The effect of treating obstructive sleep apnea with continuous positive airway pressure on posttraumatic stress disorder: A systematic review and meta-analysis with hypothetical model. (July 2019)

• Record Type: Journal Article
• Authors: Zhang, Ye; Ren, Rong; Yang, Linghui; Zhou, Junying; Sanford, Larry D.; Tang, Xiangdong
• Is Part Of: Neuroscience and biobehavioral reviews. Volume 102(2019)
• Page Start: 172
• Page End: 183
• Publication Date: 2019-07
• Subjects: AASM American Academy of Sleep Medicine -- AHI Apnea hypopnea index -- BMI Body mass index -- CAP Cyclic alternating pattern -- CVD Cardiovascular diseases -- CPAP Continuous positive airway pressure -- EEG Electroencephalogram -- MAD Mandibular advancement device -- NDQ Nightmare distress questionnaire -- NFQ Nightmare frequency questionnaire -- HPA Hypothalamic-pituitary-adrenal -- OSA Obstructive sleep apnea -- PCL Posttraumatic stress disorder checklist -- PSG Polysomnography -- PTSD Posttraumatic stress disorder -- RCTs Randomized control trials -- REM Rapid eye movement -- RoBANS Risk of bias assessment tool for non-randomized studies -- SMD Standardized mean differences -- SNS Sympathetic nervous system; Continuous positive airway pressure -- Obstructive sleep apnea -- Posttraumatic stress disorder -- Nightmare -- Meta-analysis; Psychophysiology -- Periodicals; Human behavior -- Periodicals; Animal behavior -- Periodicals; Neurology -- Periodicals; Behavior -- Periodicals; Ethology -- Periodicals; Neurology -- Periodicals; Psychophysiologie -- Périodiques; Comportement humain -- Périodiques; Animaux -- Mœurs et comportement -- Périodiques; Neurologie -- Périodiques; Animal behavior; Human behavior; Neurology; Psychophysiology; Periodicals; Electronic journals; 573.8
• DOI: 10.1016/j.neubiorev.2019.03.019
• Languages: English
• ISSNs: 0149-7634

Abstract

Highlights: CPAP treatment may improve PTSD symptoms in patients with concurrent obstructive sleep apnea. CPAP adherence is associated with improvements of PTSD. We propose a hypothetical model of how CPAP improves PTSD symptoms. Abstract: The present study explored whether continuous positive airway pressure (CPAP) treatment impacts nightmare and overall posttraumatic stress disorder (PTSD) symptoms in patients with PTSD and obstructive sleep apnea (OSA). The meta-analysis for six eligibile studies indicates that CPAP can significantly improve nightmare (standardized mean differences (SMD) = -0.778; 95% confidence interval (CI) = -1.228 to -0.327) and overall PTSD symptoms (SMD = -1.298; 95% CI = -2.128 to -0.468) in these patients. A subgroup analysis revealed that the effects of CPAP on improvements of nightmare and overall PTSD symptoms varied across CPAP treatment duration (3 and 6 months), but did not reach a statistically significant level. Furthermore, improvements in overall PTSD symptoms were associated with CPAP adherence. This review emphasizes the importance of the need for a multidisciplinary approach in treating patients with PTSD and OSA, and proposes a hypothetical model of how CPAP improves posttraumatic stress symptoms in patients with PTSD and OSA.