Prevalence of obstructive sleep apnea in patients with posttraumatic stress disorder and its impact on adherence to continuous positive airway pressure therapy: a meta-analysis

Abstract

Objective: Although some authors have recently investigated the co-occurrence of posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA), the topic remains insufficiently studied. The aim of this meta-analysis was to detect the pooled prevalence of OSA in PTSD and its impact on adherence to continuous positive airway pressure (CPAP) therapy.

Methods: We conducted a search for articles published until August 20, 2016, in PubMed, Embase, the Cochrane Library, and PsycINFO. The literature search identified 194 articles, and 12 studies were included in the meta-analysis.

Results: The pooled prevalence rates of OSA based on different apnea-hypopnea index (AHI) criteria in PTSD patients was 75.7% (95% confidence interval [CI] = 44.1-92.5%) (AHI ≥5) and 43.6% (95% CI = 20.6-69.7%) (AHI ≥10), respectively. Subgroup analysis showed that there was a significant difference between the prevalence of OSA in veterans with PTSD compared to nonveterans or mixed samples. Patients with PTSD and OSA demonstrated significantly lower adherence to CPAP therapy (regular use: g = -0.658, 95% CI = -0.856 to -0.460; time of average use per night: g = -0.873, 95% CI = -1.550 to -0.196) compared with those with OSA alone.

Conclusions: OSA is commonly seen in patients with PTSD. Given its negative impact on the adherence to CPAP therapy, the possibility of OSA should be monitored carefully in patients with PTSD.

Keywords: Adherence; Continuous positive airway pressure; Meta-analysis; Obstructive sleep apnea; Posttraumatic stress disorder; Prevalence.