Sleep and Breathing

, Volume 15, Issue 3, pp 579–587 | Cite as

The effect of nasal continuous positive airway pressure on the symptoms of Gulf War illness

  • Mohammad M. Amin
  • Morris S. Gold
  • Joan E. Broderick
  • Avram R. Gold
Original Article

Abstract

Purpose

We performed a pilot study to determine whether nasal continuous positive airway pressure (CPAP) alleviates the symptoms of veterans with Gulf War illness (GWI) and sleep disordered breathing (SDB).

Methods

Eighteen male veterans with GWI and SDB recruited by advertisement, participated in a randomized, single-masked, sham-controlled treatment trial. Participants received 3 weeks of treatment during sleep with either therapeutic nasal CPAP or sham nasal CPAP. Using validated questionnaires, pain, fatigue, cognitive function, sleep disturbance, and general health were assessed by self-report before and after treatment. One of the participants assigned to therapeutic CPAP was excluded from the trial before starting treatment, leaving 17 participants.

Results

Compared to the nine sham nasal CPAP recipients, the eight participants receiving therapeutic nasal CPAP experienced improvements in pain (34%; p = 0.0008), fatigue (38%; p = 0.0002), cognitive function (33%; p = 0.004), sleep quality (41%; p = 0.0003), physical health (34%; p = 0.0003), and mental health (16%; p = 0.03).

Conclusions

Our findings in this pilot study suggest that nasal CPAP may greatly improve symptoms in veterans with GWI and SDB.

Keywords

Gulf war illness Functional somatic syndromes Nasal continuous positive airway pressure Sleep disordered breathing Sleep stage shifts 

Notes

Acknowledgements

Dr. Amin is a recipient of a Department of Veterans Affairs Career Development Award.

Dr. Morris Gold's participation in this study was entirely voluntary. Novartis Consumer Health provided no funding or other resources for this study.

Respironics Inc. supplied, at no cost, all of the nasal CPAP hardware and software for this study.

Conflicts of interest

The authors acknowledge no conflicts of interest.

References

  1. 1.
    Barrett DH, Gray GC, Doebbeling BN, Clauw DJ, Reeves WC (2002) Prevalence of symptoms and symptom-based conditions among Gulf War veterans: current status of research findings. Epidemiol Rev 24(2):218–227PubMedCrossRefGoogle Scholar
  2. 2.
    Kang HK, Mahan CM, Lee KY, Magee CA, Murphy FM (2000) Illnesses among United States veterans of the Gulf War: a population-based survey of 30, 000 veterans. J Occup Environ Med 42(5):491–501PubMedCrossRefGoogle Scholar
  3. 3.
    Steele L (2000) Prevalence and patterns of Gulf War illness in Kansas veterans: association of symptoms with characteristics of person, place, and time of military service. Am J Epidemiol 152(10):992–1002PubMedCrossRefGoogle Scholar
  4. 4.
    Research Advisory Committee on Gulf War Veterans' Illnesses (2004). Scientific progress in understanding Gulf War Veterans' illnesses: report and recommendations. Department of Veterans Affairs, p29Google Scholar
  5. 5.
    Aaron LA, Buchwald D (2001) A review of the evidence for overlap among unexplained clinical conditions. Ann Intern Med 134(9 Pt 2):868–881PubMedGoogle Scholar
  6. 6.
    Barsky AJ, Borus JF (1999) Functional somatic syndromes. Ann Intern Med 130(11):910–921PubMedGoogle Scholar
  7. 7.
    Chervin RD, Zallek SN, Lin X, Hall JM, Sharma N, Hedger KM (2000) Sleep disordered breathing in patients with cluster headache. Neurology 54(12):2302–2306PubMedGoogle Scholar
  8. 8.
    Germanowicz D, Lumertz MS, Martinez D, Margarites AF (2006) Sleep disordered breathing concomitant with fibromyalgia syndrome. J Bras Pneumol 32(4):333–338PubMedGoogle Scholar
  9. 9.
    Gold AR, Broderick JE, Amin MM, Gold MS (2009) Inspiratory airflow dynamics during sleep in irritable bowel syndrome: a pilot study. Sleep Breath 13(4):397–407PubMedCrossRefGoogle Scholar
  10. 10.
    Gold AR, Dipalo F, Gold MS, Broderick J (2004) Inspiratory airflow dynamics during sleep in female fibromyalgia patients. Sleep 27(3):459–466PubMedGoogle Scholar
  11. 11.
    Amin MM, Belisova Z, Hossain S, Gold MS, Broderick JE, Gold AR (2010) Inspiratory airflow dynamics during sleep in Veterans with Gulf War Illness: a controlled study. Sleep Breath doi: 10.1007/s11325-010-0386-8
  12. 12.
    Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman J Jr, Friedman L, Hirshkowitz M, Kapen S, Kramer M, Lee-Chiong T, Loube DL, Owens J, Pancer JP, Wise M (2005) Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep 28(4):499–521PubMedGoogle Scholar
  13. 13.
    Rechtschaffen A, Kales A (1968) A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. US Dept of Health, Education and Welfare, BethesdaGoogle Scholar
  14. 14.
    American Sleep Disorders Association Atlas Task Force (1992) EEG arousals: scoring rules and examples. Sleep 15(2):173–184Google Scholar
  15. 15.
    Silber MH, Ancoli-Israel S, Bonnet MH, Chokroverty S, Grigg-Damberger MM, Hirshkowitz M, Kapen S, Keenan SA, Kryger MH, Penzel T, Pressman MR, Iber C (2007) The visual scoring of sleep in adults. J Clin Sleep Med 3(2):121–131PubMedGoogle Scholar
  16. 16.
    Hosselet JJ, Norman RG, Ayappa I, Rapoport DM (1998) Detection of flow limitation with a nasal cannula/pressure transducer system. Am J Respir Crit Care Med 157(5 Pt 1):1461–1467PubMedGoogle Scholar
  17. 17.
    Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD (1989) The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 46(10):1121–1123PubMedGoogle Scholar
  18. 18.
    Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28(2):193–213PubMedCrossRefGoogle Scholar
  19. 19.
    Ware J, Kosinski M, Dewey J (2000) How to score version 2 of the SF-36 Health Survey. Quality Metric Incorporated, LincolnGoogle Scholar
  20. 20.
    Montserrat JM, Ferrer M, Hernandez L, Farre R, Vilagut G, Navajas D, Badia JR, Carrasco E, De Pablo J, Ballester E (2001) Effectiveness of CPAP treatment in daytime function in sleep apnea syndrome: a randomized controlled study with an optimized placebo. Am J Respir Crit Care Med 164(4):608–613PubMedGoogle Scholar
  21. 21.
    Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Erlbaum, HillsdaleGoogle Scholar
  22. 22.
    McNicholas WT (2008) Diagnosis of obstructive sleep apnea in adults. Proc Am Thorac Soc 5(2):154–160PubMedCrossRefGoogle Scholar
  23. 23.
    Donta ST, Clauw DJ, Engel CC Jr, Guarino P, Peduzzi P, Williams DA, Skinner JS, Barkhuizen A, Taylor T, Kazis LE, Sogg S, Hunt SC, Dougherty CM, Richardson RD, Kunkel C, Rodriguez W, Alicea E, Chiliade P, Ryan M, Gray GC, Lutwick L, Norwood D, Smith S, Everson M, Blackburn W, Martin W, Griffiss JM, Cooper R, Renner E, Schmitt J, McMurtry C, Thakore M, Mori D, Kerns R, Park M, Pullman-Mooar S, Bernstein J, Hershberger P, Salisbury DC, Feussner JR (2003) Cognitive behavioral therapy and aerobic exercise for Gulf War veterans' illnesses: a randomized controlled trial. JAMA 289(11):1396–1404PubMedCrossRefGoogle Scholar
  24. 24.
    Mease P, Arnold LM, Bennett R, Boonen A, Buskila D, Carville S, Chappell A, Choy E, Clauw D, Dadabhoy D, Gendreau M, Goldenberg D, Littlejohn G, Martin S, Perera P, Russell IJ, Simon L, Spaeth M, Williams D, Crofford L (2007) Fibromyalgia syndrome. J Rheumatol 34(6):1415–1425PubMedGoogle Scholar
  25. 25.
    Burns JW, Crofford LJ, Chervin RD (2008) Sleep stage dynamics in fibromyalgia patients and controls. Sleep Med 9(6):689–696PubMedCrossRefGoogle Scholar
  26. 26.
    Hornyak M, Feige B, Voderholzer U, Philipsen A, Riemann D (2007) Polysomnography findings in patients with restless legs syndrome and in healthy controls: a comparative observational study. Sleep 30(7):861–865PubMedGoogle Scholar
  27. 27.
    Rotem AY, Sperber AD, Krugliak P, Freidman B, Tal A, Tarasiuk A (2003) Polysomnographic and actigraphic evidence of sleep fragmentation in patients with irritable bowel syndrome. Sleep 26(6):747–752PubMedGoogle Scholar
  28. 28.
    Zucconi M, Ferini-Strambi L, Gambini O, Castronovo C, Galli L, Campana A, Scarone S, Smirne S (1996) Structured psychiatric interview and ambulatory sleep monitoring in young psychophysiological insomniacs. J Clin Psychiatry 57(8):364–370PubMedGoogle Scholar
  29. 29.
    Voss U (2004) Functions of sleep architecture and the concept of protective fields. Rev Neurosci 15(1):33–46PubMedCrossRefGoogle Scholar
  30. 30.
    Agnew HW Jr, Webb WB, Williams RL (1966) The first night effect: an EEG study of sleep. Psychophysiology 2(3):263–266PubMedCrossRefGoogle Scholar

Copyright information

© © US Government 2010

Authors and Affiliations

  • Mohammad M. Amin
    • 1
  • Morris S. Gold
    • 3
  • Joan E. Broderick
    • 2
  • Avram R. Gold
    • 1
  1. 1.Division of Pulmonary/Critical Care/Sleep Medicine, (111D)DVA Medical CenterNorthportUSA
  2. 2.Department of Psychiatry and Behavioral SciencesStony Brook University School of MedicineStony BrookUSA
  3. 3.Novartis Consumer HealthParsippanyUSA

Personalised recommendations