Positive Airway Pressure Adherence in Veterans with Posttraumatic Stress Disorder

Overview

Journal Sleep

Publisher Oxford University Press

Specialty Psychiatry

Date 2010 Nov 25

PMID 21102991

Citations 35

Authors

Ali A El-Solh

Lakshmy Ayyar

Morohonfolu Akinnusi

Sachin Relia

Opeoluwa Akinnusi

Affiliations

Soon will be listed here.

Abstract

Study Objectives: to determine the short-term positive airway pressure (PAP) adherence rates and to identify non-mask-related risk factors associated with 30-day nonadherence to PAP in a population of veterans with obstructive sleep apnea (OSA) and posttraumatic stress disorder (PTSD).

Design: a retrospective study.

Settings: a Veterans Affairs hospital.

Patients: one hundred forty-eight PTSD veterans newly diagnosed with OSA and a control group of OSA without PTSD matched for age, gender, BMI, and severity of OSA.

Interventions: N/A.

Measurements And Results: at 30-day follow-up, adherence to PAP was significantly lower in the PTSD group compared to the control group (41% versus 70%, respectively; P < 0.001). Veterans with adequate PAP adherence were more likely to experience sleepiness at baseline compared to nonadherent subjects (ESS 14.4 ± 5.3 versus 12.3 ± 5.9, respectively; P = 0.04). Nightmares were more frequently reported in those who were PAP nonadherent (P = 0.002). Mask discomfort, claustrophobia, and air hunger were the reported reasons for PAP nonadherence in the PTSD group.

Conclusion: PAP usage and adherence were lower in PTSD veterans with OSA than veterans without PTSD. Excessive sleepiness predicted PAP adherence while frequent nightmares were correlated with poor adherence to PAP therapy.

Citing Articles

Development of a guide for continuous positive airway pressure use - A good fit: Making continuous positive airway pressure work for you.

Meraj A, Koep L, Baig M Can J Respir Ther. 2025; 61:7-16.

PMID: 39866656 PMC: 11760215. DOI: 10.29390/001c.127656.

Posttraumatic Stress Disorder and Obstructive Sleep Apnea in Twins.

Shah A, Vaccarino V, Goldberg J, Huang M, Ko Y, Ma X JAMA Netw Open. 2024; 7(6):e2416352.

PMID: 38913378 PMC: 11197451. DOI: 10.1001/jamanetworkopen.2024.16352.

Relationship of Nocturnal Insomnia Symptoms and Outcomes After Hypoglossal Nerve Stimulation.

Dhanda Patil R, Suurna M, Steffen A, Soose R, Coxe J, Chan T OTO Open. 2024; 8(2):e134.

PMID: 38646184 PMC: 11032643. DOI: 10.1002/oto2.134.

Improving adherence to PAP therapy: A brief PAP coaching intervention for health care providers.

He K, Crouch T, Kaitz J, Oien A, De Paul N, Palen B PEC Innov. 2023; 3:100230.

PMID: 37929052 PMC: 10624969. DOI: 10.1016/j.pecinn.2023.100230.

Race and Socioeconomic Status: Interlinked Drivers of Sleep Health Disparities.

Rojanapairat O, Beggs A, Zeidler M, Prasad B Health Equity. 2023; 7(1):307-311.

PMID: 37284532 PMC: 10240326. DOI: 10.1089/heq.2023.0012.

References

Engleman H, Wild M . Improving CPAP use by patients with the sleep apnoea/hypopnoea syndrome (SAHS). Sleep Med Rev. 2003; 7(1):81-99. DOI: 10.1053/smrv.2001.0197. View

Weaver T, Kribbs N, Pack A, Kline L, Chugh D, Maislin G . Night-to-night variability in CPAP use over the first three months of treatment. Sleep. 1997; 20(4):278-83. DOI: 10.1093/sleep/20.4.278. View

Grieger T, Cozza S, Ursano R, Hoge C, Martinez P, Engel C . Posttraumatic stress disorder and depression in battle-injured soldiers. Am J Psychiatry. 2006; 163(10):1777-83. DOI: 10.1176/ajp.2006.163.10.1777. View

Ritchie E . Psychological problems associated with mission-oriented protective gear. Mil Med. 2002; 166(12 Suppl):83-4. View

Kaplan V, Bingisser R, Li Y, Hess T, Russi E, Bloch K . [Compliance with nasal positive pressure (CPAP) in obstructive sleep apnea syndrome]. Schweiz Med Wochenschr. 1996; 126(1-2):15-21. View

Chasens E, Pack A, Maislin G, Dinges D, Weaver T . Claustrophobia and adherence to CPAP treatment. West J Nurs Res. 2005; 27(3):307-21. DOI: 10.1177/0193945904273283. View

Youakim J, Doghramji K, Schutte S . Posttraumatic stress disorder and obstructive sleep apnea syndrome. Psychosomatics. 1998; 39(2):168-71. DOI: 10.1016/S0033-3182(98)71365-9. View

Foulkes . Symposium: Normal and abnormal REM sleep regulation: Dreaming and REM sleep. J Sleep Res. 1993; 2(4):199-202. DOI: 10.1111/j.1365-2869.1993.tb00090.x. View

Lamarche L, De Koninck J . Sleep disturbance in adults with posttraumatic stress disorder: a review. J Clin Psychiatry. 2007; 68(8):1257-70. DOI: 10.4088/jcp.v68n0813. View

10.

Waldhorn R, Herrick T, Nguyen M, ODONNELL A, Sodero J, Potolicchio S . Long-term compliance with nasal continuous positive airway pressure therapy of obstructive sleep apnea. Chest. 1990; 97(1):33-8. DOI: 10.1378/chest.97.1.33. View

11.

Krieger J, Kurtz D, Petiau C, Sforza E, Trautmann D . Long-term compliance with CPAP therapy in obstructive sleep apnea patients and in snorers. Sleep. 1996; 19(9 Suppl):S136-43. DOI: 10.1093/sleep/19.suppl_9.s136. View

12.

Krieger J . Long-term compliance with nasal continuous positive airway pressure (CPAP) in obstructive sleep apnea patients and nonapneic snorers. Sleep. 1992; 15(6 Suppl):S42-6. DOI: 10.1093/sleep/15.suppl_6.s42. View

13.

Krakow B, Lowry C, Germain A, Gaddy L, Hollifield M, Koss M . A retrospective study on improvements in nightmares and post-traumatic stress disorder following treatment for co-morbid sleep-disordered breathing. J Psychosom Res. 2001; 49(5):291-8. DOI: 10.1016/s0022-3999(00)00147-1. View

14.

Kessler R, Sonnega A, Bromet E, Hughes M, Nelson C . Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995; 52(12):1048-60. DOI: 10.1001/archpsyc.1995.03950240066012. View

15.

Faccenda J, Mackay T, Boon N, Douglas N . Randomized placebo-controlled trial of continuous positive airway pressure on blood pressure in the sleep apnea-hypopnea syndrome. Am J Respir Crit Care Med. 2001; 163(2):344-8. DOI: 10.1164/ajrccm.163.2.2005037. View

16.

Drake C, Day R, Hudgel D, Stefadu Y, Parks M, Syron M . Sleep during titration predicts continuous positive airway pressure compliance. Sleep. 2003; 26(3):308-11. DOI: 10.1093/sleep/26.3.308. View

17.

Engleman H, Martin S, Kingshott R, Mackay T, Deary I, Douglas N . Randomised placebo controlled trial of daytime function after continuous positive airway pressure (CPAP) therapy for the sleep apnoea/hypopnoea syndrome. Thorax. 1998; 53(5):341-5. PMC: 1745223. DOI: 10.1136/thx.53.5.341. View

18.

Wells R, Freedland K, Carney R, Duntley S, Stepanski E . Adherence, reports of benefits, and depression among patients treated with continuous positive airway pressure. Psychosom Med. 2007; 69(5):449-54. DOI: 10.1097/psy.0b013e318068b2f7. View

19.

Stepnowsky Jr C, Marler M, Ancoli-Israel S . Determinants of nasal CPAP compliance. Sleep Med. 2003; 3(3):239-47. DOI: 10.1016/s1389-9457(01)00162-9. View

20.

Budhiraja R, Parthasarathy S, Drake C, Roth T, Sharief I, Budhiraja P . Early CPAP use identifies subsequent adherence to CPAP therapy. Sleep. 2007; 30(3):320-4. View