Knowledge, Attitudes, and Screening for Obstructive Sleep Apnea and Diabetes Mellitus among War Veterans Seeking Treatment of Posttraumatic Stress Disorder

Abstract

Posttraumatic stress disorder (PTSD) is one of the most common psychiatric disorders. However, we should not neglect the somatic aspects of PTSD. Associations with cardiovascular diseases (CVD) are particularly concerning because PTSD was associated with an even 53% higher risk for CVD. This study aimed to analyze the prevalence of several CVD risk factors, especially diabetes mellitus among PTSD patients divided into three groups according to obstructive sleep apnea (OSA) risk stratification (low, intermediate, and high). This cross-sectional study included one hundred male PTSD veterans. The mean age was 53 (40–67) years. The estimated OSA risk was 95% for the whole cohort, and 53% were in the high-risk group. Median HbA1c was 5.6 (4.6–10)%. The hemoglobin A1c (HbA1c) levels showed that 34 patients were in the prediabetes group, and 20 of them fulfilled the criteria for diabetes. However, only 13 of them were aware of their previous diagnosis of diabetes mellitus. In testing knowledge about diabetes, 62% and only 23% of patients knew the correct definition of HbA1c and level of fasting plasma glucose, respectively. Diabetic patients had insufficient knowledge about diabetic complications and treatment. A higher level of PTSD symptoms in veterans was associated with a higher prevalence of OSA. The results strongly support further research and education into early detection of CVD risk factors associated with PTSD.

Mediterranean Diet Adherence, Physical Activity, and Advanced Glycation End Products in Complex PTSD: A Comprehensive Examination of Lifestyle and Cardiovascular Risk in War Veterans

“…That increased prevalence of an unhealthy lifestyle in patients with PTSD is even more pronounced in complex PTSD is an unsurprising result. Indeed, clusters of symptoms that burden PTSD patients, such as sleep disturbance, flashbacks, and anxiety, were previously shown to substantially reduce quality of life [ 21 , 22 , 23 , 24 , 25 ]. While a limited number of studies have formally examined the differences in quality of life depending on the presence of DSO symptoms, the available results consistently indicate a correlation between poor quality of life and complex PTSD [ 26 , 27 , 28 ].…”

The influence of sleep on fear extinction in trauma-related disorders

“…Although the contribution of primary sleep disorders preceding the occurrence of trauma requires knowledge of prior medical histories, clinical studies of such sleep disorders occurring co-morbidly with PTSD strongly suggest they increase vulnerability to PTSD. For example, OSA is associated with higher severity of PTSD symptoms ( Mayer et al., 2021 ; Miles et al., 2022 ), worsened insomnia symptoms ( Krakow et al., 2019 ) and poorer PTSD treatment outcome ( Reist et al., 2017 ; Taylor et al., 2020 ) whereas treatment of OSA is associated with an improved PTSD therapeutic outcome ( Hurwitz and Khawaja, 2010 ; Krakow et al., 2000 , 2019 ). Similarly, pre-treatment insomnia is associated with lesser treatment gains ( Sullan et al., 2021 ) and residual sleep symptoms have been shown to predict poorer response to prolonged exposure therapy (PE) ( Brownlow et al., 2016 ; Lopez et al., 2017 ; Taylor et al., 2020 ).…”

The Relaxin-3 Receptor, RXFP3, Is a Modulator of Aging-Related Disease

“…It is interesting to note that the RXFP3-GIT2 signaling axis seems to be a priority signaling system for central anxiety/stress conditions, as not only is GIT2 involved in anxiety-related behavior directly, it is also a potent regulator of the glucose metabolic system that intertwines with anxiety-related conditions [156,157]. Moreover, it has been shown that both RXFP3 and GIT2 are highly expressed in the amygdala [123,158,159]. There is also evidence to suggest that through common activities related to stress responses RXFP3 and GIT2 together may contribute in a coordinated manner to interconnect anxiety behaviors [158] and stress responses such as hyperphagia or binge-eating [160][161][162].…”

“…Moreover, it has been shown that both RXFP3 and GIT2 are highly expressed in the amygdala [123,158,159]. There is also evidence to suggest that through common activities related to stress responses RXFP3 and GIT2 together may contribute in a coordinated manner to interconnect anxiety behaviors [158] and stress responses such as hyperphagia or binge-eating [160][161][162]. This anxiety-related condition will likely then feed into the generation of metabolic dysfunction via metabolic or diabetic syndromes.…”