Comorbid insomnia and sleep apnea in Veterans with post-traumatic stress disorder
Abstract
Purpose The purpose of this study was to determine the impact of insomnia in Veterans with post-traumatic stress disorder (PTSD) and obstructive sleep apnea (OSA) on health-related outcomes before and after 12 weeks of continuous positive airway pressure (CPAP) treatment.Methods We conducted a prospective cohort study of Veterans with PTSD and documented apnea hypopnea index (AHI) ≥ 5 with and without clinically significant insomnia as determined by the Insomnia Severity Index (ISI). Health-related outcomes including PTSD checklist (PCL-M), SF-36, and Pittsburgh Sleep Quality Index (PSQI) were assessed at baseline and 12 weeks after initiation of OSA treatment. CPAP adherence was retrieved at each visit.Results Seventy-two Veterans including 36 with comorbid insomnia and OSA (COMISA) and 36 OSA-only were enrolled. Veterans with COMISA were younger (p = 0.03), had lower BMI (p < 0.001), and were more likely to report depression than those with OSA-only (p = 0.004). Although AHI was higher in the COMISA (p = 0.01), both groups expressed comparable daytime sleepiness (p = 0.16). The COMISA group had no significant change in SF-36 and PSQI after 12 weeks of treatment and used CPAP much less frequently than OSA-only group (p = 0.001).Conclusions COMISA in Veterans with PTSD is associated with worse quality of life than those with OSA-only. Insomnia should be assessed in Veterans with PTSD who are not adherent to CPAP treatment.
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Since 2017, a number of other studies have confirmed associations between COMISA and increased depressive and anxiety symptoms, daytime sleepiness, reduced quality of life, neurocognitive performance, and sleep quality compared to patients with either insomnia or OSA alone.
“Since 2017, a number of other studies have confirmed associations between COMISA and increased depressive and anxiety symptoms, daytime sleepiness, reduced quality of life, neurocognitive performance, and sleep quality compared to patients with either insomnia or OSA alone [46,47,48,49,50,51,52].”
From Co-morbid insomnia and sleep apnea (COMISA): Prevalence, consequences, methodological considerations, and recent randomized controlled trials (2019) · cites this paper as [50]
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- Authors
- El-Solh, A. A., Adamo, D., & Kufel, T.
- Affiliations
- VA Western New York Healthcare System (US)
- Corresponding author
- El-Solh, Ali A.
- ORCID
- El-Solh, Ali A.
- Venue
- Sleep And Breathing
- Published
- 2018-01-10
- Volume
- 22
- Issue
- 1
- Pages
- 23-31
- ISSN
- 1520-9512 (ISSN-L)
- 1522-1709
- OpenAlex
- W2782924252
- Cited by
- 42
- References
- 42
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 5 · 2023: 3 · 2022: 7 · 2021: 4 · 2020: 6 · 2019: 6 · 2018: 3
- FWCI
- 3.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Sleep And Breathing (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs
- VA Western New York Healthcare System
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Keywords
- insomnia, obstructive sleep apnea, post-traumatic stress disorder, veterans, comorbidities, CPAP therapy, CPAP adherence, quality of life, daytime sleepiness, depression, apnea-hypopnea index
- MeSH terms
- Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, New York, Prospective Studies, Quality of Life, Stress Disorders, Post-Traumatic, Veterans, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure
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