El-Solh Ali A, Vermont Leah, Homish Gregory G, Kufel Thomas
VA Western New York Healthcare System, Buffalo, NY, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University at Buffalo, Buffalo, USA; Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, USA.
VA Western New York Healthcare System, Buffalo, NY, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University at Buffalo, Buffalo, USA.
Sleep Med. 2017 May;33:145-150. doi: 10.1016/j.sleep.2016.12.025. Epub 2017 Feb 3.
Previous retrospective studies have shown that continuous positive airway pressure (CPAP) exerts salutary effect on post-traumatic stress disorder (PTSD) symptoms and nightmare distress. The relative magnitude of therapeutic benefits from CPAP and the strength of associations between duration of CPAP use and PTSD symptomatology are unknown.
A prospective cohort design involving 47 combat veterans with PTSD and documented obstructive sleep apnea (OSA) by overnight polysomnography. Epworth Sleepiness Scale (ESS) score, PTSD checklist-Military (PCL-M), Nightmare Distress Questionnaire (NDQ), and Nightmare Frequency Questionnaire (NFQ) were administered at baseline and 3 months after CPAP therapy. Objective adherence was assessed at the 3-month follow-up.
Twenty-two veterans with mild-to-moderate PTSD (PCL-M score 17-59) and 18 with severe-to-very-severe PTSD (PCL-M score 60-85) completed the study. There was a dose-dependent response of PCL-M to duration of CPAP usage (r = 0.45; p = 0.003). Veterans with severe-to-very-severe PTSD had a larger improvement in PTSD symptoms (d = 0.65; p = 0.004) compared with those with mild-to-moderate PTSD (d = 0.47; p = 0.04). CPAP usage was the only significant predictor of overall subjective improvement in PTSD symptoms (OR 10.5; p = 0.01). Significant changes in NDQ and NFQ scores following 3 months of treatment were observed in veterans adherent to CPAP, but the correlations with duration of CPAP use were not statistically significant (r = 0.24; p = 0.13 and r = 0.13; p = 0.4, respectively).
Improvement of PTSD symptoms in veterans with OSA was more pronounced with prolonged use of CPAP. Adherence to treatment was linked to abatement in nightmare distress and frequency. Future investigation of multimodal treatment, including behavioral intervention combined with CPAP, is warranted.
既往回顾性研究表明，持续气道正压通气（CPAP）对创伤后应激障碍（PTSD）症状及噩梦困扰具有有益作用。CPAP治疗益处的相对程度以及CPAP使用时长与PTSD症状学之间关联的强度尚不清楚。
一项前瞻性队列设计，纳入47名患有PTSD且经夜间多导睡眠图记录证实患有阻塞性睡眠呼吸暂停（OSA）的退伍军人。在基线及CPAP治疗3个月后，使用爱泼华嗜睡量表（ESS）评分、PTSD检查表-军事版（PCL-M）、噩梦困扰问卷（NDQ）和噩梦频率问卷（NFQ）进行评估。在3个月随访时评估客观依从性。
22名患有轻度至中度PTSD（PCL-M评分17 - 59）的退伍军人和18名患有重度至极重度PTSD（PCL-M评分60 - 85）的退伍军人完成了研究。PCL-M对CPAP使用时长呈剂量依赖性反应（r = 0.45；p = 0.003）。与轻度至中度PTSD患者（d = 0.47；p = 0.04）相比，重度至极重度PTSD患者的PTSD症状改善更明显（d = 0.65；p = 0.004）。CPAP使用是PTSD症状总体主观改善的唯一显著预测因素（OR 10.5；p = 0.01）。在坚持使用CPAP的退伍军人中，治疗3个月后NDQ和NFQ评分有显著变化，但与CPAP使用时长的相关性无统计学意义（分别为r = 0.24；p = 0.13和r = 0.13；p = 0.4）。
对于患有OSA的退伍军人，长期使用CPAP可更显著改善PTSD症状。坚持治疗与噩梦困扰和频率的减轻有关。有必要对包括行为干预与CPAP相结合的多模式治疗进行进一步研究。
Zotero 插件