Signs and Symptoms of Sleep-Disordered Breathing in Trauma Survivors: A Matched Comparison With Classic Sleep Apnea Patients

Sleep and Human Health Institute, Albuquerque, New Mexico 87109, USA.
Journal of Nervous & Mental Disease (Impact Factor: 1.69). 06/2006; 194(6):433-9. DOI: 10.1097/01.nmd.0000221286.65021.e0
Source: PubMed


Chronic posttraumatic sleep disturbance may include sleep-disordered breathing (SDB), but this disorder of sleep respiration is usually not suspected in trauma survivors. Sleep breathing signs and symptoms were studied in 178 adults-all with SDB-including typical sleep clinic patients (N = 89) reporting classic snoring and sleepiness and crime victims (N = 89) with insomnia and posttraumatic stress. Significant differences (p < 0.0001) were common between groups. Sleep breathing complaints, loud snoring, marked obesity, and obstructive sleep apnea were prevalent in sleep clinic patients; crime victims reported more insomnia, nightmares, poor sleep quality, leg jerks, cognitive-affective symptoms, psychotropic medication usage, and less snoring but more upper airway resistance syndrome. Both groups reported high rates of fatigue or sleepiness, nocturia, morning dry mouth, and morning headaches. Awareness of these clinical features might enhance detection of SDB among trauma survivors.

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    • "This might have resulted in underestimation of OSA prevalence and severity, however this possible bias does not contradict the notion of a high prevalence. We did not have data on flow limitation or respiratory effort related arousals and thus did not assess upper airway resistance syndrome, which has been shown to be common among female patients (Anttalainen et al., 2010) and normal weight trauma survivors (Krakow et al., 2006), and has been associated with depression (Guilleminault et al., 2006). Finally, we assessed OSA only once and the patients had been already diagnosed with psychiatric disease, which precludes etiological inferences. "
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    ABSTRACT: Psychiatric diseases and symptoms are common among patients with obstructive sleep apnea (OSA). However, only a few studies have examined OSA in psychiatric patients. At the outpatient clinic of the Uusikaupunki Psychiatric Hospital, Finland, we used a low referral threshold to a diagnostic sleep study. An ambulatory cardiorespiratory polygraphy was performed in 114 of 221 patients. 95 patients were referred by the psychiatric clinic and 19 were examined in other clinical settings. We reviewed the medical files and retrospectively assessed the prevalence of OSA and the effect of gender, age, obesity, hypertension, type 2 diabetes, alcohol abuse, and symptoms suggesting OSA. 58 of the 221 patients (26.2%), 30 of 85 men (35.3%) and 28 of 136 women (20.6%), had OSA as determined by an apnea-hypopnea index (AHI) of 5/h or more. 20 patients (12 men and 8 women) had moderate or severe OSA (AHI ≥ 15/h). 46 patients (including 11 patients with moderate or severe OSA) were identified in the psychiatric clinic. In univariate analysis, a high body mass index, male gender, hypertension, snoring, and a history of witnessed apneas during sleep were associated with the presence of OSA. In multivariate analysis, a history of witnessed apneas did not remain significant. Age, type 2 diabetes, alcohol abuse, excessive daytime sleepiness (EDS), and fatigue did not associate with the presence of OSA. Our findings suggest that in psychiatric outpatients OSA is common but underdiagnosed. Presentation is often atypical, since many patients with OSA do not report witnessed apneas or EDS.
    Journal of Psychiatric Research 09/2015; 69:126-134. DOI:10.1016/j.jpsychires.2015.07.028 · 3.96 Impact Factor
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    • "OSAS was not more prevalent in patients with PTSD compared to TCs and HCs, contrary to previous uncontrolled studies that suggested indices between 60 and 90% in PTSD (Krakow, Germain, et al., 2000; Krakow et al., 2004, 2006; Yesavage et al., 2010). "
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    European Journal of Psychotraumatology 10/2012; 3. DOI:10.3402/ejpt.v3i0.19142 · 2.40 Impact Factor
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    • "Sleep quality also remained above the clinically significant cutoff . There is evidence that individuals with PTSD have high rates of sleep-disordered breathing, but atypical symptom profiles (Krakow et al., 2006). Thus, it is plausible that undetected sleep-disordered breathing partially accounts for why sleep quality remained poor. "
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    ABSTRACT: Insomnia and nightmares are hallmarks of posttraumatic stress disorder (PTSD). Sleep disturbances in PTSD negatively impact clinical course and functioning. In this open clinical trial, the preliminary effects of a combined treatment for insomnia and nightmares in combat veterans with PTSD were assessed. Ten combat veterans participated in a 10-session group treatment combining cognitive-behavioral therapy for insomnia with exposure, rescripting, and relaxation therapy. Participants maintained daily sleep and dream diaries and completed self-report measures of sleep quality and PTSD symptoms pre- and posttreatment. Participants reported improvements in sleep and nightmares following treatment. Future research using controlled designs to evaluate this treatment is warranted.
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