0547 THE IMPACT OF SEDATIVE HYPNOTIC MEDICATION ON COMPLIANCE IN PATIENTS WITH PTSD AND OSA WHO ARE TREATED WITH CPAP THERAPY

Abstract

Introduction: Patients with Post Traumatic Stress Disorder (PTSD) frequently have co‐morbid obstructive sleep apnea (OSA). Patients with comorbid PTSD/OSA have poor compliance with CPAP and worsened clinical outcomes. Previously published data from our lab has shown that non‐benzodiazepine sedative hypnotics (NBSHs) improve CPAP compliance. However, the effect of NBSH on CPAP adherence in patients with co‐morbid PTSD has never been tested. Methods: This is a subset analysis of a prospective, randomized, single‐blind, cross‐over study comparing standard auto‐set CPAP to auto‐set CPAP with the Sensawake comfort feature added. Patients diagnosed with OSA and reporting a history of PTSD who were CPAP naïve were approached for enrollment. Four weeks after randomization, patients crossed over to the other treatment group, with final follow‐up at eight weeks. Data on NBSH use chronically, during the initial PSG, or during follow‐up was abstracted. All statistical analyses were performed using SPSS IBM 22.1 software program. Results: We enrolled 41 patients with co‐morbid OSA/PTSD who were initiating CPAP for the first time. Mean age, BMI and AHI were 40.7 ± 8.0, 28.9 ± 6.8 and 11.6 ± 20.4 respectively. Average McChord and Epworth Sleepiness Scores (ESS) were 32.7 ± 14.9 and 11.5 ± 6.0 respectively. During the diagnostic PSG and CPAP initiation 16 (57.1%) and 13 (40.6%) patients received a NBSH, either eszopiclone or zolpidem. Use of a NBSH, whether for PSG or CPAP initiation, did not affect adherence at 4 weeks measured by percentage nights used (57.6 vs 64.9 (p=0.54) and 62.8 vs 62.0 (p=0.94)), hours per night used (4.3 vs 3.8 (p=0.45) and 4.8 vs 3.8 (p=0.16)) or hours used per night (2.7 vs 2.9 (p=0.80) and (3.2 vs 2.9; p=0.70) respectively. After 4 weeks of therapy, the ESS (‐3.0 (‐1.8 ‐ ‐4.1); p<0.001), ISI (‐4.0 (‐2.8 to ‐5.2); p<0.001) and FOSQ‐10 (+2.6 (0.9 to 3.1); p=0.003) showed significant improvement, but NBSH use, either during PSG or at CPAP initiation, did not affect the magnitude of improvement. Conclusion: Initial data from our study shows that for patients with comorbid OSA/PTSD, NBSH use does not affect CPAP compliance of symptomatic improvement.