Longitudinal assessment of sleep disordered breathing in Vietnam veterans with post-traumatic stress disorder.
OBJECTIVE
Previous work has demonstrated the relatively high prevalence of risk factors for cognitive impairment, such as sleep disordered breathing (SDB) and obesity, in Vietnam War era veterans with post-traumatic stress disorder (PTSD). No data are currently available on the longitudinal stability of SDB as a risk factor for cognitive decline in that population, which this study now reports.


METHODS
Sample consisted of 48 veterans of the Vietnam War with PTSD who completed longitudinal sleep assessments over a 3-year period. The primary outcome measure, the Apnea-Hypopnea Index (AHI) indicator, was determined during standard overnight polysomnography. Body mass index (BMI) was calculated using standard measurements. Measures of cognitive function tapped auditory verbal memory as measured by the Rey Auditory Verbal Learning Test and executive functioning as measured by the Color-Word Interference Test of the Delis-Kaplan Executive Function System battery. Statistical analyses included mixed effects modeling.


RESULTS
In this sample, AHI increased significantly by 2.19 points per year (β=2.19; P<0.005). AHI worsened over the 3-year period, increasing from a mean of 18.7±15.7 to 24.7±17.4 points. Neither BMI nor cognition showed significant change over the 3-year period.


CONCLUSIONS
SDB worsened in a group of veterans of the Vietnam War with PTSD over a 3-year period. The worsening of SDB over time suggests the need for appropriate countermeasures in populations at risk for progression of the condition.
Department of Veterans Affairs Health Care System, Palo Alto, CA, USA ; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
Jerome A
JA
Yesavage
Department of Veterans Affairs Health Care System, Palo Alto, CA, USA ; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
Lisa M
LM
Kinoshita
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
Art
A
Noda
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
Laura C
LC
Lazzeroni
Department of Veterans Affairs Health Care System, Palo Alto, CA, USA ; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
Jennifer Kaci
JK
Fairchild
Department of Veterans Affairs Health Care System, Palo Alto, CA, USA ; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
Leah
L
Friedman
Department of Veterans Affairs Health Care System, Palo Alto, CA, USA ; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
Gundeep
G
Sekhon
Department of Veterans Affairs Health Care System, Palo Alto, CA, USA ; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
Stephanie
S
Thompson
Department of Veterans Affairs Health Care System, Palo Alto, CA, USA ; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
Jauhtai
J
Cheng
Department of Veterans Affairs Health Care System, Palo Alto, CA, USA ; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
Jamie M
JM
Zeitzer
BMI; PTSD; SDB; cognition; obesity; sleep apnea