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Comorbid sleep apnea, post-traumatic stress disorder, and insomnia: underlying mechanisms and treatment implications—a commentary on El Solh et al.’s Impact of low arousal threshold on treatment of obstructive sleep apnea in patients with post-traumatic stress disorder

  • Sleep Breathing Physiology and Disorders • Commentary
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  • volume 25, pages 605–607 (2021)
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References

  1. El-Solh AA, Riaz U, Roberts J (2018) Sleep disorders in patients with posttraumatic stress disorder. Chest. 154:427–439

    Article  Google Scholar 

  2. Caldwell JA, Knapik JJ, Shing TL, Kardouni JR, Lieberman HR (2019) The association of insomnia and sleep apnea with deployment and combat exposure in the entire population of US army soldiers from 1997 to 2011: a retrospective cohort investigation. Sleep 42:zsz112. https://doi.org/10.1093/sleep/zsz112

  3. Vasterling JJ, Aslan M, Proctor SP, Ko J, Marx BP, Jakupcak M, Schnurr PP, Gleason T, Huang GD, Concato J (2016) Longitudinal examination of posttraumatic stress disorder as a long-term outcome of Iraq war deployment. Am J Epidemiol 184:796–805

    Article  Google Scholar 

  4. Wallace DM, Wohlgemuth WK (2019) Predictors of insomnia severity index profiles in United States veterans with obstructive sleep apnea. J Clin Sleep Med 15:1827–1837

    Article  Google Scholar 

  5. Colvonen PJ, Straus LD, Stepnowsky C, McCarthy MJ, Goldstein LA, Norman SB (2018) Recent advancements in treating sleep disorders in co-occurring PTSD. Curr Psychiatry Rep 20:48

    Article  Google Scholar 

  6. Sweetman A, Lack L, Bastien C (2019) Co-morbid insomnia and sleep apnea (COMISA): prevalence, consequences, methodological considerations, and recent randomized controlled trials. Brain Sci 9:371. https://doi.org/10.3390/brainsci9120371

  7. Wallace DM, Sawyer AM, Shafazand S (2018) Comorbid insomnia symptoms predict lower 6-month adherence to CPAP in US veterans with obstructive sleep apnea. Sleep Breath 22:5–15

    Article  Google Scholar 

  8. Mysliwiec V, Gill J, Lee H, Baxter T, Pierce R, Barr TL, Krakow B, Roth BJ (2013) Sleep disorders in US military personnel: a high rate of comorbid insomnia and obstructive sleep apnea. Chest. 144:549–557

    Article  Google Scholar 

  9. Veterans Affairs Office of the Inspector General (2020) Opportunities missed to contain spending on sleep apnea devices and improve veterans’ outcomes. Available at www.va.gov/oig. Accessed 1 March 2020

  10. Eckert DJ, White DP, Jordan AS, Malhotra A, Wellman A (2013) Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets. Am J Respir Crit Care Med 188:996–1004

    Article  Google Scholar 

  11. Jordan AS, Wellman A, Heinzer RC, Lo YL, Schory K, Dover L, Gautam S, Malhotra A, White DP (2007) Mechanisms used to restore ventilation after partial upper airway collapse during sleep in humans. Thorax. 62:861–867

    Article  Google Scholar 

  12. Zinchuk A, Edwards BA, Jeon S, Koo BB, Concato J, Sands S, Wellman A, Yaggi HK (2018) Prevalence, associated clinical features, and impact on continuous positive airway pressure use of a low respiratory arousal threshold among male United States veterans with obstructive sleep apnea. J Clin Sleep Med 14:809–817

    Article  Google Scholar 

  13. El-Solh AA, Lawson Y, Wilding GE (2020) Impact of low arousal threshold on treatment of obstructive sleep apnea in patients with post-traumatic stress disorder. Sleep Breath. https://doi.org/10.1007/s11325-020-02106-0

  14. Smith PR, Sheikh KL, Costan-Toth C, Forsthoefel D, Bridges E, Andrada TF, Holley AB (2017) Eszopiclone and zolpidem do not affect the prevalence of the low arousal threshold phenotype. J Clin Sleep Med 13:115–119

    Article  Google Scholar 

  15. Eckert DJ, Owens RL, Kehlmann GB, Wellman A, Rahangdale S, Yim-Yeh S, White DP, Malhotra A (2011) Eszopiclone increases the respiratory arousal threshold and lowers the apnoea/hypopnoea index in obstructive sleep apnoea patients with a low arousal threshold. Clin Sci (Lond) 120:505–514

    Article  Google Scholar 

  16. Crawford MR, Espie CA, Bartlett DJ, Grunstein RR (2014) Integrating psychology and medicine in CPAP adherence--new concepts? Sleep Med Rev 18:123–139

    Article  Google Scholar 

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Authors and Affiliations

  1. Sleep Disorders Center, Miami VA Healthcare System, Room A212, Miami, FL, 33125, USA

    Douglas M. Wallace

  2. Department of Neurology, Sleep Medicine division, University of Miami Miller School of Medicine, Miami, FL, USA

    Douglas M. Wallace

  3. The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, SA, 5042, Australia

    Alexander Sweetman

Authors
  1. Douglas M. Wallace
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Correspondence to Douglas M. Wallace.

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Wallace, D.M., Sweetman, A. Comorbid sleep apnea, post-traumatic stress disorder, and insomnia: underlying mechanisms and treatment implications—a commentary on El Solh et al.’s Impact of low arousal threshold on treatment of obstructive sleep apnea in patients with post-traumatic stress disorder. Sleep Breath 25, 605–607 (2021). https://doi.org/10.1007/s11325-020-02107-z

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  • DOI: https://doi.org/10.1007/s11325-020-02107-z

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