Obstructive Sleep Apnea Treatment Prevents Progression of Subclinical PTSD in Veterans

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CPAP compliance is the most important predictive factor for symptom improvement in PTSD.
CPAP compliance is the most important predictive factor for symptom improvement in PTSD.

In veterans with posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA), continuous positive airway pressure (CPAP) therapy reduces PTSD symptoms as measured by both a PTSD Checklist score and reported nightmare frequency. Results were published in the Journal of Clinical Sleep Medicine.

Mohammad I. Ullah, MD, MPH, of the University of Mississippi Medical Center, Jackson, Mississippi, and colleagues studied veterans with newly diagnosed OSA and assigned them to either a PTSD or non-PTSD cohort, based on chart review. Each patient then completed the military version of the PTSD Checklist, the Epworth Sleepiness Scale, and reported nightmare frequency at baseline and 6 months after initiation of CPAP therapy. Machine compliance data documented CPAP adherence.

The investigators obtained complete data for 177 veterans, 59 with PTSD and 118 without, for analysis. The PTSD cohort had a mean total PTSD Checklist score at baseline of 66.06, which decreased to 61.27 after 6 months of CPAP therapy (P =.004). Mean nightmare frequency at baseline was 4.61, which fell to 1.49 after 6 months of CPAP therapy (P =.0001). Linear regression analysis showed that CPAP compliance was the only significant predictor for these changes, with greater beneficial changes evident with greater compliance. In the non-PTSD group, in those with poorer compliance (50% or less compliance), the mean total PTSD Checklist score increased despite the patients receiving some CPAP therapy, and the score decreased (improved) slightly in patients with better compliance, although this was not statistically significant.

Although symptoms of PTSD declined even in those patients with the poorest compliance in the PTSD group, among those who did not have a diagnosis of PTSD, poor compliance was associated with increase in PTSD Checklist score. The authors suggest that among these veterans, undertreated OSA may lead to overt PTSD, unmasking subclinical PTSD.

Those in the PTSD group were already under treatment by their psychiatrists with stable disease before initiating CPAP, and this is among the limitations of the study. A future study should be done to recruit people newly diagnosed with PTSD and those with OSA who may then be prescribed CPAP and this group compared with a control group of people who do not have PTSD but do have OSA to determine the true effects of CPAP before medication is prescribed for PTSD. The authors also suggested the value of a study to investigate whether higher CPAP compliance can prevent overt PTSD in veterans who have signs of subclinical PTSD as measured by PTSD Checklist score.

Reference

Ullah MI, Campbell DG, Bhagat R, Lyons JA, Tamanna S. Improving PTSD symptoms and preventing progression of subclinical PTSD to an overt disorder by treating comorbid OSA with CPAP. J Clin Sleep Med. 2017:13;1191-1198.

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