The Impact of Posttraumatic Stress Disorder on Continuous Positive Airway Pressure Adherence in Patients With Comorbid OSA

Abstract

PURPOSE: Therapeutic adherence is frequently poor among patients with posttraumatic stress disorder (PTSD). OSA is common in patients with PTSD and inadequately treated OSA may adversely impact outcomes. The treatment for OSA is continuous positive airway pressure (CPAP), and achieving compliance is often challenging. The poor sleep quality, including initiation insomnia and sleep fragmentation, common among patients with PTSD, may impair CPAP adherence. We sought to determine the impact of PTSD on CPAP adherence. METHODS: Retrospective case-control study. Patients with OSA and PTSD were compared to those with OSA alone. Groups were matched for age, BMI, and apneahypopnea index (AHI). We compared objective measures of CPAP use between the two groups to determine if CPAP adherence was impaired in patients with PTSD. RESULTS: 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 an increased rate of insomnia among those with PTSD, which did not reach statistical significance (25.8% vs. 11.1%, p=0.10). PTSD was associated with significantly less use of CPAP. Specifically, CPAP was used on 65.6+26.5% of nights in those with PTSD compared with 76.3+22.6% in those without PTSD (p = 0.03). Similarly, mean nightly use of CPAP was 3.7+1.8 hours in the PTSD group compared with 4.6+1.7 hours among controls (p=0.02). Regular use of CPAP, defined as >4 hours per night for >70% of nights, was significantly lower among those with PTSD (26.7% vs. 53.3%, p=0.01). CONCLUSIONS: Compared with controls, patients with PTSD had significantly lower rates of adherence to CPAP therapy. This may create an additional barrier to care in this already compromised patient population. CLINICAL IMPLICATIONS: Resolution of poor sleep quality should be prioritized in the treatment of PTSD with particular attention to factors that hinder CPAP compliance.