Trauma Recovery Center, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, USA.
Sleep Medicine Program, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, USA.
J Trauma Stress. 2017 Dec;30(6):646-655. doi: 10.1002/jts.22245. Epub 2017 Nov 13.
Recent studies have called attention to the need for enhancing treatment outcome in trauma-focused psychotherapies, such as cognitive processing therapy (CPT), with veterans. Given the prevalence of posttraumatic-related sleep disturbances, and the role of sleep in emotional learning and processing, sleep quality may be a target for improving CPT outcome. Elevated rates of obstructive sleep apnea (OSA) have been reported in samples of veterans with posttraumatic stress disorder (PTSD); however, the impact of OSA on response to CPT is unclear. In this study, CPT outcome was examined in veterans with and without a diagnosis of OSA. Following chart review, 68 OSA-positive and 276 OSA-negative veterans were identified. Generalized estimating equations were used to compare between-group differences in weekly self-reported PTSD symptomatology. The OSA-positive veterans reported greater PTSD severity over the course of treatment and at posttreatment compared with veterans without OSA (B = -0.657). Additionally, OSA-positive veterans with access to continuous positive airway pressure (CPAP) therapy reported less PTSD severity relative to OSA-positive veterans without access to CPAP (B = -0.421). Apnea appears to be a contributing factor to the reduced effectiveness of evidence-based psychotherapy for veterans with PTSD; however, preliminary evidence indicates that CPAP therapy may help mitigate the impact of OSA on treatment outcome.
最近的研究引起了人们对创伤焦点心理治疗（如认知加工治疗（CPT））在退伍军人中的治疗效果的关注。鉴于创伤后相关睡眠障碍的普遍性，以及睡眠在情绪学习和处理中的作用，睡眠质量可能是改善 CPT 效果的目标。有研究报告称，创伤后应激障碍（PTSD）退伍军人样本中阻塞性睡眠呼吸暂停（OSA）的发生率较高；然而，OSA 对 CPT 反应的影响尚不清楚。在这项研究中，检查了有和没有 OSA 诊断的退伍军人的 CPT 结果。通过图表审查，确定了 68 名 OSA 阳性和 276 名 OSA 阴性退伍军人。使用广义估计方程比较了组间每周自我报告 PTSD 症状的差异。与没有 OSA 的退伍军人相比，OSA 阳性退伍军人在治疗过程中和治疗后报告的 PTSD 严重程度更高（B = -0.657）。此外，与没有 CPAP 治疗机会的 OSA 阳性退伍军人相比，有 CPAP 治疗机会的 OSA 阳性退伍军人报告的 PTSD 严重程度较低（B = -0.421）。呼吸暂停似乎是 PTSD 退伍军人基于证据的心理治疗效果降低的一个因素；然而，初步证据表明 CPAP 治疗可能有助于减轻 OSA 对治疗效果的影响。
