A Narrative Review of the Association between Post-Traumatic Stress Disorder and Obstructive Sleep Apnea

Abstract

Obstructive sleep apnea (OSA) and post-traumatic stress disorder (PTSD) are often co-morbid with implications for disease severity and treatment outcomes. OSA prevalence is higher in PTSD sufferers than in the general population, with a likely bidirectional effect of the two illnesses. There is substantial evidence to support the role that disturbed sleep may play in the pathophysiology of PTSD. Sleep disturbance associated with OSA may interfere with normal rapid eye movement (REM) functioning and thus worsen nightmares and sleep-related movements. Conversely, hyperarousal and hypervigilance symptoms of PTSD may lower the arousal threshold and thus increase the frequency of sleep fragmentation related to obstructive events. Treating OSA not only improves OSA symptoms, but also nightmares and daytime symptoms of PTSD. Evidence suggests that positive airway pressure (PAP) therapy reduces PTSD symptoms in a dose-dependent fashion, but also presents challenges to tolerance in the PTSD population. Alternative OSA treatments may be better tolerated and effective for improving both OSA and PTSD. Further research avenues will be introduced as we seek a better understanding of this complex relationship.

Assessing the causal relationship between psychiatric disorders and obstructive sleep apnea: a bidirectional Mendelian randomization

“…In this study, no causal link was found between psychiatric conditions like SCZ, BIP, PTSD, and OSA, diverging from previous research outcomes. Earlier observational studies suggested an increased OSA risk among SCZ patients compared to those without SCZ ( 56 , 57 ) and a higher OSA prevalence in individuals with PTSD and BIP than in the general population ( 10 – 12 ). However, these contrasts with our MR analysis might stem from confounding elements in observational studies.…”

“…The potential link between PDs and OSA has recently garnered increasing research interest ( 5 – 7 ). Numerous studies indicate a high prevalence of OSA in patients with psychiatric conditions ( 5 , 8 , 9 ), with elevated rates of OSA observed explicitly in patients with post-traumatic stress disorder (PTSD) and bipolar disorder (BIP) compared to the general population ( 10 – 12 ). Conversely, increased incidences of PDs are reported in individuals with OSA ( 13 , 14 ), with depression and anxiety disorder (ANX) being more common in OSA patients than in non-OSA counterparts ( 15 , 16 ).…”

Preliminary evidence of transcutaneous vagus nerve stimulation effects on sleep in veterans with post‐traumatic stress disorder

“…In addition, our participants varied in their history of sleep‐disordered breathing. Participants with a history of obstructive sleep apnea (OSA) were not excluded from the study, due to high levels of comorbidity between PTSD and OSA (Jaoude et al, 2015); however, there is a complex relationship between PTSD and OSA (McCall & Watson, 2022), as well as between surgically implanted VNS and OSA (Dye et al, 2021; Guo et al, 2021; Gurung et al, 2020). Continued research is needed to clarify the relationship between tVNS and OSA and how this may affect application of tVNS to a PTSD population.…”

The Present and Future of the Clinical Use of Physiological Traits for the Treatment of Patients with OSA: A Narrative Review

“…A low ArTH is more common in individuals with REM-dependent OSA [ 44 ], and among those who are non-obese, older, and taking antidepressants [ 45 ]. Individuals with post-traumatic stress disorder may also have a lower ArTH, presumably due to their hyperadrenergic state [ 46 ].…”