title: Treatment of OSA with CPAP Is Associated with Improvement in PTSD Symptoms among Veterans.
abstract: Posttraumatic stress disorder (PTSD) is common among veterans of the military, with sleep disturbance as a hallmark manifestation. A growing body of research has suggested a link between obstructive sleep apnea and PTSD, potentially due to obstructive sleep apnea (OSA) related sleep disruption, or via other mechanisms. We examined the hypothesis that treatment of OSA with positive airway pressure would reduce PTSD symptoms over 6 months.
  
  
  
  A prospective study of Veterans with confirmed PTSD and new diagnosis of OSA not yet using PAP therapy were recruited from a Veteran's Affairs sleep medicine clinic. All subjects were instructed to use PAP each night. Assessments were performed at 3 and 6 months. The primary outcome was a reduction in PTSD symptoms at 6 months.
  
  
  
  Fifty-nine subjects were enrolled; 32 remained in the study at 6 months. A significant reduction in PTSD symptoms, measured by PCL-S score was observed over the course of the study (60.6 ± 2.7 versus 52.3 ± 3.2 points; p < 0.001). Improvement was also seen in measures of sleepiness, sleep quality, and daytime functioning, as well as depression and quality of life. Percentage of nights in which PAP was used, but not mean hours used per night, was predictive of improvement.
  
  
  
  Treatment of OSA with PAP therapy is associated with improvement in PTSD symptoms, although the mechanism is unclear. Nonetheless, PAP should be considered an important component of PTSD treatment for those with concurrent OSA. Improving PAP compliance is a challenge in this patient population warranting further investigation.
  
  
  
  ClinicalTrials.gov, ID: NCT02019914.
  
  
  
  A commentary on this article appears in this issue on page 5.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California San Diego, San Diego, CA.
authors.forename: Jeremy E
authors.initials: JE
authors.lastname: Orr
authors.affiliation: Veterans Affairs San Diego Healthcare System, San Diego, CA.
authors.forename: Carolina
authors.initials: C
authors.lastname: Smales
authors.affiliation: Veterans Affairs San Diego Healthcare System, San Diego, CA.|Division of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, CA.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Alexander
authors.affiliation: Veterans Affairs San Diego Healthcare System, San Diego, CA.
authors.forename: Carl
authors.initials: C
authors.lastname: Stepnowsky
authors.affiliation: Department of Sleep and Pediatrics, Carmel Medical Center, Haifa, Israel.
authors.forename: Giora
authors.initials: G
authors.lastname: Pillar
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California San Diego, San Diego, CA.
authors.forename: Atul
authors.initials: A
authors.lastname: Malhotra
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California San Diego, San Diego, CA.|Veterans Affairs San Diego Healthcare System, San Diego, CA.
authors.forename: Kathleen F
authors.initials: KF
authors.lastname: Sarmiento
mesh_terms: D000328:Adult; D000368:Aged; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000628:therapy*; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000628:therapy; D016896:Treatment Outcome; D014728:Veterans / Q000706:statistics & numerical data*
keywords: continuous positive airway pressure; lung; obstructive sleep apnea; posttraumatic stress disorder