0652 A Novel Cognitive-Behavioral Therapy to Increase PAP Adherence in Veterans With Posttraumatic Stress Disorder: Preliminary Results

Abstract

Introduction: The occurrence of obstructive sleep apnea (OSA) is high in veterans with posttraumatic stress disorder (PTSD). Our previous research on OSA in Vietnam‐era veterans found that 69% had an AHI≥10 (Yesavage, 2012). Efficacious treatments are available for OSA, PAP therapy; however, veterans with OSA frequently fail to use them (Yesavage, 2012; Kuna, 2011). Of the veterans diagnosed with OSA, 63% were not using their prescribed PAP device. The reasons for low PAP adherence include discomfort using PAP and psychological barriers. We developed a novel cognitivebehavioral therapy (CBT) intervention to increase PAP adherence in veterans with PTSD and OSA, called CBT‐OSA. Methods: Participants included 37 veterans age 18+ from clinics at VA Palo Alto. Participants were randomly assigned to CBT‐OSA or an education arm. All participants received treatment as usual in VA Pulmonary Service or a community‐based Sleep Medicine Center. Participants in CBT‐OSA received therapy from a Clinical Psychologist. The other veterans received education sessions. All participants received weekly, individual sessions during the first four weeks of PAP treatment. Average mask on time was calculated for each participant during week 1‐4 of PAP use. Results: An independent samples t‐test was conducted to compare average mask on time in the CBT‐OSA and education conditions. There was a significant difference in the average mask on time for CBT‐OSA (M=235.33, SD=139.22) and education (M=136.68; SD=149.19); t(35)=‐2.08, p=0.045. These results suggest that veterans who received the CBT treatment increased their PAP use compared to the veterans in the education condition. Conclusion: CBT‐OSA has shown early efficacy. CBT‐OSA increased PAP adherence in veterans with PTSD compared to veterans in the education condition. Veterans receiving CBT‐OSA demonstrated a longer average mask on time compared to veterans in the education condition. We are following the participants for one year to examine if CBT‐OSA fosters long‐term PAP adherence.