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. 2024 Jun 3;7(6):e2416352.
doi: 10.1001/jamanetworkopen.2024.16352.

Posttraumatic Stress Disorder and Obstructive Sleep Apnea in Twins

Amit J Shah  1   2   3 , Viola Vaccarino  1   2 , Jack Goldberg  4   5 , Minxuan Huang  6 , Yi-An Ko  7 , Xin Ma  8 , Oleksiy M Levantsevych  1 , Nicholas L Smith  4   5 , Nikila Alagar  1 , Iman Mousselli  1 , Dayna A Johnson  1 , Gari D Clifford  9   10 , J Douglas Bremner  11   12 , Donald L Bliwise  13
Affiliations

Posttraumatic Stress Disorder and Obstructive Sleep Apnea in Twins

Amit J Shah et al. JAMA Netw Open. .

Abstract

Importance: Obstructive sleep apnea (OSA) is a common condition in older adult (aged >65 years) populations, but more mechanistic research is needed to individualize treatments. Previous evidence has suggested an association between OSA and posttraumatic stress disorder (PTSD) but is limited by possible selection bias. High-quality research on this association with a careful evaluation of possible confounders may yield important mechanistic insight into both conditions and improve treatment efforts.

Objective: To investigate the association of current PTSD symptoms and PTSD diagnosis with OSA.

Design, setting, and participants: This cross-sectional study of twin pairs discordant for PTSD, which allows for adjustment for familial factors, was conducted using in-laboratory polysomnography from March 20, 2017, to June 3, 2019. The study sample comprised male veteran twins recruited from the Vietnam Era Twin Registry. The data analysis was performed between June 11, 2022, and January 30, 2023.

Exposure: Symptoms of PTSD in twins who served in the Vietnam War. Diagnosis of PTSD was a secondary exposure.

Main outcomes and measures: Obstructive sleep apnea was assessed using the apnea-hypopnea index (AHI) (≥4% oxygen saturation criterion as measured by events per hour) with overnight polysomnography. Symptoms of PTSD were assessed using the PTSD Checklist (PCL) and structured clinical interview for PTSD diagnosis.

Results: A total of 181 male twins (mean [SD] age, 68.4 [2.0] years) including 66 pairs discordant for PTSD symptoms and 15 pairs discordant for a current PTSD diagnosis were evaluated. In models examining the PCL and OSA within pairs and adjusted for body mass index (BMI) and other sociodemographic, cardiovascular, and psychiatric risk factors (including depression), each 15-point increase in PCL was associated with a 4.6 (95% CI, 0.1-9.1) events-per-hour higher AHI. Current PTSD diagnosis was associated with an adjusted 10.5 (95% CI, 5.7-15.3) events-per-hour higher AHI per sleep-hour. Comparable standardized estimates of the association of PTSD symptoms and BMI with AHI per SD increase (1.9 events per hour; 95% CI, 0.5-3.3 events per hour) were found.

Conclusions and relevance: This cross-sectional study found an association between PTSD and sleep-disordered breathing. The findings have important public health implications and may also enhance understanding of the many factors that potentially affect OSA pathophysiology.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Johnson reported receiving personal fees from Idorisa outside the submitted work. Dr Bliwise reported receiving personal fees from CliniLabs, Eisai, Ferring, Huxley, Idorsia, and Merck outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Association of Posttraumatic Stress Disorder Checklist (PCL) Score Tertile Among Individual Twins With Apnea Hypopnea Index (AHI)
The PCL tertile was based on PCL scores of less than 2 for the first tertile, 2 to 9 for the second tertile, and greater than 9 for the third tertile (n = 181). The diagonal dotted line indicates the trend slope, and the whiskers indicate the SE.
Figure 2.
Figure 2.. Association of Posttraumatic Stress Disorder Checklist (PCL) Score Tertile Among Individual Twins With Moderate to Severe Obstructive Sleep Apnea (OSA)
The PCL tertile was based on PCL scores of less than 2 for the first tertile, 2 to 9 for the second tertile, and greater than 9 for the third tertile (n = 181).
See this image and copyright information in PMC

Comment in

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