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Comorbid insomnia and sleep apnea in Veterans with post-traumatic stress disorder

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

The purpose of this study was to determine the impact of insomnia in Veterans with post-traumatic stress disorder (PTSD) and obstructive sleep apnea (OSA) on health-related outcomes before and after 12 weeks of continuous positive airway pressure (CPAP) treatment.

Methods

We conducted a prospective cohort study of Veterans with PTSD and documented apnea hypopnea index (AHI) ≥ 5 with and without clinically significant insomnia as determined by the Insomnia Severity Index (ISI). Health-related outcomes including PTSD checklist (PCL-M), SF-36, and Pittsburgh Sleep Quality Index (PSQI) were assessed at baseline and 12 weeks after initiation of OSA treatment. CPAP adherence was retrieved at each visit.

Results

Seventy-two Veterans including 36 with comorbid insomnia and OSA (COMISA) and 36 OSA-only were enrolled. Veterans with COMISA were younger (p = 0.03), had lower BMI (p < 0.001), and were more likely to report depression than those with OSA-only (p = 0.004). Although AHI was higher in the COMISA (p = 0.01), both groups expressed comparable daytime sleepiness (p = 0.16). The COMISA group had no significant change in SF-36 and PSQI after 12 weeks of treatment and used CPAP much less frequently than OSA-only group (p = 0.001).

Conclusions

COMISA in Veterans with PTSD is associated with worse quality of life than those with OSA-only. Insomnia should be assessed in Veterans with PTSD who are not adherent to CPAP treatment.

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Acknowledgments

The views expressed in this manuscript do not communicate an official position of the Department of Veterans Affairs.

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Authors and Affiliations

  1. VA Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY, 14215, USA

    Ali A. El-Solh, David Adamo & Thomas Kufel

  2. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, State University of New York at Buffalo School of Medicine and Biomedical Sciences and School of Public Health and Health Professions, Buffalo, NY, USA

    Ali A. El-Solh & Thomas Kufel

  3. Department of Epidemiology and Environmental Health, State University of New York at Buffalo School of Medicine and Biomedical Sciences and School of Public Health and Health Professions, Buffalo, NY, USA

    Ali A. El-Solh

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  1. Ali A. El-Solh
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  2. David Adamo
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Correspondence to Ali A. El-Solh.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the VA WNYHS institutional review board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

Additional information

This article is part of the Topical Collection on Comorbid Insomnia and OSA (COMISA) in Veterans

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El-Solh, A.A., Adamo, D. & Kufel, T. Comorbid insomnia and sleep apnea in Veterans with post-traumatic stress disorder. Sleep Breath 22, 23–31 (2018). https://doi.org/10.1007/s11325-017-1618-y

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  • DOI: https://doi.org/10.1007/s11325-017-1618-y

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