title: Sleep disorders in combat-related PTSD.
abstract: OBJECTIVE
  We sought to assess the rate of sleep complaints and sleep disorders among active duty soldiers with deployment-related PTSD and to determine whether any clinical features differentiated those with sleep disorders.
  
  
  METHODS
  Retrospective review of consecutive soldiers diagnosed with PTSD. We recorded subjective measures of sleep and polysomnographic data. We compared clinical and demographic variables including psychoactive medication use, psychiatric comorbidity, and combat-related traumatic injury with the presence of sleep disorders.
  
  
  RESULTS
  One hundred thirty patients were included (91.5 % male, mean age of 35.1 ± 10.6 years, mean body mass index (BMI) 28.9 ± 4.4 Kg/m(2)). About 88.5 % had comorbid depression, with the majority (96.2 %) taking psychoactive medications (mean 3.4 ± 1.6 medications per patient). Over half of the cohort suffered combat-related traumatic physical injuries (54.6 %). The obstructive sleep apnea syndrome (OSAS) was diagnosed in 67.3 % (80 % of the cohort underwent polysomnography), with a mean apnea hypopnea index of 24.1 ± 22.8 events/hour and a mean oxygen saturation nadir of 84.2 ± 5.7 %. OSAS was significantly more common in the non-injured soldiers (72.9 vs. 38.0 %, p < 0.001). In multivariate analysis, absence of physical injury showed a trend towards predicting OSAS.
  
  
  CONCLUSIONS
  Sleep complaints are common among soldiers with PTSD. We observed significantly higher rates of OSAS among those without physical injuries, raising the possibility that underlying sleep-disordered breathing is a risk factor for the development of PTSD. This potential association requires further validation.
authors.affiliation: Pulmonary, Critical Care, and Sleep Medicine, Womack Army Medical Center, Fort Bragg, NC, USA.
authors.forename: Scott G
authors.initials: SG
authors.lastname: Williams
authors.forename: Jacob
authors.initials: J
authors.lastname: Collen
authors.forename: Nicholas
authors.initials: N
authors.lastname: Orr
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Holley
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lettieri
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D015331:Cohort Studies; D003130:Combat Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data*; D017286:Polysomnography; D012189:Retrospective Studies; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology*; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000453:epidemiology; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000453:epidemiology
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