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

Ye Zhang; Rong Ren; Linghui Yang; Junying Zhou; Larry D Sanford; Xiangdong Tang

doi:10.1016/j.neubiorev.2019.03.019

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.

Authors

Ye Zhang¹, Rong Ren¹, Linghui Yang², Junying Zhou¹, Larry D Sanford³, Xiangdong Tang⁴

Affiliations

¹ Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
² Laboratory of Anaestheisa & Critical Care Medicine, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
³ Sleep Research Laboratory, Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA, USA. Electronic address: SanforLD@evms.edu.
⁴ Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China. Electronic address: 2372564613@qq.com.

PMID: 31042558
DOI: 10.1016/j.neubiorev.2019.03.019

Abstract

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*