Study Objectives: Patients with comorbid posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA) manifest low adherence to continuous positive airway pressure (CPAP) due to fixed, pressure-induced expiratory pressure intolerance (EPI), a subjective symptom and objective sign aggravated by anxiety sensitivity and somatosensory amplification. As advanced PAP therapy modes (ie, auto-bilevel PAP [ABPAP] or adaptive servo-ventilation [ASV]) may address these side effects, we hypothesized such treatment would be associated with decreased expiratory intolerance and increased adherence in posttraumatic stress patients with co-occurring OSA.
Methods: We reviewed charts of 147 consecutive adult patients with moderately severe posttraumatic stress symptoms and objectively diagnosed OSA. All patients failed or rejected CPAP and were manually titrated on auto-adjusting, dual-pressure ABPAP or ASV modes in the sleep laboratory, a technique to eliminate flow limitation breathing events while resolving EPI. Patients were then prescribed either mode of therapy. Follow-up encounters assessed patient use, and objective data downloads (ODDs) measured adherence.
Results: Of 147 charts reviewed, 130 patients were deemed current PAP users, and 102 provided ODDs: 64 used ASV and 38 used ABPAP. ODDs yielded three groups: 59 adherent per insurance conventions, 19 subthreshold compliant partial users, and 24 noncompliant. Compliance based on available downloads was 58%, notably higher than recently reported rates in PTSD patients with OSA. Among the 19 partial users, 17 patients were minutes of PAP use or small percentages of nights removed from meeting insurance compliance criteria for PAP devices.
Conclusion: Research is warranted on advanced PAP modes in managing CPAP failure in PTSD patients with comorbid OSA. Subthreshold adherence constructs may inform clinical care in a patient-centric model distinct from insurance conventions. Speculatively, clinical application of this transitional zone ("subthreshold" number of hours) may increase PAP use and eventual adherence.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5700760 | PMC |
| http://dx.doi.org/10.2147/PPA.S148099 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Post-Traumatic Stress Across Color Lines: A History of Anti-Black Exclusion & PTSD.
Community Ment Health J
January 2025
School of Social Work, Virginia Commonwealth University, Richmond, VA, USA.
Black Americans with Posttraumatic Stress Disorder have less access to mental healthcare compared to White Americans. Many factors contribute to this inequity, including broader disparities within the healthcare system driven by systemic racism, and an underutilization of mental health services by Black Americans due to provider bias and stigma around mental health care. These disparities are rooted in a racist historical context of exclusion and abuse of the Black community by the White psychiatric establishment, and a perpetration of further trauma on Black clients, a context that is largely missing from traditional mental health education and literature on Black mental health today.
View Article and Find Full Text PDFPsychosocial situation, burden, and unmet needs among informal caregivers prior to hematopoietic stem cell transplantation: a systematic review of quantitative and qualitative data.
Support Care Cancer
January 2025
Nursing Department, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Yuelu District, Hexi District, Changsha, Hunan, China.
Background: Informal caregivers may face challenges, especially during the pre-transplant phase. We have learned about the challenges faced by informal caregivers during hematopoietic stem cell transplantation; there is a lack of consensus about the challenges faced by them before transplantation. We identified the psychosocial well-being of informal caregivers to patients before hematopoietic stem cell transplantation.
View Article and Find Full Text PDFCardiovascular risk and allostatic load in PTSD: The role of cumulative trauma and resilience in affected and trauma-exposed adults.
J Psychiatr Res
January 2025
Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; South African Medical Research Council Genomics of Brain Disorders Unit, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
Background: The pathophysiology of posttraumatic stress disorder (PTSD) involves dysregulation of stress-sensitive biological systems due to repeated trauma exposure, predisposing individuals to the development of cardiovascular disease (CVD). Allostatic load (AL), an indicator of maladaptive stress responses, could shed light on the underlying biological mechanisms. We determined whether CVD risk and AL were associated with trauma load and resilience in women with PTSD and trauma-exposed controls (TEC).
View Article and Find Full Text PDFPathways from violence exposure to medication non-adherence: exploration of mental health symptoms and coping in people living with HIV in the U.S. South.
AIDS Care
January 2025
Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
In the current study, we examine associations between exposure to violence and antiretroviral medication adherence in persons with HIV (PWH) in a southern city in the United States. We include investigation of a variety of violence exposures including childhood sexual abuse, physical abuse, witnessing family violence, lifetime violence exposures and current stress related to violence experiences, as well as neighborhood violence exposure. We examined associations between violence exposures and adherence and mediational pathways between these variables including mental health symptoms - specifically depressive, anxiety, and posttraumatic stress symptoms - as well as coping strategies.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!