The effect of continuous positive airway pressure on post-traumatic stress disorder symptoms in veterans with post-traumatic stress disorder and obstructive sleep apnea: a prospective study

Sleep Med. 2017 May:33:145-150. doi: 10.1016/j.sleep.2016.12.025. Epub 2017 Feb 3.

Abstract

Objectives: Previous retrospective studies have shown that continuous positive airway pressure (CPAP) exerts salutary effect on post-traumatic stress disorder (PTSD) symptoms and nightmare distress. The relative magnitude of therapeutic benefits from CPAP and the strength of associations between duration of CPAP use and PTSD symptomatology are unknown.

Methods: A prospective cohort design involving 47 combat veterans with PTSD and documented obstructive sleep apnea (OSA) by overnight polysomnography. Epworth Sleepiness Scale (ESS) score, PTSD checklist-Military (PCL-M), Nightmare Distress Questionnaire (NDQ), and Nightmare Frequency Questionnaire (NFQ) were administered at baseline and 3 months after CPAP therapy. Objective adherence was assessed at the 3-month follow-up.

Results: Twenty-two veterans with mild-to-moderate PTSD (PCL-M score 17-59) and 18 with severe-to-very-severe PTSD (PCL-M score 60-85) completed the study. There was a dose-dependent response of PCL-M to duration of CPAP usage (r = 0.45; p = 0.003). Veterans with severe-to-very-severe PTSD had a larger improvement in PTSD symptoms (d = 0.65; p = 0.004) compared with those with mild-to-moderate PTSD (d = 0.47; p = 0.04). CPAP usage was the only significant predictor of overall subjective improvement in PTSD symptoms (OR 10.5; p = 0.01). Significant changes in NDQ and NFQ scores following 3 months of treatment were observed in veterans adherent to CPAP, but the correlations with duration of CPAP use were not statistically significant (r = 0.24; p = 0.13 and r = 0.13; p = 0.4, respectively).

Conclusions: Improvement of PTSD symptoms in veterans with OSA was more pronounced with prolonged use of CPAP. Adherence to treatment was linked to abatement in nightmare distress and frequency. Future investigation of multimodal treatment, including behavioral intervention combined with CPAP, is warranted.

Keywords: Continuous positive airway pressure (CPAP); Nightmares; Post-traumatic stress disorder (PTSD); Sleep apnea.

Publication types

  • Observational Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Continuous Positive Airway Pressure / methods*
  • Dreams / psychology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Polysomnography
  • Prevalence
  • Prospective Studies
  • Sleep Apnea, Obstructive / complications
  • Sleep Apnea, Obstructive / diagnosis*
  • Sleep Apnea, Obstructive / physiopathology
  • Sleep Apnea, Obstructive / therapy*
  • Stress Disorders, Post-Traumatic / complications
  • Stress Disorders, Post-Traumatic / diagnosis*
  • Stress Disorders, Post-Traumatic / epidemiology
  • Stress Disorders, Post-Traumatic / therapy
  • Treatment Outcome
  • Veterans / statistics & numerical data