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: 1.84). 06/2006; 194(6):433-9. DOI: 10.1097/01.nmd.0000221286.65021.e0
Source: PubMed

ABSTRACT 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.

  • Source
    [Show abstract] [Hide abstract]
    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.
    Journal of Traumatic Stress 11/2009; 22(6):639-42. · 2.72 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Obstructive sleep apnea (OSA) is a common comorbid condition in patients with posttraumatic stress disorder (PTSD); insufficiently treated OSA may adversely impact outcomes. Sleep fragmentation and insomnia are common in PTSD and may impair CPAP adherence. We sought to determine the impact of combat-related PTSD on CPAP adherence in soldiers. Retrospective case-control study. Objective measures of CPAP use were compared between OSA patients with and without PTSD. Groups were matched for age, BMI, and apnea-hypopnea index (AHI). We included 90 patients (45 Control, 45 PTSD). Among the cohort, mean age was 39.9 ± 11.2, mean BMI 27.9 ± 8.0, mean ESS 13.6 ± 5.7, and mean AHI 28.2 ± 22.4. There was a trend towards a higher rate of comorbid insomnia among patients with PTSD (25.8% vs. 11.1%, p = 0.10). PTSD was associated with significantly less use of CPAP. Specifically, CPAP was used on 61.4% ± 22.2% of nights in PTSD patients compared with 76.8% ± 16.4% in patients without PTSD (p = 0.001). Mean nightly use of CPAP was 3.4 ± 1.2 h in the PTSD group compared with 4.7 ± 2.2 h among controls (p < 0.001). Regular use of CPAP (> 4 h per night for > 70% of nights) was also lower among PTSD patients (25.2% vs. 58.3%, p = 0.01). Among soldiers with OSA, comorbid PTSD was associated with significantly decreased CPAP adherence. Given the potential for adverse clinical outcomes, resolution of poor sleep quality should be prioritized in the treatment of PTSD and potential barriers to CPAP adherence should be overcome in patients with comorbid OSA. CITATION: Collen JF; Lettieri CJ; Hoffman M. The impact of posttraumatic stress disorder on CPAP adherence in patients with obstructive sleep apnea. J Clin Sleep Med 2012;8(6):667-672.
    Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 01/2012; 8(6):667-72. · 2.93 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We sought to assess the rate of sleep complaints and sleep disorders among active duty soldiers with deployment-related PTSD and to determine whether any clinical features differentiated those with sleep disorders. Retrospective review of consecutive soldiers diagnosed with PTSD. We recorded subjective measures of sleep and polysomnographic data. We compared clinical and demographic variables including psychoactive medication use, psychiatric comorbidity, and combat-related traumatic injury with the presence of sleep disorders. One hundred thirty patients were included (91.5 % male, mean age of 35.1 ± 10.6 years, mean body mass index (BMI) 28.9 ± 4.4 Kg/m(2)). About 88.5 % had comorbid depression, with the majority (96.2 %) taking psychoactive medications (mean 3.4 ± 1.6 medications per patient). Over half of the cohort suffered combat-related traumatic physical injuries (54.6 %). The obstructive sleep apnea syndrome (OSAS) was diagnosed in 67.3 % (80 % of the cohort underwent polysomnography), with a mean apnea hypopnea index of 24.1 ± 22.8 events/hour and a mean oxygen saturation nadir of 84.2 ± 5.7 %. OSAS was significantly more common in the non-injured soldiers (72.9 vs. 38.0 %, p < 0.001). In multivariate analysis, absence of physical injury showed a trend towards predicting OSAS. Sleep complaints are common among soldiers with PTSD. We observed significantly higher rates of OSAS among those without physical injuries, raising the possibility that underlying sleep-disordered breathing is a risk factor for the development of PTSD. This potential association requires further validation.
    Sleep And Breathing 04/2014; · 2.26 Impact Factor


Available from
May 16, 2014