Introduction: Obstructive sleep apnea (OSA) is a disorder with prevalence reported as high as 26% in adults between the ages of 30 and 70 years. Despite being a prevalent comorbidity, the clinical impact of OSA has historically been underestimated. Recently OSA has been recognized as having major effects on the global disease burden. Previous studies have shown Post-Traumatic Stress Disorder (PTSD) and traumatic events correlate with many comorbidities including increased cardiovascular disease and OSA. None, however, have shown a relationship between PTSD and OSA independent of cardiac risk factors. In this abstract we aim to show the relationship between PTSD and OSA independent of CVD risk factors.
Methods: We evaluated 1,012 participants in the World Trade Center (WTC)-CHEST Program from January 2011 to September 2013. PTSD was defined as self-reported diagnosis and/or a score of above 50 on the PCL-S questionnaire. Subjects also completed the Perceived Stress Scale (PSS) questionnaire. OSA Diagnosis defined by patient reported physician diagnosis and/or diagnosis on home sleep test (Watch Pat) with Apnea/Hypopnea Index All Night > 5.0. Chi-square analysis, independent t-test, and logistic regressions were performed in SAS 9.4.
Results: Those with PTSD were 2.4 times more likely to have OSA diagnosis than those without (OR=2.386, 95% CI=1.624, 3.509, p=<0.0001. For every increased score on the PSS there was a 5% increase in the change of OSA (OR=1.051, 95% CI=1.029-1.075, p <0.0001). After adjusting for age, gender, body mass index, history of hypertension, hyperlipidemia and diabetes and high sensitivity C-Reactive Protein both PTSD and PSS remain significant with OR=2.187, 95% CI 1,430, 3.342, p=0.0003 and OR=1.050, 95% CI=1.025, 1.076, p<0.0001 respectively.
Conclusions: PTSD is significantly associated with OSA independently of CVD risk factors. It is important that those with PTSD and high levels of stress be assessed for possible OSA.