Table 1.
Studies evaluating OSA treatment effects on PTSD. PAP, positive airway pressure. MRD, mandibular repositioning device. HNS, hypoglossal nerve stimulation. REM, rapid eye movement sleep. NREM, non-rapid eye movement sleep. PCL-M, PTSD checklist-military. PCL-S, PTSD checklist-specific. PCL-5, PTSD checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
| Authors | Year | Study Type | Study Population | Age (Mean Years ± SD) | Sex (% Male) | Treatment Type | Main Findings |
|---|---|---|---|---|---|---|---|
| Youakim et al. [81] | 1998 | Case Report | Veteran | 42 | 100 | PAP therapy | Nightmare frequency and intensity was improved after 4 months of PAP therapy, as well as daytime PTSD symptoms. |
| Krakow et al. [82] | 2000 | Retrospective | Civilians | Treatment: 43.8 ± 14.1 No treatment: 50.8 ± 14.9 |
Not reported | PAP therapy | PAP users reported a median 75% improvement in PTSD symptoms; subjects without PAP therapy reported worsening symptoms. |
| Tamanna et al. [83] | 2014 | Retrospective | Veterans | 58 ± 12.05 | 97 | PAP therapy | The mean number of nightmares per week was reduced over 6 months of PAP therapy. Reduced nightmare frequency was best predicted by PAP adherence. |
| El-Solh et al. [84] | 2017a | Prospective cohort | Veterans | 52.6 ± 14.2 | 92.5 | PAP therapy | PCL-M scores improved after 3 months of PAP therapy, in a dose-dependent manner. PAP usage was the only significant predictor of overall PTSD symptom improvement. |
| Orr et al. [85] | 2017 | Prospective cohort | Veterans | 52 (range 43-65) | 87.5 | PAP therapy | PCL-S scores improved over 6 months of PAP therapy. The percentage of nights in which PAP was used, but not mean hours used per night, predicted improvement. |
| Ullah et al. [86] | 2017 | Prospective cohort | Veterans | 51.24 ± 14.74 | Not reported | PAP therapy | PCL-M scores improved after 6 months of PAP therapy in PTSD patients, whereas non-PTSD patients with low adherence showed worsening of PCL-M scores. |
| El-Solh et al. [89] | 2017b | Randomized crossover trial | Veterans | 52.7 ± 11.6 | Not reported | MRD compared to PAP therapy | 71% of CPAP users and 14% of MRD users had complete OSA resolution during titration studies; however MRD users had longer sleep time, higher sleep efficiency and better adherence to treatment. Both treatments showed similar improvements in PCL-M scores after 3 months. |
| El-Solh et al. [90] | 2018 | Prospective | Veterans | PTSD with comorbid OSA and insomnia: 47.2 ± 10.8 | PTSD with comorbid OSA and insomnia: 72 | PAP therapy | PCL-M scores improved after 3 months of PAP therapy in patients with and without insomnia. The change in PCL-M scores was smaller in those with insomnia. PAP adherence was also lower in the insomnia group. |
| PTSD with OSA: 52.7 ± 9.7 | PTSD with OSA: 86 | ||||||
| Patil et al. [97] | 2021 | Retrospective and prospective case series | Veterans | 59.3 ± 10.6 | 96.2 | HNS | Resolution of OSA and adherence were similar for patients with and without PTSD; adherence was lower in PTSD patients with insomnia. PCL-5 scores obtained 6–12 months after surgery did not significantly change from baseline. |