Comprehensive Sleep Apnea Screening in Veterans with Posttraumatic Stress Disorder

Objectives: Recent studies have shown a higher prevalence of sleep apnea in veterans with Posttraumatic Stress Disorder (PTSD). It is estimated that 69 to 83% of veterans have Obstructive Sleep Apnea (OSA) while 80 to 90% are undiagnosed or untreated. Untreated OSA can lead to severe chronic medical conditions as well as impairment of neurocognitive and fear extinction processing potentially decreasing responsiveness to trauma focused therapy. Despite the widespread dissemination of knowledge regarding the negative effects of OSA, many veterans are not screened. The goal of this project is to increase the rate of identifying veterans who are high-risk for OSA. Methods: The Epworth Sleepiness Scale (ESS) and Berlin Questionnaire (BQ) were administered to veterans who presented for PTSD treatment over a two-month period. High-risk veterans were referred for a sleep study and treatment if diagnosed with OSA. Veterans with a prior diagnosis of OSA were screened to identify undertreatment. Results: Increase in identifying high-risk OSA from 5.5% to 71.4%, with an overall increase in the diagnostic rate from 22.2% to 78.3%. In veterans previously diagnosed with OSA, 90.1% were undertreated. Conclusions: Implementing a comprehensive screening process significantly improved the identification of veterans who are high-risk for OSA compared to usual practice. Identification and treatment of OSA is associated with an improvement in PTSD symptoms. Due to the potential effects of untreated OSA on psychiatric and medical conditions this screening process is applicable to both mental health and primary care settings