Diagnosing obstructive sleep apnea in a residential treatment program for veterans with substance use disorder and PTSD.

Abstract

Background: Obstructive sleep apnea (OSA) is often comorbid with both substance use disorders (SUD) and posttraumatic stress disorder (PTSD), yet frequently goes undiagnosed and untreated. We present data on the feasibility and acceptability of objective OSA diagnosis procedures, findings on OSA prevalence, and the relationship between OSA and baseline SUD/PTSD symptoms among veterans in residential treatment for comorbid PTSD/SUD. Methods: Participants were 47 veterans admitted to residential PTSD/SUD treatment. Participants completed questionnaires assessing PTSD and sleep symptoms, and filled out a sleep diary for seven days. Apnea-hypopnea index (AHI) was recorded using the overnight Home Sleep Apnea test (HSAT; OSA was diagnosed with AHI $ 5). Results: Objective OSA diagnostic testing was successfully completed in 95.7% of participants. Of the 45 veterans who went through HSAT, 46.7% had no OSA, 35.6% received a new OSA diagnosis, and 8.9% were previously diagnosed with OSA and were using positive airway pressure treatment (PAP); an additional 8.9% were previously diagnosed with OSA, reconfirmed with the HSAT, but were not using PAP. One hundred percent of respondents during follow-up deemed the testing protocol's usefulness as "Good" or "Excellent." Conclusion: OSA diagnostic testing on the residential unit was feasible and acceptable by participants and was effective in diagnosing OSA. OSA testing should be considered for everyone entering a SUD and PTSD residential unit. Clinical Impact StatementObstructive sleep apnea (OSA) is very often comorbid with both posttraumatic stress disorder (PTSD) and substance use disorders (SUD). Unfortunately, due to the limitations of self-report OSA screeners and atypical presentation of OSA in individuals with SUD/PTSD, OSA often goes undiagnosed for individuals with SUD/PTSD. Our study found that OSA diagnostic testing was feasible and acceptable to participants in a residential treatment program for SUD/PTSD, and effective in diagnosing OSA. Diagnosing OSA on a residential unit for SUD/PTSD is a necessary first step to treating OSA and may help improve long-term outcomes for individuals with SUD/PTSD.