Skip to main content

Sleep-Disordered Breathing and Posttraumatic Stress Disorder

  • Chapter
  • First Online:
Sleep and Combat-Related Post Traumatic Stress Disorder

Abstract

Sleep-disordered breathing (SDB) and posttraumatic stress disorder (PTSD) are relatively common in isolation within the adult population. Data reflecting causes, prevalence, and long-term physical and psychological consequences are substantial for either condition. Less known is the prevalence of comorbidity among the two. Moreover, there is a dearth of literature explaining the biopsychosocial interactions, which likely contribute to development, maintenance, and exacerbation of symptoms when the conditions co-occur. In this chapter we review the scant literature on the comorbidity of SDB and PTSD regarding prevalence, clinical implications, and recommendations related to improved diagnostic assessment and treatment strategies.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230–5.

    Article  CAS  PubMed  Google Scholar 

  2. Iber C A-ISCAQS. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Westchester: American Academy of Sleep Medicine; 2007.

    Google Scholar 

  3. Sanner B, Schafer T. Central sleep apnea syndrome. Dtsch Med Wochenschr. 2008;133(14):722–6.

    Article  CAS  PubMed  Google Scholar 

  4. Krakow B, Romero EA, Ulibarri VA, Kikta S, Thomas RJ. ASV therapy in anxious or insomnia patients with complex sleep apnea. Sleep. 2010;33:A146. Abstract

    Article  Google Scholar 

  5. Webster JB, Bell KR, Hussey JD, Natale TK, Lakshminarayan S. Sleep apnea in adults with traumatic brain injury: a preliminary investigation. Arch Phys Med Rehabil. 2001;82(3):316–21.

    Article  CAS  PubMed  Google Scholar 

  6. Boscarino JA. Posttraumatic stress disorder and physical illness: results from clinical and epidemiologic studies. Ann N Y Acad Sci. 2004;1032:141–53.

    Article  PubMed  Google Scholar 

  7. Pietrzak RH, Goldstein RB, Southwick SM, Grant BF. Physical health conditions associated with posttraumatic stress disorder in U.S. older adults: results from wave 2 of the National Epidemiologic Survey on alcohol and related conditions. J Am Geriatr Soc. 2012;60(2):296–303.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Shamsuzzaman AS, Gersh BJ, Somers VK. Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA. 2003;290(14):1906–14.

    Article  CAS  PubMed  Google Scholar 

  9. Sledjeski EM, Speisman B, Dierker LC. Does number of lifetime traumas explain the relationship between PTSD and chronic medical conditions? Answers from the National Comorbidity Survey-Replication (NCS-R). J Behav Med. 2008;31(4):341–9.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A, et al. Sleep apnea and cardiovascular disease: an American Heart Association/american college of cardiology foundation scientific statement from the American Heart Association Council for high blood pressure research professional education committee, Council on clinical cardiology, stroke Council, and Council on cardiovascular nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on sleep disorders research (National Institutes of Health). Circulation. 2008;118(10):1080–111.

    Article  PubMed  Google Scholar 

  11. Nazarian D, Kimerling R, Frayne SM. Posttraumatic stress disorder, substance use disorders, and medical comorbidity among returning U.S. veterans. J Trauma Stress. 2012;25(2):220–5.

    Article  PubMed  Google Scholar 

  12. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342(19):1378–84.

    Article  CAS  PubMed  Google Scholar 

  13. Kang JH, Lin HC. Obstructive sleep apnea and the risk of autoimmune diseases: a longitudinal population-based study. Sleep Med. 2012;13(6):583–8.

    Article  PubMed  Google Scholar 

  14. Ablin JN, Cohen H, Eisinger M, Buskila D. Holocaust survivors: the pain behind the agony. Increased prevalence of fibromyalgia among Holocaust survivors. Clin Exp Rheumatol. 2010;28(6 Suppl 63):S51–6.

    CAS  PubMed  Google Scholar 

  15. Raphael KG, Janal MN, Nayak S. Comorbidity of fibromyalgia and posttraumatic stress disorder symptoms in a community sample of women. Pain Med. 2004;5(1):33–41.

    Article  PubMed  Google Scholar 

  16. Gold AR, Dipalo F, Gold MS, Broderick J. Inspiratory airflow dynamics during sleep in women with fibromyalgia. Sleep. 2004;27(3):459–66.

    Article  PubMed  Google Scholar 

  17. Shah MA, Feinberg S, Krishnan E. Sleep-disordered breathing among women with fibromyalgia syndrome. J Clin Rheumatol. 2006;12(6):277–81.

    Article  PubMed  Google Scholar 

  18. Attal P, Chanson P. Endocrine aspects of obstructive sleep apnea. J Clin Endocrinol Metab. 2010;95(2):483–95.

    Article  CAS  PubMed  Google Scholar 

  19. Vgontzas AN, Bixler EO, Chrousos GP. Metabolic disturbances in obesity versus sleep apnoea: the importance of visceral obesity and insulin resistance. J Intern Med. 2003;254(1):32–44.

    Article  CAS  PubMed  Google Scholar 

  20. Rains JC, Poceta JS. Headache and sleep disorders: review and clinical implications for headache management. Headache. 2006;46(9):1344–63.

    Article  PubMed  Google Scholar 

  21. Bahammam SA, Sharif MM, Jammah AA, Bahammam AS. Prevalence of thyroid disease in patients with obstructive sleep apnea. Respir Med. 2011;105(11):1755–60.

    Article  PubMed  Google Scholar 

  22. Krakow B, Germain A, Tandberg D, Koss M, Schrader R, Hollifield M, et al. Sleep breathing and sleep movement disorders masquerading as insomnia in sexual-assault survivors. Compr Psychiatry. 2000;41(1):49–56.

    Article  CAS  PubMed  Google Scholar 

  23. Krakow B, Tandberg D, Sandoval D, Cutchen L, Schrader R. Severity of sleep disturbances in sexual assault survivors. Sleep. 1998:3(6):583–8.

    Google Scholar 

  24. Youakim JM, Doghramji K, Schutte SL. Posttraumatic stress disorder and obstructive sleep apnea syndrome. Psychosomatics. 1998;39(2):168–71.

    Article  CAS  PubMed  Google Scholar 

  25. Dagan Y, Lavie P, Bleich A. Elevated awakening thresholds in sleep stage 3-4 in war-related post-traumatic stress disorder. Biol Psychiatry. 1991;30(6):618–22.

    Article  CAS  PubMed  Google Scholar 

  26. Lavie P, Katz N, Pillar G, Zinger Y. Elevated awaking thresholds during sleep: characteristics of chronic war-related posttraumatic stress disorder patients. Biol Psychiatry. 1998;44(10):1060–5.

    Article  CAS  PubMed  Google Scholar 

  27. de Groen JH, Op den Velde W, Hovens JE, Falger PR, Schouten EG, van Duijn H. Snoring and anxiety dreams. Sleep. 1993;16(1):35–6.

    PubMed  Google Scholar 

  28. Guilleminault C. Sleep disorders. In: Handbook of clinical neurology: clinical neuropsychology. Amsterdam: Elsevier; 1985. p. 129–45.

    Google Scholar 

  29. Krakow B, Lowry C, Germain A, Gaddy L, Hollifield M, Koss M, et al. A retrospective study on improvements in nightmares and post-traumatic stress disorder following treatment for co-morbid sleep-disordered breathing. J Psychosom Res. 2000;49(5):291–8.

    Article  CAS  PubMed  Google Scholar 

  30. Krakow B, Artar A, Warner TD, Melendrez D, Johnston L, Hollifield M, et al. Sleep disorder, depression, and suicidality in female sexual assault survivors. Crisis. 2000;21(4):163–70.

    Article  CAS  PubMed  Google Scholar 

  31. Krakow B, Germain A, Warner TD, Schrader R, Koss M, Hollifield M, et al. The relationship of sleep quality and posttraumatic stress to potential sleep disorders in sexual assault survivors with nightmares, insomnia, and PTSD. J Trauma Stress. 2001;14(4):647–65.

    Article  CAS  PubMed  Google Scholar 

  32. Krakow B, Melendrez D, Pedersen B, Johnston L, Hollifield M, Germain A, et al. Complex insomnia: insomnia and sleep-disordered breathing in a consecutive series of crime victims with nightmares and PTSD. Biol Psychiatry. 2001;49(11):948–53.

    Article  CAS  PubMed  Google Scholar 

  33. Krakow B, Melendrez D, Johnston L, Warner TD, Clark JO, Pacheco M, et al. Sleep-disordered breathing, psychiatric distress, and quality of life impairment in sexual assault survivors. J Nerv Ment Dis. 2002;190(7):442–52.

    Article  PubMed  Google Scholar 

  34. Krakow B, Melendrez D, Warner TD, Dorin R, Harper R, Hollifield M. To breathe, perchance to sleep: sleep-disordered breathing and chronic insomnia among trauma survivors. Sleep Breath. 2002;6(4):189–202.

    Article  PubMed  Google Scholar 

  35. Series F, Roy N, Marc I. Effects of sleep deprivation and sleep fragmentation on upper airway collapsibility in normal subjects. Am J Respir Crit Care Med. 1994;150(2):481–5.

    Article  CAS  PubMed  Google Scholar 

  36. Lopez-Ibor JJ. The classification of stress-related disorders in ICD-10 and DSM-IV. Psychopathology. 2002;35(2–3):107–11.

    Article  PubMed  Google Scholar 

  37. Pearn J. Traumatic stress disorders: a classification with implications for prevention and management. Mil Med. 2000;165(6):434–40.

    CAS  PubMed  Google Scholar 

  38. Yufik T, Simms LJ. A meta-analytic investigation of the structure of posttraumatic stress disorder symptoms. J Abnorm Psychol. 2010;119(4):764–76.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Pagel JF Jr. Nightmares. Am Fam Physician. 1989;39(3):145–8.

    PubMed  Google Scholar 

  40. Ross RJ, Ball WA, Sullivan KA, Caroff SN. Sleep disturbance as the hallmark of posttraumatic stress disorder. Am J Psychiatry. 1989;146(6):697–707.

    Article  CAS  PubMed  Google Scholar 

  41. Benca RM. Sleep in psychiatric disorders. Neurol Clin. 1996;14(4):739–64.

    Article  CAS  PubMed  Google Scholar 

  42. Mellman TA. Psychobiology of sleep disturbances in posttraumatic stress disorder. Ann N Y Acad Sci. 1997;821:142–9.

    Article  CAS  PubMed  Google Scholar 

  43. Pillar G, Malhotra A, Lavie P. Post-traumatic stress disorder and sleep-what a nightmare! Sleep Med Rev. 2000;4(2):183–200.

    Article  PubMed  Google Scholar 

  44. Singareddy RK, Balon R. Sleep in posttraumatic stress disorder. Ann Clin Psychiatry. 2002;14(3):183–90.

    Article  PubMed  Google Scholar 

  45. Harvey AG, Jones C, Schmidt DA. Sleep and posttraumatic stress disorder: a review. Clin Psychol Rev. 2003;23(3):377–407.

    Article  PubMed  Google Scholar 

  46. Caldwell BA, Redeker N. Sleep and trauma: an overview. Issues Ment Health Nurs. 2005;26(7):721–38.

    Article  PubMed  Google Scholar 

  47. Maher MJ, Rego SA, Asnis GM. Sleep disturbances in patients with post-traumatic stress disorder: epidemiology, impact and approaches to management. CNS Drugs. 2006;20(7):567–90.

    Article  CAS  PubMed  Google Scholar 

  48. Mellman TA, Hipolito MM. Sleep disturbances in the aftermath of trauma and posttraumatic stress disorder. CNS Spectr. 2006;11(8):611–5.

    Article  PubMed  Google Scholar 

  49. Kobayashi I, Boarts JM, Delahanty DL. Polysomnographically measured sleep abnormalities in PTSD: a meta-analytic review. Psychophysiology. 2007;44(4):660–9.

    Article  PubMed  Google Scholar 

  50. Lamarche LJ, De Koninck J. Sleep disturbance in adults with posttraumatic stress disorder: a review. J Clin Psychiatry. 2007;68(8):1257–70.

    Article  PubMed  Google Scholar 

  51. van Liempt S, Vermetten E, de Groen JH, Westenberg HG. Sleep disturbances in post-traumatic stress disorder. An overview of the literature. Tijdschr Psychiatr. 2007;49(9):629–38.

    PubMed  Google Scholar 

  52. Germain A, Buysse DJ, Nofzinger E. Sleep-specific mechanisms underlying posttraumatic stress disorder: integrative review and neurobiological hypotheses. Sleep Med Rev. 2008;12(3):185–95.

    Article  PubMed  Google Scholar 

  53. Spoormaker VI, Montgomery P. Disturbed sleep in post-traumatic stress disorder: secondary symptom or core feature? Sleep Med Rev. 2008;12(3):169–84.

    Article  PubMed  Google Scholar 

  54. Aurora RN, Zak RS, Auerbach SH, Casey KR, Chowdhuri S, Karippot A, et al. Best practice guide for the treatment of nightmare disorder in adults. J Clin Sleep Med. 2010;6(4):389–401.

    PubMed  PubMed Central  Google Scholar 

  55. Babson KA, Feldner MT. Temporal relations between sleep problems and both traumatic event exposure and PTSD: a critical review of the empirical literature. J Anxiety Disord. 2010;24(1):1–15.

    Article  PubMed  PubMed Central  Google Scholar 

  56. American Academy of Sleep Medicine. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The report of an American Academy of sleep medicine task force. Sleep. 1999;22:667–89.

    Article  Google Scholar 

  57. American Academy of Sleep Medicine. International classification of sleep disorders: diagnostic & Coding Manual. 2nd ed. Westchester, IL: American Academy of Sleep Medicine; 2005.

    Google Scholar 

  58. Breslau N, Roth T, Burduvali E, Kapke A, Schultz L, Roehrs T. Sleep in lifetime posttraumatic stress disorder: a community-based polysomnographic study. Arch Gen Psychiatry. 2004;61(5):508–16.

    Article  PubMed  Google Scholar 

  59. Habukawa M, Uchimura N, Maeda M, Kotorii N, Maeda H. Sleep findings in young adult patients with posttraumatic stress disorder. Biol Psychiatry. 2007;62(10):1179–82.

    Article  PubMed  Google Scholar 

  60. Yetkin S, Aydin H, Ozgen F. Polysomnography in patients with post-traumatic stress disorder. Psychiatry Clin Neurosci. 2010;64(3):309–17.

    Article  PubMed  Google Scholar 

  61. Engdahl BE, Eberly RE, Hurwitz TD, Mahowald MW, Blake J. Sleep in a community sample of elderly war veterans with and without posttraumatic stress disorder. Biol Psychiatry. 2000;47(6):520–5.

    Article  CAS  PubMed  Google Scholar 

  62. Yesavage JA, Kinoshita LM, Kimball T, Zeitzer J, Friedman L, Noda A et al. Sleep-disordered breathing in Vietnam veterans with posttraumatic stress disorder. Am J Geriatr Psychiatry. 2010:3(6):583–8.

    Google Scholar 

  63. Mellman TA, Kulick-Bell R, Ashlock LE, Nolan B. Sleep events among veterans with combat-related posttraumatic stress disorder. Am J Psychiatry. 1995;152(1):110–5.

    Article  CAS  PubMed  Google Scholar 

  64. Fuller KH, Waters WF, Scott O. An investigation of slow-wave sleep processes in chronic PTSD patients. J Anxiety Disord. 1994;8(3):227–36.

    Article  Google Scholar 

  65. Sharafkhaneh A, Giray N, Richardson P, Young T, Hirshkowitz M. Association of psychiatric disorders and sleep apnea in a large cohort. Sleep. 2005;28(11):1405–11.

    Article  PubMed  Google Scholar 

  66. Raper TB, Li J, Desai NR, Hayek H, Thammasitboon S. Posttraumatic stress disorder is highly prevalent in veterans with obstructive sleep apnea. Sleep. 2010;33:A235. Abstract

    Article  Google Scholar 

  67. Wolf J, Lewicka J, Narkiewicz K. Obstructive sleep apnea: an update on mechanisms and cardiovascular consequences. Nutr Metab Cardiovasc Dis. 2007;17(3):233–40.

    Article  PubMed  Google Scholar 

  68. Pietrzak RH, Goldstein RB, Southwick SM, Grant BF. Medical comorbidity of full and partial posttraumatic stress disorder in US adults: results from wave 2 of the National Epidemiologic Survey on alcohol and related conditions. Psychosom Med. 2011;73(8):697–707.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Ohayon MM, Schatzberg AF. Chronic pain and major depressive disorder in the general population. J Psychiatr Res. 2010;44(7):454–61.

    Article  PubMed  Google Scholar 

  70. Garrido M, Hash-Converse J, Leventhal H, Leventhal E. The handbook of stress science: biology, psychology, and health [e-book]. Internet, 487–500. 2011. Springer Publishing Co. Electronic Citation.

    Google Scholar 

  71. Ware JE, Koskinski M, Keller SD. SF-36 physical and mental health summary scales: a user’s manual. Boston: The Health Institute; 1994.

    Google Scholar 

  72. Kushida CA, Littner MR, Hirshkowitz M, Morgenthaler TI, Alessi CA, Bailey D, et al. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep. 2006;29(3):375–80.

    Article  PubMed  Google Scholar 

  73. El Solh AA, Ayyar L, Akinnusi M, Relia S, Akinnusi O. Positive airway pressure adherence in veterans with posttraumatic stress disorder. Sleep. 2010;33(11):1495–500.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Means MK, Ulmer CS, Edinger JD. Ethnic differences in continuous positive airway pressure (CPAP) adherence in veterans with and without psychiatric disorders. Behav Sleep Med. 2010;8(4):260–73.

    Article  PubMed  Google Scholar 

  75. Lajos LE, Molina PE, Im SS, Gonzales PA, Garza PC, Ingmundson PT. Continuous positive airway pressure adherence among veterans with and without posttraumatic stress disorder. Sleep. 2004;27:A228.

    Google Scholar 

  76. Hoffman M, Lettieri C. Adherence to continuous positive airway pressure treatment of obstructive sleep apnea in patients with posttraumatic stress disorder. Sleep. 2010;33:A237. Abstract

    Google Scholar 

  77. Bollig SM. Encouraging CPAP adherence: it is everyone’s job. Respir Care. 2010;55(9):1230–9.

    PubMed  Google Scholar 

  78. Self guided imagery enhances PAP therapy adaptation. 08 June; 2008.

    Google Scholar 

  79. McIver ND, Krakow B, Romero EA, Trujillo LL. Subjective effects of self-guided imagery on PAP therapy adaptation. Sleep. 2008;31. Abstract.

    Google Scholar 

  80. Krakow B. Sound sleep, sound mind: 7 keys to sleeping through the night. New York: Wiley; 2007.

    Google Scholar 

  81. Krakow B, Ulibarri VA, Romero EA, Thomas R, Togami L. Adaptive servo-ventilation therapy for expiratory pressure intolerance and complex sleep apnea in patients with co-morbid insomnia: a retrospective case series. (in submission). J Sleep Disor Treat Care. 2013;2:1–10.

    Article  Google Scholar 

  82. Krakow B, Ulibarri V, Melendrez D, Kikta S, Togami L, Haynes P. A daytime, abbreviated cardio-respiratory sleep study (CPT 95807-52) to acclimate insomnia patients with sleep disordered breathing to positive airway pressure (PAP-NAP). J Clin Sleep Med. 2008;4(3):212–22.

    PubMed  PubMed Central  Google Scholar 

  83. Krakow B. Paving the way to optimal titrations. The PAP-NAP: a titration by any other name. Sleep Rev J Sleep Specialists. 2011;11:14–21.

    Google Scholar 

  84. Eastwood PR, Malhotra A, Palmer LJ, Kezirian EJ, Horner RL, Ip MS, et al. Obstructive sleep apnoea: from pathogenesis to treatment: current controversies and future directions. Respirology. 2010;15(4):587–95.

    Article  PubMed  PubMed Central  Google Scholar 

  85. Hamner MB, Frueh BC, Ulmer HG, Huber MG, Twomey TJ, Tyson C, et al. Psychotic features in chronic posttraumatic stress disorder and schizophrenia: comparative severity. J Nerv Ment Dis. 2000;188(4):217–21.

    Article  CAS  PubMed  Google Scholar 

  86. Reiber GE, McFarland LV, Hubbard S, Maynard C, Blough DK, Gambel JM, et al. Service members and veterans with major traumatic limb loss from Vietnam war and OIF/OEF conflicts: survey methods, participants, and summary findings. J Rehabil Res Dev. 2010;47(4):275–97.

    Article  PubMed  Google Scholar 

  87. Hurwitz TD, Khawaja I. Treatment of obstructive sleep apnea may be an important adjunct to therapy of posttraumatic stress disorder not to be overlooked. Sleep. 2010;33(11):1435–6.

    Article  PubMed  PubMed Central  Google Scholar 

  88. Krakow B, Melendrez D, Lee SA, Warner TD, Clark JO, Sklar D. Refractory insomnia and sleep-disordered breathing: a pilot study. Sleep Breath. 2004;8(1):15–29.

    Article  PubMed  Google Scholar 

  89. Krakow B, Ulibarri VA. Prevalence of sleep breathing complaints reported by treatment-seeking chronic insomnia disorder patients on presentation to a sleep medical center: a preliminary report. Sleep Breath. 2012. Epub (Ahead of Print). 3(6):583–8.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Barry Krakow .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer Science+Business Media LLC

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Krakow, B., Moore, B., Ulibarri, V.A. (2018). Sleep-Disordered Breathing and Posttraumatic Stress Disorder. In: Vermetten, E., Germain, A., Neylan, T. (eds) Sleep and Combat-Related Post Traumatic Stress Disorder. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-7148-0_21

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-7148-0_21

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-7146-6

  • Online ISBN: 978-1-4939-7148-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics