Positive Airway Pressure Adherence in Veterans with Posttraumatic Stress Disorder

El-Solh, Ali; Ayyar, Lakshmy; Akinnusi, Morohonfolu; Relia, Sachin; Akinnusi, Opeoluwa

doi:10.1093/sleep/33.11.1495

Cited by 83 publications

(54 citation statements)

References 32 publications

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“…18 The authors found that excessive sleepiness was predictive of improved use of CPAP, while nightmares correlated with poorer CPAP adherence. Given the increased prevalence of OSA among patients with PTSD and the adverse impact of untreated OSA on clinical outcomes, understanding how PTSD affects CPAP adherence is critical.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 97%

“…Similarly, nightmares, mask discomfort, air hunger, and claustrophobia are correlated with poor CPAP adherence among PTSD patients. 18 A recent study in an older veterans population demonstrated that CPAP adherence was signifi cantly reduced in veterans with BRIEF SUMMARY Current Knowledge/Study Rationale: There has been a dramatic rise in diagnoses of PTSD in US military combat veterans over the past decade. PTSD often coexists with both sleep-disordered breathing and insomnia, potentially worsening clinical outcomes.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

“…42,44,45 Our findings are similar to a recent study by El-Solh et al, who assessed CPAP use in a cohort of older veterans with PTSD and multiple comorbidities. 18 Despite differences in study populations, they also found that CPAP use was significantly decreased in patients with PTSD and OSA compared to a control group without PTSD. This suggests that PTSD, and not the underlying comorbid conditions, can have a profound impact of adherence.…”

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confidence: 95%

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The Impact of Posttraumatic Stress Disorder on CPAP Adherence in Patients with Obstructive Sleep Apnea

Collen

Lettieri

Hoffman

2012

Journal of Clinical Sleep Medicine

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Introduction:Obstructive sleep apnea (OSA) is a common comorbid condition in patients with posttraumatic stress disorder (PTSD); insuffi ciently treated OSA may adversely impact outcomes. Sleep fragmentation and insomnia are common in PTSD and may impair CPAP adherence. We sought to determine the impact of combat-related PTSD on CPAP adherence in soldiers. Methods: Retrospective case-control study. Objective measures of CPAP use were compared between OSA patients with and without PTSD. Groups were matched for age, BMI, and apnea-hypopnea index (AHI). Results: We included 90 patients (45 Control, 45 PTSD). Among the cohort, mean age was 39.9 ± 11.2, mean BMI 27.9 ± 8.0, mean ESS 13.6 ± 5.7, and mean AHI 28.2 ± 22.4. There was a trend towards a higher rate of comorbid insomnia among patients with PTSD (25.8% vs. 11.1%, p = 0.10). PTSD was associated with signifi cantly less use of CPAP. Specifi cally, CPAP was used on 61.4% ± 22.2% of nights in PTSD patients compared with 76.8% ± 16.4% in patients without PTSD (p = 0.001). Mean nightly use of CPAP was 3.4 ± 1.2 h in the PTSD group compared with 4.7 ± 2.2 h among controls (p < 0.001). Regular use of CPAP (> 4 h per night for > 70% of nights) was also lower among PTSD patients (25.2% vs. 58.3%, p = 0.01). Conclusion: Among soldiers with OSA, comorbid PTSD was associated with signifi cantly decreased CPAP adherence. Given the potential for adverse clinical outcomes, resolution of poor sleep quality should be prioritized in the treatment of PTSD and potential barriers to CPAP adherence should be overcome in patients with comorbid OSA. Keywords: Posttraumatic stress order, sleep apnea, obstructive sleep apnea, CPAP, CPAP compliance, CPAP adherence, sleep disordered breathing, deployment related sleep disorders Citation: Collen JF; Lettieri CJ; Hoffman M. The impact of posttraumatic stress disorder on CPAP adherence in patients with obstructive sleep apnea.

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Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 97%

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

mentioning

confidence: 95%

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The Impact of Posttraumatic Stress Disorder on CPAP Adherence in Patients with Obstructive Sleep Apnea

Collen

Lettieri

Hoffman

2012

Journal of Clinical Sleep Medicine

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“…Similar to findings with MDD, the treatment of OSA through the use of CPAP reduces symptoms of PTSD and panic. [22][23][24] Unfortunately, over 50% of veterans with PTSD are non-adherent to CPAP, a significantly lower adherence rate than veterans without PTSD, 25 suggesting that PTSD itself may interfere with successful treatment of OSA.…”

Section: Osa and Anxiety Disordersmentioning

confidence: 99%

The Comorbidity of Sleep Apnea and Mood, Anxiety, and Substance Use Disorders among Obese Military Veterans within the Veterans Health Administration

Babson

Bonn‐Miller

et al. 2013

Journal of Clinical Sleep Medicine

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“…A retrospective study of 15 individuals with SDB and PTSD treated with continuous positive airway pressure (CPAP) therapy revealed a 75 percent improvement in nightmares and overall PTSD symptoms (Krakow et al [34]). A second study found that, although PTSD patients were less likely to adhere to recommendations concerning use of CPAP, patients with PTSD who did adhere to CPAP treatment reported decreased nightmares and improved sleep (El-Solh et al [35]). A detailed case study of a patient with SDB and PTSD treated with CPAP, with polysomnography to examine sleep architecture, demonstrated normalization of sleep architecture.…”

Section: Sleep Disordered Breathingmentioning

confidence: 99%

Treatment of sleep disturbances in posttraumatic stress disorder: A review

Schoenfeld

DeViva²,

Manber³

2012

JRRD

219

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Abstract-Sleep disturbances are among the most commonly reported posttraumatic stress disorder (PTSD) symptoms. It is essential to conduct a careful assessment of the presenting sleep disturbance to select the optimal available treatment. Cognitivebehavioral therapies (CBTs) are at least as effective as pharmacologic treatment in the short-term and more enduring in their beneficial effects. Cognitive-behavioral treatment for insomnia and imagery rehearsal therapy have been developed to specifically treat insomnia and nightmares and offer promise for more effective relief of these very distressing symptoms. Pharmacotherapy continues to be an important treatment choice for PTSD sleep disturbances as an adjunct to CBT, when CBT is ineffective or not available, or when the patient declines CBT. Great need exists for more investigation into the effectiveness of specific pharmacologic agents for PTSD sleep disturbances and the dissemination of the findings to prescribers. The studies of prazosin and the findings of its effectiveness for PTSD sleep disturbance are examples of studies of pharmacologic agents needed in this area. Despite the progress made in developing more specific treatments for sleep disturbances in PTSD, insomnia and nightmares may not fully resolve.

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Positive Airway Pressure Adherence in Veterans with Posttraumatic Stress Disorder

Abstract: PAP usage and adherence were lower in PTSD veterans with OSA than veterans without PTSD. Excessive sleepiness predicted PAP adherence while frequent nightmares were correlated with poor adherence to PAP therapy.

Cited by 83 publications

References 32 publications

The Impact of Posttraumatic Stress Disorder on CPAP Adherence in Patients with Obstructive Sleep Apnea

The Impact of Posttraumatic Stress Disorder on CPAP Adherence in Patients with Obstructive Sleep Apnea

The Comorbidity of Sleep Apnea and Mood, Anxiety, and Substance Use Disorders among Obese Military Veterans within the Veterans Health Administration

Treatment of sleep disturbances in posttraumatic stress disorder: A review

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