Sleep-Disordered Breathing in Vietnam Veterans with Posttraumatic Stress Disorder

Yesavage, Jerome A.; Kinoshita, Lisa M.; Kimball, Timothy; Zeitzer, Jamie M.; Friedman, Leah; Noda, Art; David, Renaud; Hernandez, Beatriz; Lee, Tina; Cheng, Jun; O’Hara, Ruth

doi:10.1097/jgp.0b013e3181e446ea

Cited by 49 publications

(36 citation statements)

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“…Kinoshita (83%) and Yesavage (69%) required participants to be male, aged ≥ 55 with a CAPS score ≥ 40, each of which acts as a selection bias towards increased OSA prevalence. 41,42 Two studies by Mysliwiec 26,43 examined postcombat PSG in military personnel, and the second of these 43 required a PTSD Checklist Military Version score ≥ 50, both of which act as selection biases. The van Liempt study also included male veterans with a CAPS score > 50.…”

Section: 2640-44mentioning

confidence: 99%

“…[24][25][26][39][40][41][42][43][44] The clinic-based studies reported a prevalence range of 0.7% to 83%.…”

mentioning

confidence: 99%

“…Six of the 9 studies were conducted in past and present military populations, which reported a range of 42.7% to 50% for both classes of study. 25,26,[41][42][43][44] Civilian populations had the greatest discrepancy in prevalence rates from 0.7% to 50%.…”

mentioning

confidence: 99%

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Obstructive Sleep Apnea and Psychiatric Disorders: A Systematic Review

Gupta

Simpson

2015

Journal of Clinical Sleep Medicine

258

156

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Study Objectives: Obstructive sleep apnea (OSA) has been associated with psychiatric pathology. Psychiatric comorbidity in OSA may affect patient quality of life and adherence to CPAP. A focused evaluation of OSA in highly selected groups of primarily psychiatric patients may provide further insights into the factors contributing to comorbidity of OSA and psychopathology. The goal of this study is to examine the prevalence and treatment of OSA in psychiatric populations. Methods: A systematic review following the PRISMA guidelines was conducted to determine the prevalence of OSA in schizophrenia and other psychotic disorders, mood disorders, and anxiety disorders, and to examine potential interventions. The PubMed, EMBASE, and PsycINFO databases were searched (last search April 26, 2014) using keywords based on the ICD-9-CM coding for OSA and the DSM-IV-TR diagnostic groups. Results: The search retrieved 48 records concerning studies of OSA in the selected disorders. The prevalence studies indicate that there may be an increased prevalence of OSA in individuals with major depressive disorder (MDD) and posttraumatic stress disorder (PTSD), despite considerable heterogeneity and a high risk of bias. There was insuffi cient evidence to support increased OSA in schizophrenia and psychotic disorders, bipolar and related disorders, and anxiety disorders other than PTSD. Studies of treatment of OSA indicate an improvement in both OSA and psychiatric symptoms. CPAP adherence was reduced in veterans with PTSD. Conclusions: OSA prevalence may be increased in MDD and PTSD. In individuals with OSA and psychiatric illness, treatment of both disorders should be considered for optimal treatment outcomes. 1 According to a major US study of OSA diagnosed by polysomnography (PSG), the prevalence of OSA, as defi ned by an apnea-hypopnea index (AHI) ≥ 5 and without inclusion of a daytime sleepiness criterion, was reported as 24% for men and 9% for women under the age of 65 years; addition of a daytime sleepiness criterion reduced these estimates to 4% for men and 2% for women. 1,2 OSA is commonly associated with metabolic syndrome including comorbid obesity, hypertension, and diabetes.1 Upper airway obstruction may present as apneas, hypopneas, or respiratory effort-related arousals (RERAs), resulting in oxygen desaturation, repeated arousals and sleep fragmentation. Recently, there has been an increase in reports of comorbidity of OSA with psychological/psychiatric symptoms. Psychiatric comorbidity in OSA has been reported to adversely affect the quality of life of OSA patients and adherence to CPAP therapy. 3-5Psychological symptoms such as depression and anxiety are commonly reported in adults with OSA; however, the relationship between OSA and full psychiatric syndromes is less clear. Global prevalence studies and reviews have suggested that there are elevated rates of psychological symptoms in individuals with OSA. [17][18][19] Studies that have evaluated the prevalence of OSA in the highly selected groups of psychiatric popu...

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Section: 2640-44mentioning

confidence: 99%

“…[24][25][26][39][40][41][42][43][44] The clinic-based studies reported a prevalence range of 0.7% to 83%.…”

mentioning

confidence: 99%

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Obstructive Sleep Apnea and Psychiatric Disorders: A Systematic Review

Gupta

Simpson

2015

Journal of Clinical Sleep Medicine

258

156

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“…Prevalence estimations for OSA in PTSD patients range from 52% to 69%, with some as high as 95%. [10][11][12] The odds of PTSD have been estimated at 2.7-fold higher in patients with sleep apnea. 13 While the nature of this interaction is unclear, it has been hypothesized that OSA-related sleep disruption contributes to PTSD, either by contributing to symptoms or more direct influences on disease pathogenesis.…”

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

Treatment of OSA with CPAP Is Associated with Improvement in PTSD Symptoms among Veterans

Orr

Smales

Alexander

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: Posttraumatic stress disorder (PTSD) is common among veterans of the military, with sleep disturbance as a hallmark manifestation. A growing body of research has suggested a link between obstructive sleep apnea and PTSD, potentially due to obstructive sleep apnea (OSA) related sleep disruption, or via other mechanisms. We examined the hypothesis that treatment of OSA with positive airway pressure would reduce PTSD symptoms over 6 months. Methods: A prospective study of Veterans with confirmed PTSD and new diagnosis of OSA not yet using PAP therapy were recruited from a Veteran's Affairs sleep medicine clinic. All subjects were instructed to use PAP each night. Assessments were performed at 3 and 6 months. The primary outcome was a reduction in PTSD symptoms at 6 months. Results: Fifty-nine subjects were enrolled; 32 remained in the study at 6 months. A significant reduction in PTSD symptoms, measured by PCL-S score was observed over the course of the study (60.6 ± 2.7 versus 52.3 ± 3.2 points; p < 0.001). Improvement was also seen in measures of sleepiness, sleep quality, and daytime functioning, as well as depression and quality of life. Percentage of nights in which PAP was used, but not mean hours used per night, was predictive of improvement. I NTRO DUCTI O NPosttraumatic stress disorder (PTSD) is highly prevalent among veterans of the United States armed forces, afflicting 11% to 22% of those returning from Iraq and Afghanistan.1,2 Among Vietnam veterans, the lifetime prevalence approaches 31%, and despite 40 years having elapsed since combat exposure, PTSD remains in 10% of veterans of this era, reflecting the challenges for recovery.3 Patients with PTSD have a substantially reduced quality of life and increased mortality.4,5 Sleep disturbance is often called the "hallmark" of PTSD, 6 and formal DSM-5 criteria includes several sleep-related complaints, including recurrent distressing dreams and sleep disturbances. Sleep disturbance has been recognized as both an early predictor of development of PTSD, and a marker of disease severity.7-9 However, whether sleep disturbance is a reflection of disease, or a predisposing factor in development and continuance of PTSD is an ongoing subject of debate. Moreover, treatment of PTSD has been elusive, leading to a search for potential therapeutic targets in this condition. Sleep and Pediatrics, Carmel Medical Center, Haifa, A growing body of research has suggested an association between OSA and PTSD. Prevalence estimations for OSA in PTSD patients range from 52% to 69%, with some as high as 95%. [10][11][12] The odds of PTSD have been estimated at 2.7-fold higher in patients with sleep apnea. SCIENTIFIC INVESTIGATIONS13 While the nature of this interaction is unclear, it has been hypothesized that OSA-related sleep disruption contributes to PTSD, either by contributing to symptoms or more direct influences on disease pathogenesis. In general, untreated OSA might contribute to symptoms of depression and anxiety. 14,15 In PTSD patients, recurrent BRI...

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Posttraumatic Stress Disorder and Obstructive Sleep Apnea in Twins

Shah,

Vaccarino,

Goldberg

et al. 2024

JAMA Netw Open

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ImportanceObstructive sleep apnea (OSA) is a common condition in older adult (aged &gt;65 years) populations, but more mechanistic research is needed to individualize treatments. Previous evidence has suggested an association between OSA and posttraumatic stress disorder (PTSD) but is limited by possible selection bias. High-quality research on this association with a careful evaluation of possible confounders may yield important mechanistic insight into both conditions and improve treatment efforts.ObjectiveTo investigate the association of current PTSD symptoms and PTSD diagnosis with OSA.Design, Setting, and ParticipantsThis cross-sectional study of twin pairs discordant for PTSD, which allows for adjustment for familial factors, was conducted using in-laboratory polysomnography from March 20, 2017, to June 3, 2019. The study sample comprised male veteran twins recruited from the Vietnam Era Twin Registry. The data analysis was performed between June 11, 2022, and January 30, 2023.ExposureSymptoms of PTSD in twins who served in the Vietnam War. Diagnosis of PTSD was a secondary exposure.Main Outcomes and MeasuresObstructive sleep apnea was assessed using the apnea-hypopnea index (AHI) (≥4% oxygen saturation criterion as measured by events per hour) with overnight polysomnography. Symptoms of PTSD were assessed using the PTSD Checklist (PCL) and structured clinical interview for PTSD diagnosis.ResultsA total of 181 male twins (mean [SD] age, 68.4 [2.0] years) including 66 pairs discordant for PTSD symptoms and 15 pairs discordant for a current PTSD diagnosis were evaluated. In models examining the PCL and OSA within pairs and adjusted for body mass index (BMI) and other sociodemographic, cardiovascular, and psychiatric risk factors (including depression), each 15-point increase in PCL was associated with a 4.6 (95% CI, 0.1-9.1) events-per-hour higher AHI. Current PTSD diagnosis was associated with an adjusted 10.5 (95% CI, 5.7-15.3) events-per-hour higher AHI per sleep-hour. Comparable standardized estimates of the association of PTSD symptoms and BMI with AHI per SD increase (1.9 events per hour; 95% CI, 0.5-3.3 events per hour) were found.Conclusions and RelevanceThis cross-sectional study found an association between PTSD and sleep-disordered breathing. The findings have important public health implications and may also enhance understanding of the many factors that potentially affect OSA pathophysiology.

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Sleep-Disordered Breathing in Vietnam Veterans with Posttraumatic Stress Disorder

Cited by 49 publications

References 28 publications

Obstructive Sleep Apnea and Psychiatric Disorders: A Systematic Review

Obstructive Sleep Apnea and Psychiatric Disorders: A Systematic Review

Treatment of OSA with CPAP Is Associated with Improvement in PTSD Symptoms among Veterans

Posttraumatic Stress Disorder and Obstructive Sleep Apnea in Twins

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