title: A Comparative Analysis of Sleep Disordered Breathing in Active Duty Service Members with and without Combat-Related Posttraumatic Stress Disorder.
abstract: OBJECTIVE
  Posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA) are frequently co-occurring illnesses. The purpose of this study was to determine whether comorbid PTSD/OSA is associated with increased PTSD symptoms or decreased OSA severity compared to PTSD or OSA alone in recently deployed Active Duty Service Members (ADSM).
  
  
  METHODS
  Cross-sectional observational study of ADSM who returned from combat within 24 months. Participants underwent an attended diagnostic polysomnogram and were assessed for PTSD, depression, combat exposure severity, sleepiness, and sleep quality with validated clinical instruments.
  
  
  RESULTS
  Our study included 109 military personnel who returned from a combat deployment within 24 months with a mean age of 34.3 ± 8.23 and BMI of 30.8 ± 3.99. Twenty-four participants had PTSD/OSA, 68 had OSA, and 17 had PTSD. Mean PTSD Checklist- Military Version (PCL-M) scores were 62.0 ± 8.95, 60.5 ± 4.73, and 32.5 ± 8.95 in PTSD/OSA, PTSD, and OSA, respectively. The mean AHI was 16.9 ± 15.0, 18.9 ± 17.0, and 1.73 ± 1.3 for those with PTSD/OSA, OSA, and PTSD. PTSD symptoms and OSA severity in military personnel with comorbid PTSD/OSA were not significantly different from those with PTSD or OSA alone. On multivariate analysis, BMI was a significant predictor of OSA (OR, 1.21; 95% CI, 1.04-1.44) and age trended towards significance. Depression, but not OSA severity, was associated with PTSD symptoms.
  
  
  CONCLUSIONS
  Following recent combat exposure, comorbid PTSD/OSA is not associated with increased PTSD symptoms or decreased severity of OSA. Early evaluation after traumatic exposure for comorbid OSA is indicated in PTSD patients with sleep complaints given the high co-occurrence and adverse clinical implications.
authors.affiliation: 121st General Hospital, Medical Specialties Clinic Unit #15281.
authors.forename: Vincent
authors.initials: V
authors.lastname: Mysliwiec
authors.affiliation: Naval Postgraduate School, Department of Operations Research, Monterey, CA.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Matsangas
authors.affiliation: National Institutes of Health National Institute of Nursing Research, Bethesda, MD.
authors.forename: Jessica
authors.initials: J
authors.lastname: Gill
authors.affiliation: Madigan Army Medical Center, Tacoma, WA.
authors.forename: Tristin
authors.initials: T
authors.lastname: Baxter
authors.affiliation: Madigan Army Medical Center, Tacoma, WA.
authors.forename: Brian
authors.initials: B
authors.lastname: O'Reilly
authors.affiliation: Brooke Army Medical Center, JBSA FT Sam Houston, TX.
authors.forename: Jacob F
authors.initials: JF
authors.lastname: Collen
authors.affiliation: Madigan Army Medical Center, Tacoma, WA.
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Roth
mesh_terms: D000328:Adult; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000453:epidemiology*; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: combat; depression; military; obstructive sleep apnea; posttraumatic stress disorder