title: Obstructive sleep apnea, posttraumatic stress disorder, and health in immigrants.
abstract: OBJECTIVE
  To determine whether obstructive sleep apnea mediates the relationship between posttraumatic stress disorder (PTSD) and psychosomatic and somatic disorders and its implications for self-rated health (SRH) among Iraqi immigrants in the United States.
  
  
  METHODS
  A random sample of immigrants who had left Iraq before the 1991 Gulf War (n = 145) or after (n = 205) and are residing in metropolitan Detroit responded to a structured interview covering questions on sociodemographics, premigration trauma, SRH, physician-diagnosed and -treated obstructive sleep apnea, somatic disorders, and psychosomatic disorders. Structural equation modeling was used to evaluate the relationship between premigration trauma scores and health, as well as to explore mediating pathways between PTSD, obstructive sleep apnea, and health.
  
  
  RESULTS
  The prevalence of obstructive sleep apnea among post-Gulf Warimmigrants (30.2%) was significantly higher than among pre-Gulf War immigrants (0.7%; p < .001). Premigration trauma scores were positively associated with depression and PTSD. Structural equation modeling supported a model in which obstructive sleep apnea mediated the relationship between PTSD and psychosomatic and somatic disorders. Premigration trauma also related directly to SRH.
  
  
  CONCLUSIONS
  Part of the PTSD-associated adverse health effects observed in Iraqi immigrants is mediated by obstructive sleep apnea. Because sleep apnea in the current study is based on medical history and current treatment, there is a need for future confirmatory polysomnographic studies.
authors.affiliation: School of Medicine, Wayne State University, Detroit, MI 48201, USA. barnetz@med.wayne.edu
authors.forename: Bengt B
authors.initials: BB
authors.lastname: Arnetz
authors.forename: Thomas
authors.initials: T
authors.lastname: Templin
authors.forename: Waleed
authors.initials: W
authors.lastname: Saudi
authors.forename: Hikmet
authors.initials: H
authors.lastname: Jamil
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D054242:Emigrants and Immigrants / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D047830:Gulf War; D006304:Health Status; D006801:Humans; D007493:Iraq / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D011602:Psychophysiologic Disorders / Q000453:epidemiology* / Q000208:ethnology; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology* / Q000208:ethnology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000208:ethnology; D014481:United States / Q000453:epidemiology