The Effect of Nasal Continuous Positive Airway Pressure Treatment on PTSD Symptoms.
Condition: Post Traumatic Stress Disorder; Anxiety; Nightmares; Unrefreshed Sleep
MeSH terms: Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic
Study type: Observational

Summary: 
      We hypothesize that prevention of Sleep Disordered Breathing among PTSD patients with nasal
      CPAP will result improve their anxiety, insomnia and alcohol craving (among those who use
      alcohol to control their symptoms).
    

Detailed description: 
      Design: This is a pilot study to study the effect of nasal CPAP on the symptoms of PTSD in
      veterans.

      Recruitment Methods:

      Veterans with PTSD will be recruited from the Northport VAMC PTSD unit. The ACOS/Mental
      Health will refer patients that meet inclusion criteria and do not have an impaired decision
      making capacity. Subjects will be screened for decision-making capacity by their treating
      psychiatrist as part of their clinical assessment upon admission to the PTSD unit.

      Study Methods

      This will be a prospective, randomized, controlled interventional trial:

        1. Participants will undergo a routine clinical sleep study at the PTSD unit (using a
           portable polysomnographic recording unit). or undergo a routine clinical polysomnography
           to diagnose sleep disordered breathing

        2. Participants who demonstrate SDB will be randomized into two groups based upon their
           body mass index

             1. Group A: BMI < 30 kg/m2

             2. Group B: BMI > 30 kg/m2 The reason for these two arms is to study the effect of
                nasal CPAP upon PTSD symptoms in veterans with a high prevalence of sleep apnea (
                BMI above 30 kg/m2) and in veterans with predominantly snoring (BMI below 30
                kg/m2).

           Each group will then be randomized into two sub-groups regarding treatment.

             1. Treatment group receives an automated CPAP unit to use during sleep for 6 weeks in
                conjunction with their usual care in the PTSD unit (psychotherapy).

             2. Control group receives the usual care that is provided in the PTSD unit for 6 weeks
                (change in medications will exclude the subject from the study), if any participant
                in the control group would like to try nasal CPAP, then he will be crossed over to
                use an automated CPAP unit during sleep for his second 6 weeks in the PTSD unit
                together with usual care.

        3. All participants will fill out the following questionnaires at baseline and after 6
           weeks. (Those in the control group who have been crossed-over to nasal CPAP will also
           fill out a set of questionnaire at 12 weeks).

             1. PTSD checklist-military version (anxiety)

             2. MASQ anxious arousal subscale (anxiety)

             3. Insomnia Severity Index (insomnia)

             4. The alcohol craving questionnaire (with an alcohol history during the intake) The
                changes in patient's reported outcomes will be compared before and after CPAP
                treatment and psychotherapy alone
    

Intervention name(s): CPAP
Intervention type(s): Other
Intervention description(s): 6 weeks of CPAP
Observational model: Case-Crossover
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        veterans admitted to PTSD unit at Northport VAMC