创伤后应激障碍和阻塞性睡眠呼吸暂停退伍军人的残余嗜睡。

Residual sleepiness in veterans with post-traumatic stress disorder and obstructive sleep apnea.

机构信息

Medical Research, The Veterans Affairs Western New York Healthcare System, Bldg. 20 (151) VISN02, 3495 Bailey Avenue, Buffalo, NY, 14215-1199, USA.

Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Western New York Respiratory Research Center, The State University of New York at Buffalo School of Medicine and Biomedical Sciences and School of Public Health and Health Professions, Buffalo, NY, USA.

出版信息

Sleep Breath. 2023 Jun;27(3):853-860. doi: 10.1007/s11325-022-02678-z. Epub 2022 Jul 8.

DOI:10.1007/s11325-022-02678-z

PMID:35802313

Abstract

PURPOSE

The causes of residual excessive sleepiness (RES) in patients with post-traumatic stress disorder (PTSD) and obstructive sleep apnea (OSA) are multifactorial and modulated by comorbid conditions. The aim of the present study was to elucidate clinical and polysomnographic determinants of RES in continuous positive airway pressure (CPAP)-adherent OSA veterans with PTSD.

METHODS

The study protocol consisted of a retrospective analysis of consecutive cases of patients with PTSD who presented to the Veterans Affairs sleep clinics with adequately treated OSA between June 1, 2017 and October 15, 2021. Based on the Epworth Sleepiness Scale (ESS), patients were categorized into RES (ESS ≥ 11) and no RES (ESS < 11) groups. Demographic and PSG data were subjected to univariate and multivariate analyses to ascertain predictive factors of RES.

RESULTS

Out of 171 veterans with PTSD who were adherent to CPAP, 59 (35%) continued to experience RES. The RES group had a decrease in mean ESS score of 1.2 ± 4.5 after CPAP treatment compared with 4.6 ± 4.9 for the no RES group (< 0.001). A dose-response was observed between CPAP use and RES (p = 0.003). Multivariate regression analysis identified higher baseline ESS (OR 1.30; 95% CI 1.16-1.44), greater percentage of time spent in REM sleep (OR 0.91; 95% CI 0.85-0.96), CPAP use less than 6 h (OR 2.82; 95% CI 1.13-7.01), and a positive screen for depression (OR 1.69; 95% CI 1.03-4.72) as independent predictors of RES in patients with PTSD and OSA.

CONCLUSION

RES is highly prevalent in patients with PTSD and OSA despite adherence to CPAP and is independently associated with percentage time spent in REM, duration of CPAP utilization, and symptoms of depression.

摘要

目的

创伤后应激障碍（PTSD）和阻塞性睡眠呼吸暂停（OSA）患者残余过度嗜睡（RES）的原因是多因素的，并受合并症的调节。本研究的目的是阐明在接受持续气道正压通气（CPAP）治疗的 PTSD 合并 OSA 退伍军人中，RES 的临床和多导睡眠图决定因素。

方法

该研究方案包括对 2017 年 6 月 1 日至 2021 年 10 月 15 日期间因 OSA 在退伍军人事务睡眠诊所就诊且 OSA 得到充分治疗的 PTSD 患者的连续病例进行回顾性分析。根据 Epworth 嗜睡量表（ESS），患者被分为 RES（ESS≥11）和无 RES（ESS<11）组。对人口统计学和 PSG 数据进行单变量和多变量分析，以确定 RES 的预测因素。

结果

在 171 名依从 CPAP 治疗的 PTSD 退伍军人中，有 59 名（35%）继续出现 RES。RES 组 CPAP 治疗后 ESS 评分平均下降 1.2±4.5，而无 RES 组为 4.6±4.9（<0.001）。CPAP 使用与 RES 之间存在剂量反应关系（p=0.003）。多变量回归分析确定了更高的基线 ESS（OR 1.30；95%CI 1.16-1.44）、REM 睡眠时间百分比更大（OR 0.91；95%CI 0.85-0.96）、CPAP 使用时间少于 6 小时（OR 2.82；95%CI 1.13-7.01）和抑郁筛查阳性（OR 1.69；95%CI 1.03-4.72）是 PTSD 和 OSA 患者 RES 的独立预测因素。