Modeling the effects of obstructive sleep apnea and hypertension in Vietnam veterans with PTSD
- 493 Downloads
The present work aimed to extend models suggesting that obstructive sleep apnea (OSA) is associated with worse cognitive performance in community-dwelling older adults. We hypothesized that in addition to indices of OSA severity, hypertension is associated with worse cognitive performance in such adults.
The PTSD Apnea Clinical Study recruited 120 community-dwelling, male veterans diagnosed with PTSD, ages 55 and older. The Rey Auditory Verbal Learning Test (RAVLT) and Color-Word Interference Test (CWIT) were measures of auditory verbal memory and executive function, respectively. Apnea–hypopnea index (AHI), minimum and mean pulse oximeter oxygen saturation (min SpO2, mean SpO2) indicators were determined during standard overnight polysomnography. Multivariate linear regression and receiver operating characteristic (ROC) curve analyses were performed.
In regression models, AHI (β = −4.099; p < 0.01) and hypertension (β = −4.500; p < 0.05) predicted RAVLT; hypertension alone (β = 9.146; p < 0.01) predicted CWIT. ROC analyses selected min SpO2 cut-points of 85% for RAVLT (κ = 0.27; χ² = 8.23, p < 0.01) and 80% for CWIT (κ = 0.25; χ² = 12.65, p < 0.01). Min SpO2 cut-points and hypertension were significant when added simultaneously in a regression model for RAVLT (min SpO2, β = 4.452; p < 0.05; hypertension, β = −4.332; p < 0.05), and in separate models for CWIT (min SpO2, β = −8.286; p < 0.05; hypertension, β = −8.993; p < 0.01).
OSA severity and presence of self-reported hypertension are associated with poor auditory verbal memory and executive function in older adults.
KeywordsObstructive sleep apnea (OSA) Hypertension Posttraumatic stress disorder (PTSD) Rey Auditory Verbal Learning Test (RAVLT) Color-Word Interference Test (CWIT)
This research was supported by the Medical Research Service of the Department of Veterans Affairs, VA Merit Review Grant and the Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC). B.K.S. is currently supported by the Office of Academic Affiliations, Advanced Fellowship Program in Mental Illness Research and Treatment, Department of Veteran Affairs, by the Medical Research Service of the Veterans Affairs Palo Alto Health Care System, and by the Department of Veterans Affairs Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC). The authors would like to acknowledge the efforts of Emily Luther, Tim Kimball, Rachel Cooper, Kader Ucar, Claire Stewart, Candace Romandia, and Shannon Hsu for their assistance with study coordination and data collection.
Conflict of interest
The authors declare that they have no conflict of interest.
- 2.Alessi CA, Cassel CJ (2004) Medical evaluation and common medical problems of the geriatric psychiatry patient. In: Sadavoy J et al (eds) Comprehensive textbook of geriatric psychiatry. WW Norton, New York, pp 281–313Google Scholar
- 7.Vieweg WV, Julius DA, Fernandez A, Tassone DM, Narla SN, Pandurangi AK (2006) Posttraumatic stress disorder in male military veterans with comorbid overweight and obesity: psychotropic, antihypertensive, and metabolic medications. Prim Care Companion J Clin Psychiatry 8:25–31PubMedCrossRefGoogle Scholar
- 8.Yesavage JA, Kinoshita LM, Kimball T, Zeitzer J, Friedman L, Noda A, David R, Hernandez B, Lee T, Cheng J, O’Hara R (2011) Sleep-disordered breathing in Vietnam veterans with posttraumatic stress disorder. Am J Geriatr Psychiatr. doi: 10.1097/JGP.0b013e3181e446ea
- 15.American Academy of Sleep Medicine (2005) International classification of sleep disorders: diagnostic and coding manual, 2nd edn. American Academy of Sleep Medicine, WestchesterGoogle Scholar
- 17.Hrubos-Strom H, Nordhus IH, Einvik G, Randby A, Omland T, Sundet K, Moum T, Dammen T (2011) Obstructive sleep apnea, verbal memory, and executive function in a community-based high-risk population identified by the Berlin Questionnaire Akershus Sleep Apnea Project. Sleep Breath. doi: 10.1007/s11325-011-0493-1
- 21.Rey A (1964) L’Examen Clinique en Psychologie, 2nd edn. Presses Universitaires de France, ParisGoogle Scholar
- 24.Delis D, Kaplan E, Kramer J (2003) D-KEFS. The Psychological Corporation, San AntonioGoogle Scholar
- 25.Iber C, Ancoli-Israel S, Chesson AL, Quan SF (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. American Academy of Sleep Medicine, WestchesterGoogle Scholar
- 28.Kraemer HC (1992) Evaluating medical tests: objective and quantitative guidelines. Sage, Newbury ParkGoogle Scholar
- 29.Yesavage JA, Kraemer HC (2007) Signal detection software for receiver operator characteristics (version 4.22). Computer software. http://www.stanford.edu/∼yesavage/ROC.html. Accessed 25 May 2007
- 35.Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ (2003) The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 289:2560–2572PubMedCrossRefGoogle Scholar
- 38.Lin QC, Zhang XB, Chen GP, Huang DY, Din HB, Tang AZ (2011) Obstructive sleep apnea syndrome is associated with some components of metabolic syndrome in nonobese adults. Sleep Breath. doi: 10.1007/s11325-011-0544-7
- 40.Kushida CA, Littner MR, Hirshkowitz M, Morgenthaler TI, Alessi CA, Bailey D, Boehlecke B, Brown TM, Coleman J Jr, Friedman L, Kapen S, Kapur VK, Kramer M, Lee-Chiong T, Owens J, Pancer JP, Swick TJ, Wise MS (2006) Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep 29:375–380PubMedGoogle Scholar