications; without obesity; without alcohol abuse or dependence in the previous 2 years; without substance abuse or dependence in the previous year; without any psychiatric disorder; without childhood trauma.

van Liempt et al., 2013 [37]

Medically healthy, and free from psychotropic medication and alcohol or drugs dependence in the past six months; without a history of psychiatric disorders; without sleep complaints; without obstructive sleep apnea syndrome and periodic limb movement disorder.

Yetkin et al., 2010 [38]

Without physical problem; no history of any primary sleep disorder; no personal or family psychiatric disorders; recruited from schools and hospital employees.

Habukawa et al., 2007 [40]

No physical diseases and other sleep disorders; recruited from medical school students and through newspaper advertisements.

Raboni et al., 2014 [41]

Not use of any medication that could interfere with sleep architecture; not use of psychotropic drugs and any medication that could increase rapid eye movements; without clinical and neurologic disorders, past history of neurologic, endocrine or hepatic disease; without dissociative disorders or psychosis and history of sleep disorder; recruited by newspaper, TV and radio announcements.

10

Germain et al., 2003 [44]

Excluding those who were currently under medications known to influence sleep and dreams; without a major psychiatric disorder or other sleep problem; without a neurologic disorder; without irregular sleep–wake schedules or had undergone jet lag in the previous 3 months; not using alcohol or drugs on a regular basis; recruited from an advertisement in the same university newspaper.

Hurwitz et al., 1998 [45]

Without current axis I psychiatric illness; abstinence from illicit drugs, alcohol, and any psychotropic medication for at least 2 weeks prior to sleep studies; negative urine toxicology screens and breath alcohol determinations when studied in the laboratory.

Mellman et al., 1995 [46]

Without lifetime PTSD and anxiety, mood, and substance use disorders, and significant medical problems; be free of medication which in the patients had been discontinued for a minimum of 2 weeks.

Woodward et al., 1996 [49]

Without histories of mental illness

Glaubman et al., 1990 [51]

The control group consisted of seven normal male subjects matched to the PTSD group for age and education.

Fuller et al., 1994 [52]

No current symptoms or previous history of psychiatric disturbance or substance abuse; maintaining a regular nocturnal sleep schedule; recruited from community.

Germain et al., 2006 [53]

Archival healthy subjects

11

Figure S1. Forest plot for meta-analysis of the difference in total sleep time between patients with posttraumatic stress disorder and controls.

12

Figure S2. Precision plot for random-effects meta-analysis of studies estimating the difference in total sleep time between patients with posttraumatic stress disorder and controls; Egger test: Intercept=-1.796, standard error=0.445; 95% confidence interval: -2.697 to -0.895, t=4.036, p=0.00025.

13

Figure S3. Forest plot for meta-analysis of the difference in sleep latency between patients with posttraumatic stress disorder and controls.

14

Figure S4. Precision plot for random-effects meta-analysis of studies estimating the difference in sleep latency between patients with posttraumatic stress disorder and controls; Egger test: Intercept=0.746, standard error=0.433; 95% confidence interval: -0.134 to 1.625, t=1.722, p=0.094.

15

Figure S5. Forest plot for meta-analysis of the difference in wake time after sleep onset between patients with posttraumatic stress disorder and controls.

16

Figure S6. Precision plot for random-effects meta-analysis of studies estimating the difference in wake time after sleep onset between patients with posttraumatic stress disorder and controls; Egger test: Intercept=2.654, standard error=0.337; 95% confidence interval: 1.955 to 3.352, t=7.880, p<0.0001.

17

Figure S7. Forest plot for meta-analysis of the difference in sleep efficiency between patients with posttraumatic stress disorder and controls.

18

Figure S8. Precision plot for random-effects meta-analysis of studies estimating the difference in sleep efficiency between patients with posttraumatic stress disorder and controls; Egger test: Intercept=-2.322, standard error=0.499; 95% confidence interval: -3.333 to -1.310, t=4.655, p=0.00004.

19

Figure S9. Forest plot for meta-analysis of the difference in N1 percentage between patients with posttraumatic stress disorder and controls.

20

Figure S10. Precision plot for random-effects meta-analysis of studies estimating the difference in N1 percentage between patients with posttraumatic stress disorder and controls; Egger test: Intercept=1.640, standard error=0.525; 95% confidence interval: 0.576 to 2.704, t=3.127, p=0.00349.

22


23

Figure S12. Precision plot for random-effects meta-analysis of studies estimating the difference in N2 percentage between patients with posttraumatic stress disorder and controls; Egger test: Intercept=0.554, standard error=0.516; 95% confidence interval:-0.492 to 1.600, t=1.072, p=0.291.

24


25

Figure S14. Precision plot for random-effects meta-analysis of studies estimating the difference in N3 percentage between patients with posttraumatic stress disorder and controls; Egger test: Intercept=-2.172, standard error=0.502; 95% confidence interval: -3.189 to -1.155, t=4.323, p=0.00011.

26

Figure S15. Forest plot for meta-analysis of the difference in REM percentage between patients with posttraumatic stress disorder and controls.

Figure S16. Precision plot for random-effects meta-analysis of studies estimating the difference in REM percentage between patients with

27

posttraumatic stress disorder and controls; Egger test: Intercept=-0.793, standard error=0.627; 95% confidence interval: -2.062 to 0.477, t=1.264, p=0.214.

Figure S17. Forest plot for meta-analysis of the difference in REM latency between patients with posttraumatic stress disorder and controls.

28

Figure S18. Precision plot for random-effects meta-analysis of studies estimating the difference in REM latency between patients with

29

posttraumatic stress disorder and controls; Egger test: Intercept=0.402, standard error=0.885; 95% confidence interval:-1.403 to 2.206, t=0.454, p=0.653.

Figure S19. Forest plot for meta-analysis of the difference in REM density between patients with posttraumatic stress disorder and controls.

30

Figure S20. Precision plot for random-effects meta-analysis of studies estimating the difference in REM density between patients with

31

posttraumatic stress disorder and controls; Egger test: Intercept=4.846, standard error=0.810; 95% confidence interval: 3.080 to 6.612, t=5.979, p=0.00006.

Figure S21. Forest plot for meta-analysis of the difference in REM percentage between patients with PTSD and controls in studies in which

32

PTSD patients had a mean age < 30 y; PTSD, posttraumatic stress disorder.

Figure S22. Precision plot for random-effects meta-analysis of studies estimating the difference in REM percentage between patients with PTSD

33

and controls in studies in which PTSD patients had a mean age < 30 y; PTSD, posttraumatic stress disorder; Egger test: Intercept=1.466; standard error=1.418; 95% confidence interval:-1.804 to 4.737, t=1.034, p=0.331.


34

PTSD patients with mean ages of 30-40 y. PTSD, posttraumatic stress disorder.


35

and controls in studies in which PTSD patients with mean ages of 30-40 y; PTSD, posttraumatic stress disorder; Egger test: Intercept=-0.259; standard error=3.310; 95% confidence interval:-8.359 to 7.842, t=0.078, p=0.940.


36

PTSD patients had a mean age > 40 y; PTSD, posttraumatic stress disorder.


37

and controls in studies in which PTSD patients had a mean age > 40 y; PTSD, posttraumatic stress disorder; Egger test: Intercept=-0.428; standard error=0.812; 95% confidence interval: -2.128 to 1.271, t=0.528, p=0.604.

Figure S27. Forest plot for meta-analysis of the difference in wake time after sleep onset between patients with PTSD and controls in studies in

38

which PTSD patients had a mean age < 30 y; PTSD, posttraumatic stress disorder.

Figure S28. Precision plot for random-effects meta-analysis of studies estimating the difference in wake time after sleep onset between patients

39

with PTSD and controls in studies in which PTSD patients had a mean age < 30 y; PTSD, posttraumatic stress disorder; Egger test: Intercept=3.983; standard error=1.271; 95% confidence interval: 0.715 to 7.251, t=3.133, p=0.026.

Figure S29. Forest plot for meta-analysis of the difference in wake time after sleep onset between patients with PTSD and controls in studies in

40

which PTSD patients with mean ages of 30-40 y; PTSD, posttraumatic stress disorder.


41

with PTSD and controls in studies in which PTSD patients with mean ages of 30-40 y; PTSD, posttraumatic stress disorder; Egger test: Intercept=2.933; standard error=1.027; 95% confidence interval: 0.504 to 5.361, t=2.856, p=0.025.

42

Figure S31. Forest plot for meta-analysis of the difference in wake time after sleep onset between patients with PTSD and controls in studies in which PTSD patients had a mean age > 40 y; PTSD, posttraumatic stress disorder.

43

Figure S32. Precision plot for random-effects meta-analysis of studies estimating the difference in wake time after sleep onset between patients with PTSD and controls in studies in which PTSD patients had a mean age > 40 y; PTSD, posttraumatic stress disorder; Egger test: Intercept=2.049; standard error=0.622; 95% confidence interval: 0.527 to 3.572, t=3.295, p=0.0165.

44

Figure S33. Forest plot for meta-analysis of the difference in N3 percentage between patients with posttraumatic stress disorder and healthy controls.

45

Figure S34. Precision plot for random-effects meta-analysis of studies estimating the difference in N3 percentage between patients with posttraumatic stress disorder and healthy controls; Egger test: Intercept=-4.109; standard error=1.012; 95% confidence interval:-6.255 to -1.962, t=4.058, p=0.00091.

46

Figure S35. Forest plot for meta-analysis of the difference in N3 percentage between patients with PTSD and trauma exposed survivors with PTSD; PTSD, posttraumatic stress disorder.

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Figure S36. Precision plot for random-effects meta-analysis of studies estimating the difference in N3 percentage between PTSD patients and trauma exposed survivors without PTSD; PTSD, posttraumatic stress disorder; Egger test: Intercept=-0.788; standard error=0.532; 95% confidence interval:-1.902 to 0.325, t=1.482, p=0.155.

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Figure S37. Forest plot for meta-analysis of the difference in wake time after sleep onset between patients with posttraumatic stress disorder and healthy controls.

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Figure S38. Precision plot for random-effects meta-analysis of studies estimating the difference in wake time after sleep onset between patients with posttraumatic stress disorder and healthy controls; Egger test: Intercept=4.900; standard error=1.242; 95% confidence interval: 1.964 to 7.837, t=3.947, p=0.00556.

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Figure S39. Forest plot for meta-analysis of the difference in wake time after sleep onset between PTSD patients and trauma exposed survivors with PTSD; PTSD, posttraumatic stress disorder.

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Figure S40. Precision plot for random-effects meta-analysis of studies estimating the difference in wake time after sleep onset between PTSD patients and trauma exposed survivors without PTSD; PTSD, posttraumatic stress disorder; Egger test: Intercept=2.379; standard error=0.303; 95% confidence interval:1.719 to 3.038, t=7.858, p<0.00001.

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Figure S41. Forest plot for meta-analysis of the difference in sleep efficiency between patients with posttraumatic stress disorder and healthy controls.

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Figure S42. Precision plot for random-effects meta-analysis of studies estimating the difference in sleep efficiency between patients with posttraumatic stress disorder and healthy controls; Egger test: Intercept=-5.335; standard error=1.883; 95% confidence interval: -9.349 to -1.321, t=2.833, p=0.013.

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Figure S43. Forest plot for meta-analysis of the difference in sleep efficiency between PTSD patients and trauma exposed survivors without PTSD; PTSD, posttraumatic stress disorder.

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Figure S44. Precision plot for random-effects meta-analysis of studies estimating the difference in sleep efficiency between PTSD patients and trauma exposed survivors without PTSD; PTSD, posttraumatic stress disorder; Egger test: Intercept=-1.619; standard error=0.407; 95% confidence interval:-2.474 to -0.764, t=3.978, p=0.00088.

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Figure S45. Forest plot for meta-analysis of the difference in total sleep time between patients with posttraumatic stress disorder and healthy controls.

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Figure S46. Precision plot for random-effects meta-analysis of studies estimating the difference in total sleep time between patients with posttraumatic stress disorder and healthy controls; Egger test: Intercept=-1.893; standard error=1.686; 95% confidence interval:-5.487 to 1.700, t=1.123, p=0.279.

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Figure S47. Forest plot for meta-analysis of the difference in total sleep time between PTSD patients and trauma exposed survivors without PTSD; PTSD, posttraumatic stress disorder.

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Figure S48. Precision plot for random-effects meta-analysis of studies estimating the difference in total sleep time between PTSD patients and trauma exposed survivors without PTSD; PTSD, posttraumatic stress disorder; Egger test: Intercept=-1.593; standard error=0.527; 95% confidence interval:-2.693 to -0.493, t=3.021, p=0.00675.

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Figure S49. Forest plot for meta-analysis of the difference in wake time after sleep onset between patients with posttraumatic stress disorder and controls in studies in which the trauma type is combat exposure.

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Figure S50. Precision plot for random-effects meta-analysis of studies estimating the difference in wake time after sleep onset between patients with posttraumatic stress disorder and controls in studies in which the trauma type is combat exposure.; Egger test: Intercept=1.914; standard

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error=0.339; 95% confidence interval:1.147 to 2.681, t=5.646, p=0.00032.

Figure S51. Forest plot for meta-analysis of the difference in wake time after sleep onset between patients with posttraumatic stress disorder and

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controls in studies in which the trauma type is non-combat exposure.


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with posttraumatic stress disorder and controls in studies in which the trauma type is non-combat exposure.; Egger test: Intercept=3.698; standard error=0.981; 95% confidence interval:1.298 to 6.009, t=3.770, p=0.00929.

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Figure S53. Forest plot for meta-analysis of the difference in sleep efficiency between patients with posttraumatic stress disorder and controls in studies in which the trauma type is combat exposure.

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Figure S54. Precision plot for random-effects meta-analysis of studies estimating the difference in sleep efficiency between patients with posttraumatic stress disorder and controls in studies in which the trauma type is combat exposure.; Egger test: Intercept=-1.269; standard error=0.505; 95% confidence interval:-2.330 to -0.208, t=2.513, p=0.022.

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Figure S55. Forest plot for meta-analysis of the difference in sleep efficiency between patients with posttraumatic stress disorder and controls in studies in which the trauma type is non-combat exposure.

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Figure S56. Precision plot for random-effects meta-analysis of studies estimating the difference in sleep efficiency between patients with posttraumatic stress disorder and controls in studies in which the trauma type is non-combat exposure.; Egger test: Intercept=-4.790; standard error=1.341; 95% confidence interval:-7.823 to -1.757, t=3.572, p=0.006.

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Figure S57. Forest plot for meta-analysis of the difference in REM sleep percentage between patients with posttraumatic stress disorder and controls in studies in which the trauma type is combat exposure.

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Figure S58. Precision plot for random-effects meta-analysis of studies estimating the difference in REM sleep percentage between patients with posttraumatic stress disorder and controls in studies in which the trauma type is combat exposure; Egger test: Intercept=0.382; standard error=0.831; 95% confidence interval:-1.357 to 2.121, t=0.460, p=0.651.

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Figure S59. Forest plot for meta-analysis of the difference in REM sleep percentage between patients with posttraumatic stress disorder and controls in studies in which the trauma type is non-combat exposure.

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Figure S60. Precision plot for random-effects meta-analysis of studies estimating the difference in REM sleep percentage between patients with posttraumatic stress disorder and controls in studies in which the trauma type is non-combat exposure; Egger test: Intercept=0.610; standard error=1.642; 95% confidence interval:-3.272 to 4.493, t=0.372, p=0.721.

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