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Impact of low arousal threshold on treatment of obstructive sleep apnea in patients with post-traumatic stress disorder

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

We sought to determine the prevalence of low arousal threshold (LAT) in veterans with post-traumatic stress disorder (PTSD) and whether or not LAT is associated with decreased use of continuous positive airway pressure (CPAP).

Methods

We conducted a retrospective study of all veterans with documented PTSD who had an apnea hypopnea index > 5/h over a 27-month period. Demographic, clinical characteristics, and CPAP usage were extracted from the medical records. A multivariate analysis was conducted to assess predictors of CPAP use at 3 months in patients with LAT after adjusting for severity of PTSD.

Results

LAT was identified in 55% of 119 patients with PTSD and newly diagnosed OSA. LAT was associated with younger age (odds ratio [OR] 0.91; 95% confidence interval [CI] 0.86–0.95), lower BMI (OR 0.82; 95% CI 0.73–0.91), presence of insomnia (OR 1.34; 95% CI 1.19–1.81), and use of antidepressant (OR 1.14; 95% CI 1.09–2.01). PTSD severity, REM rebound, and the presence of baseline comorbid insomnia were each associated with CPAP use at 3 months. Neither daytime sleepiness, body mass index (BMI), nor LAT endotype was correlated with CPAP utilization. Insomnia was the only factor associated with decreased CPAP use in patients with PTSD and LAT (P = 0.04).

Conclusion

The LAT endotype is common among veterans with PTSD. An improved understanding of how insomnia in this population affects CPAP utilization would be instrumental in designing targeted therapy to improve sleep quality.

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Funding

This study was partially funded by a Merit Review Award from the U.S. Department of Veterans Affairs (CX001656).

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Authors and Affiliations

  1. The Veterans Affairs Western New York Healthcare System, Medical Research, Bldg. 20 (151) VISN02 3495 Bailey Avenue, Buffalo, NY, 14215-1199, USA

    Ali A El-Solh & Yolanda Lawson

  2. Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Jacobs School of Medicine and Biomedical Sciences and School of Public Health and Health Professions, Buffalo, NY, USA

    Ali A El-Solh

  3. Department of Epidemiology and Environmental Health, Jacobs School of Medicine and Biomedical Sciences and School of Public Health and Health Professions, Buffalo, NY, USA

    Ali A El-Solh

  4. Department of Biostatistics, Jacobs School of Medicine and Biomedical Sciences and School of Public Health and Health Professions, Buffalo, NY, USA

    Gregory E. Wilding

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  1. Ali A El-Solh
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  3. Gregory E. Wilding
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Correspondence to Ali A El-Solh.

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AES has received funding from the US Department of Veterans Affairs. All other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The VA Western New York Healthcare System Institutional Review Board approved this study.

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El-Solh, A.A., Lawson, Y. & Wilding, G.E. Impact of low arousal threshold on treatment of obstructive sleep apnea in patients with post-traumatic stress disorder. Sleep Breath 25, 597–604 (2021). https://doi.org/10.1007/s11325-020-02106-0

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  • DOI: https://doi.org/10.1007/s11325-020-02106-0

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