Obstructive sleep apnea in combat-related posttraumatic stress disorder: a controlled polysomnography study

Saskia van Liempt, Herman G M Westenberg, Johan Arends, Eric Vermetten, Saskia van Liempt, Herman G M Westenberg, Johan Arends, Eric Vermetten

Abstract

Background: Obstructive sleep apnea (OSA) may be highly prevalent in posttraumatic stress disorder (PTSD) and may exacerbate PTSD complaints.

Objective: Our objective was to determine whether the prevalence of OSA was high in a sample of Dutch veterans with PTSD as compared to age- and trauma-matched controls, and whether OSA was associated with more severe PTSD complaints.

Methods: We determined the apnea hypopnea indices (AHI) with polysomnographic registrations in 20 veterans with PTSD, 24 veterans without PTSD, and 17 healthy controls. PTSD severity and nightmare complaints were assessed with the Clinician-Administered PTSD Scale (CAPS).

Results: The prevalence of an AHI>10 was 29% in PTSD, 21% in trauma controls, and 29% in healthy controls (χ(2)= 0.60, df=2, p=n.s.). The mean CAPS score in patients with OSA (n=6) was significantly higher than in patients without OSA (p<0.05), while nightmare severity was similar in PTSD patients with OSA as compared to PTSD patients without OSA (p=n.s.). Furthermore, there was a significant correlation between AHI and CAPS score in PTSD patients (r=0.46, p<0.05, df=14).

Conclusions: Our results indicate that PTSD is not necessarily associated with a higher prevalence of OSA. However, PTSD severity was related to OSA, which may possibly mean that comorbid OSA leads to an increase in PTSD complaints. However, future research should indicate whether OSA exerts a negative influence on PTSD, and treatment of OSA alleviates PTSD symptoms.

Keywords: OSA; PTSD; apnea; polysomnography; sleep.

Figures

Fig. 1
Fig. 1
Relationship between apnea hypopnea index and PTSD severity. Notes: AHI, apnea hypopnea index; CAPS, clinician-administered PTSD scale; PTSD, posttraumatic stress disorder.

References

    1. Blake D. D., Weathers F. W., Nagy L. M., Kaloupek D. G., Gusman F. D., Charney D. S., et al. The development of a Clinician-Administered PTSD Scale. Journal of Traumatic Stress. 1995;8:75–90.
    1. Breslau N., Roth T., Burduvali E., Kapke A., Schultz L., Roehrs T. Sleep in lifetime posttraumatic stress disorder: A community-based polysomnographic study. Archives of General Psychiatry. 2004;61:508–516.
    1. De Groen J. H., Op Den Velde W., Hovens J. E., Falger P. R., Schouten E. G., Van Duijn H. Snoring and anxiety dreams. Sleep. 1993;16:35–36.
    1. Dolly F. R., Block A. J. Effect of flurazepam on sleep-disordered breathing and nocturnal oxygen desaturation in asymptomatic subjects. American Journal of Medicine. 1982;73:239–243.
    1. Engdahl B. E., Eberly R. E., Hurwitz T. D., Mahowald M. W., Blake J. Sleep in a community sample of elderly war veterans with and without posttraumatic stress disorder. Biological Psychiatry. 2000;47:520–525.
    1. Epstein L. J., Kristo D., Strollo P. J., Friedman N., Malhotra A., Patil S. P., et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. Journal of Clinical Sleep Medicine. 2009;5:263–276.
    1. Hurwitz T. D., Khawaja I. Treatment of obstructive sleep apnea may be an important adjunct to therapy of posttraumatic stress disorder not to be overlooked. Sleep. 2010;33:1435–1436.
    1. Kobayashi I., Boarts J. M., Delahanty D. L. Polysomnographically measured sleep abnormalities in PTSD: A meta-analytic review. Psychophysiology. 2007;44:660–669.
    1. Krakow B., Germain A., Warner T. D., Schrader R., Koss M., Hollifield M., et al. The relationship of sleep quality and posttraumatic stress to potential sleep disorders in sexual assault survivors with nightmares, insomnia, and PTSD. Journal of Traumatic Stress. 2001a;14:647–665.
    1. Krakow B., Haynes P. L., Warner T. D., Santana E., Melendrez D., Johnston L., et al. Nightmares, insomnia, and sleep-disordered breathing in fire evacuees seeking treatment for posttraumatic sleep disturbance. Journal of Traumatic Stress. 2004;17:257–268.
    1. Krakow B., Lowry C., Germain A., Gaddy L., Hollifield M., Koss M., et al. A retrospective study on improvements in nightmares and post-traumatic stress disorder following treatment for co-morbid sleep-disordered breathing. Journal of Psychosomatic Research. 2000;49:291–298.
    1. Krakow B., Melendrez D., Johnston L., Warner T. D., Clark J. O., Pacheco M., et al. Sleep-disordered breathing, psychiatric distress, and quality of life impairment in sexual assault survivors. Journal of Nervous and Mental Disease. 2002;190:442–452.
    1. Krakow B., Melendrez D., Pedersen B., Johnston L., Hollifield M., Germain A., et al. Complex insomnia: Insomnia and sleep-disordered breathing in a consecutive series of crime victims with nightmares and PTSD. Biological Psychiatry. 2001b;49:948–953.
    1. Mellman T. A., Nolan B., Hebding J., Kulick-Bell R., Dominguez R. A. Polysomnographic comparison of veterans with combat-related PTSD, depressed men, and non-ill controls. Sleep. 1997;20:46–51.
    1. Neylan T. C., Marmar C. R., Metzler T. J., Weiss D. S., Zatzick D. F., Delucchi K. L., et al. Sleep disturbances in the Vietnam generation: Findings from a nationally representative sample of male Vietnam veterans. American Journal of Psychiatry. 1998;155:929–933.
    1. Rechtschaffen A., Kales A. A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Washington, DC: US Government Printing Office; 1968.
    1. Saunamäki T., Jehkonen M. Depression and anxiety in obstructive sleep apnea syndrome: A review. Acta Neurologica Scandinavia. 2007;116(5):277–288.
    1. Spitzer R. L., Williams J. B., Gibbon M., First M. B. The structured clinical interview for DSM-III-R (SCID) I: History, rationale, and description. Archives of General Psychiatry. 1992;49:624–629.
    1. Spoormaker V. I., Montgomery P. Disturbed sleep in post-traumatic stress disorder: Secondary symptom or core feature? Sleep Medicine Reviews. 2008;12(3):169–184.
    1. Van Liempt S., Vermetten E., Lentjes E., Arends J., Westenberg H. Decreased nocturnal growth hormone secretion and sleep fragmentation in combat-related posttraumatic stress disorder: Potential predictors of impaired memory consolidation. Psychoneuroendocrinology. 2011;36(9):1361–1369.
    1. Yesavage J. A., Kinoshita L. M., Kimball T., Zeitzer J., Friedman L., Noda A., et al. Sleep-disordered breathing in Vietnam veterans with posttraumatic stress disorder; American Journal of Geriatric Psychiatry; 2010. Epub ahead of print.

Source: PubMed

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