Changes in insomnia severity with advanced PAP therapy in patients with posttraumatic stress symptoms and comorbid sleep apnea:A retrospective,nonrandomized controlled study

作     者：Barry J.Krakow Natalia D.McIver Jessica J.Obando Victor A.Ulibarri 

作者机构：Sleep&Human Health Institute6739 Academy Rd NE Ste380AlbuquerqueNM 87109USA Maimonides Sleep Arts&Sciences6739 Academy Rd NE Ste380AlbuquerqueNM 87109USA Los Alamos Medical Center3917 W RdLos AlamosNM 87544USA Institution:Mozaik SolutionsSolana BeachCA 92075USA 

出 版 物：《Military Medical Research》 (军事医学研究（英文版）)

年 卷 期：2019年第6卷第4期

页      面：308-319页

核心收录：

学科分类：1002[医学-临床医学] 100205[医学-精神病与精神卫生学] 10[医学] 

基　　金：small private donations to the Sleep&Human Health Institute 

主　　题：Insomnia Obstructive sleep apnea Complex insomnia CBT-I Posttraumatic stress symptoms CPAP Auto bi-level Adaptive servo-ventilation 

摘      要：Background:Sleep disorders frequently occur in posttraumatic stress disorder(PTSD)*** insomnia is a common feature of and criteria for the diagnosis of *** sleep disorder,obstructive sleep apnea(OSA),also occurs frequently in PTSD,and emerging research indicates OSA fuels chronic *** research has investigated the impact of OSA treatment on insomnia outcomes(Insomnia Severity Index,ISI)in trauma ***:OSA patients with moderately severe posttraumatic stress symptoms were studied in a retrospective chart ***-six patients who failed CPAP therapy due to expiratory pressure intolerance or complex sleep apnea or both underwent manual titration with advanced PAP modes[autobilevel(ABPAP);adaptive servo-ventilation(ASV)],which were subsequently *** use measured by objective data downloads divided the sample into three groups:compliant regular users(C-RU):n=68;subthreshold users(SC-RU):n=12;and noncompliant users(NC-MU):n=*** average follow-up was 11.89±12.22 *** and posttreatment ISI scores were analyzed to assess residual insomnia symptoms as well as cure ***:The C-RU group showed significant improvements in insomnia with very large effects compared to those in the NC-MU reference group(P=0.019).Insomnia severity significantly decreased in all three groups with large effects(C-RU,P=0.001;SC-RU,P=0.027;NC-MU,P=0.007).Hours of weekly PAP use and insomnia severity were inversely correlated(P=0.001,r=–0.321).However,residual insomnia symptoms based on established ISI cut-offs were quite common,even among the C-RU *** hoc analysis showed that several categories of sedating medications reported at baseline(hypnotics,anti-epileptic,opiates)as well as actual use of any sedating medication(prescription or nonprescription)were associated with smaller insomnia improvements than those in patients not using any sedating ***:In a retrospective,nonrandomized analysis of a selec