Posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA) are two entities that are clearly tied together. In a recent study OSA was found to be present in over half of the patients with PTSD. The presence of OSA is associated with worsening outcomes in patients with PTSD. These patients have a reduced quality of life, daytime sleepiness, and fatigue. The prevalence of OSA in patients with PTSD is so prevalent, and so associated with symptoms and a reduced quality of life, that sleep studies should be considered in all patients with PTSD. Patients with PTSD/OSA have been found to have poor adherence with the most common therapy for sleep apnea, which is CPAP.
This group has some of the worst adherence rates for CPAP therapy. This could be due to lack of understanding about the need and benefits of CPAP therapy. It should also be said that PTSD seems to blunt the usual therapeutic response to CPAP treatment. The reasons for this may be several fold including polypharmacy, psychoactive medications (many tend to fragment sleep) and a common problem in service members so-called “pharmacotherapy-refractory insomnia”. Although CPAP therapy can significantly improve the quality of life for these service members, the benefits can be limited by poor adherence in an already compromised group of patients. Patient with PTSD need a careful and often individualized approach to OSA since all the other risks associated with OSA, such as an increased incidence in strokes and heart attacks, still apply.