Sleep-Disordered Breathing in Patients with Post-traumatic Stress Disorder

Abstract

Post-traumatic stress disorder (PTSD) and sleep-disordered breathing (SDB) are shared by many patients. They both affect sleep and the quality of life of affected subjects. A critical review of the literature supports an association between the two disorders in both combat-related and non-combat-related PTSD. The exact mechanism linking PTSD and SDB is not fully understood. A complex interplay between sleep fragmentation and neuroendocrine pathways is suggested. The overlap of symptoms between PTSD and SDB raises diagnostic challenges that may require a novel approach in the methods used to diagnose the coexisting disorders. Similar therapeutic challenges face patients and providers when treating concomitant PTSD and SDB. Although continuous positive airway pressure therapy imparts a mitigating effect on PTSD symptomatology, lack of both acceptance and adherence are common. Future research should focus on ways to improve adherence to continuous positive airway pressure therapy and on the use of alternative therapeutic methods for treating SDB in patients with PTSD.

Treatment of OSA with CPAP Is Associated with Improvement in PTSD Symptoms among Veterans

“…Prevalence estimations for OSA in PTSD patients range from 52% to 69%, with some as high as 95%. [10][11][12] The odds of PTSD have been estimated at 2.7-fold higher in patients with sleep apnea. 13 While the nature of this interaction is unclear, it has been hypothesized that OSA-related sleep disruption contributes to PTSD, either by contributing to symptoms or more direct influences on disease pathogenesis.…”

“…17 More fundamentally, there are a number of mechanisms by which OSA has been postulated to contribute to disease development, persistence or progression, primarily relating to the effects of state instability. 12,18 Given the possible causal role of sleep apnea in PTSD severity, we hypothesized that for patients with concurrent PTSD and OSA, treatment with CPAP might reduce PTSD symptoms and improve quality of life in Veterans of the United States Armed Services.…”

“…Prevalence estimations for OSA in PTSD patients range from 52% to 69%, with some as high as 95%. [10][11][12] The odds of PTSD have been estimated at 2.7-fold higher in patients with sleep apnea. …”

Treatment of PTSD-Related OSA With CPAP is Associated With Only a Modest Improvement in PTSD: Possible Adjunctive Treatment With Mood Stabilizers

“…3 Orr and colleagues 1 examined the effect of positive airway pressure (PAP) therapy in veterans with PTSD and recently diagnosed OSA and noticed a modest improvement in PTSD severity as measured by the PTSD Checklist-Specific (PCL-S), from baseline to 6 months. There was a significant decrease (albeit below the minimum threshold to qualify as a response to treatment) in PCL-S scores from baseline to 3 months, with no significant change from 3 to 6 months.…”

Dementia Risk in Posttraumatic Stress Disorder: the Relevance of Sleep-Related Abnormalities in Brain Structure, Amyloid, and Inflammation

“…In this model, decreased sleep time could either predate PTSD or be caused by it. Similarly, individuals with PTSD have a high rate of high risk health-related behaviors such as smoking [132] and heavy alcohol use [133] and a high prevalence of obstructive sleep apnea (OSA) [134, 135]. These factors could elevate risk of dementia in PTSD via mechanisms separate from or complimentary to those discussed above [94, 136], as described by the glucocorticoid vulnerability hypothesis referenced above [57].…”