Impact of Post-traumatic Stress Disorder on Adherence to CPAP Treatment Obstructive Sleep Apnea among American Veterans

Ntroduction: Adherence to continuous positive airway pressure (CPAP) treatment for obstructive Sleep apnea (OSA) is variable. Patients with both OSA and PTSD may not have complete restoration of sleep quality with CPAP therapy owing to flare ups of nightmares associated with restoration of sleep continuity may negatively affect adherence to CPAP therapy. Methods: Patients' records diagnosed to have OSA by polysomnography for last 3 years were reviewed. Thirty seven patients with OSA and PTSD were compared with 159 patients with OSA without PTSD. Age, gender, BMI, and AHI index were recorded. Adherence data recorded; Days CPAP used/30 days, and hours used per night. Linear regression analysis was developed to determine if adherence is affected by presence of PTSD. Results: Mean age of patients was 61.8+ 12.5 years. Mean BMI was 33.9 + 7.2 kg/m² and mean AHI 34.3+ 24.6 per hour. Both groups were similar in age (61.7 + 10.7 Vs 61.9 + 13.02 years, p=0.92), gender (male; 89% VS 97%), BMI (33.5 + 8.75 Vs 34.01 + 6.89 kg/m², p=0.74), AHI (33.4 + 12.7 Vs 34.5+ 26.2 per hour, p=0.86). There was no difference in days CPAP was used per month (22.6 + 9.6 VS 21.9 + 10.1 days, p=0.70) or average nightly use when CPAP was used (5.07 + 2.78 Vs 5.26 + 3.06 hours, p=0.74). In multi regression, while adjusting for age, sex, BMI and AHI, PTSD was predictive of adherence (coefficient -1.65, p=0.02). Conclusion: Presence of PTSD in patients with OSA negatively affects adherence with CPAP therapy.