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Title Limited Evidence Supports Association Between Obstructive Sleep Apnea And Post Traumatic Stress Disorder
Clinical Question In veterans with post traumatic stress disorder, does the incidence of obstructive sleep apnea increase?
Clinical Bottom Line There is an association between post traumatic stress disorder (PTSD) and obstructive sleep apnea (OSA), and evidence that treating OSA may improve the symptoms of PTSD. Obstructive sleep apnea may worsen post traumatic stress disorder, however there is currently no evidence on PTSD’s influence on OSA. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21102984Hurwitz/2010289 veterans with post traumatic stress disorderLiterature review
Key resultsIncreased incidence of OSA in patients with post traumatic stress disorder. Treating OSA can improve PTSD as well.
#2) 22893807van Leimpt/201147 veterans and 17 civilians with and without post traumatic stress disorderCase Study
Key resultsThere is a relationship between post traumatic stress disorder severity and OSA, however no correlation could be made between PTSD and a higher prevalence of OSA. The study found apnea hypopnea indices (AHI) of >10 in 29% of veterans with PTSD, 21% of veterans without PTSD and 29% of healthy civilians/service members who never deployed.
Evidence Search ("Stress Disorders, Post-Traumatic"[Mesh]) AND "Sleep Apnea, Obstructive"[Mesh]
Comments on
The Evidence
Studies were limited in sample size, did not have evidence to make a clinically significant difference, and were based on questionnaires.
Applicability Patients suffering from post traumatic stress disorder may have worsening symptoms if obstructive sleep apnea is a comorbidity. Treatment of the obstructive sleep apnea may improve the symptoms of PTSD as well.
Specialty/Discipline (Public Health) (Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery) (Orthodontics) (Prosthodontics) (Restorative Dentistry) (Basic Science) (Dental Hygiene) (Behavioral Science)
Keywords Post traumatic stress disorder, obstructive sleep apnea
ID# 2358
Date of submission: 03/18/2013spacer
E-mail percy@livemail.uthscsa.edu
Author Sarah Percy
Co-author(s) e-mail
Faculty mentor/Co-author Concepcion Barboza, DDS
Faculty mentor/Co-author e-mail barbozaArgue@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Ann Sue von Gonten, DDS / Kelsey Rockey (San Antonio, TX) on 05/15/2013
An article published by Mysliwiec, et al., in 2013 provides the prevalence of sleep disorders in a military population with deployment history (PMID 23372263 ). In this retrospective cross-sectional study, 725 medical record reviews were conducted. Individuals in the study had been referred for polysomnography and identification of comorbid diagnoses and specific sleep disorders. Medical record reviews revealed that of those individuals with primary sleep diagnoses, 27.2% had mild OSA, 24% had moderate-to-severe OSA, and 24.7% had insomnia. Significant associations were found between PTSD, pain syndromes, and insomnia, but not OSA. Disturbed sleep may be a precipitating and perpetuating factor in PTSD, but the current literature does not support a strong association between OSA and PTSD.

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