The effect of treating obstructive sleep apnea with continuous positive airway pressure on posttraumatic stress disorder: A systematic review and meta-analysis with hypothetical model

Neurosci Biobehav Rev. 2019 Jul:102:172-183. doi: 10.1016/j.neubiorev.2019.03.019. Epub 2019 Apr 28.


The present study explored whether continuous positive airway pressure (CPAP) treatment impacts nightmare and overall posttraumatic stress disorder (PTSD) symptoms in patients with PTSD and obstructive sleep apnea (OSA). The meta-analysis for six eligibile studies indicates that CPAP can significantly improve nightmare (standardized mean differences (SMD) = -0.778; 95% confidence interval (CI) = -1.228 to -0.327) and overall PTSD symptoms (SMD = -1.298; 95% CI = -2.128 to -0.468) in these patients. A subgroup analysis revealed that the effects of CPAP on improvements of nightmare and overall PTSD symptoms varied across CPAP treatment duration (3 and 6 months), but did not reach a statistically significant level. Furthermore, improvements in overall PTSD symptoms were associated with CPAP adherence. This review emphasizes the importance of the need for a multidisciplinary approach in treating patients with PTSD and OSA, and proposes a hypothetical model of how CPAP improves posttraumatic stress symptoms in patients with PTSD and OSA.

Keywords: Continuous positive airway pressure; Meta-analysis; Nightmare; Obstructive sleep apnea; Posttraumatic stress disorder.

Publication types

  • Meta-Analysis
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Comorbidity*
  • Continuous Positive Airway Pressure*
  • Humans
  • Models, Biological*
  • Outcome Assessment, Health Care*
  • Sleep Apnea, Obstructive / epidemiology
  • Sleep Apnea, Obstructive / therapy*
  • Stress Disorders, Post-Traumatic / epidemiology
  • Stress Disorders, Post-Traumatic / therapy*