Examining Early Intervention Obstructive Sleep Apnea Treatment on Long-Term Outcomes in Veterans with SUD/PTSD in a Residential Treatment Program

目标。物质使用障碍(SUD)和创伤后应激障碍(PTSD)经常并存 其中一种情况会使另一种情况恶化。患有这两种疾病的人表现得更差 比单独患有任何一种障碍的人在多个领域发挥作用的人更多。这一点在 这两种疾病都比门诊更严重的居住环境。与退伍军人相比， 作为一种单一的障碍，患有SUD/PTSD的退伍军人也更有可能有自杀念头和 自杀未遂。检查与改善的SUD和PTSD相关的可治疗条件 结果，如阻塞性睡眠呼吸暂停(OSA)，可以最大限度地提高治疗效果的退伍军人在危急 恢复的时间到了。 阻塞性睡眠呼吸暂停综合征与创伤后应激障碍和创伤后应激障碍高度并存，67%至83%的退伍军人患有创伤后应激障碍或 创伤后应激障碍也有阻塞性睡眠呼吸暂停。此外，未经治疗的阻塞性睡眠呼吸暂停综合征与更严重的功能损害有关 多个领域，更差的生活质量，更糟糕的创伤后应激障碍，以及更高的药物使用率和复发率。重要的是 未经治疗的阻塞性睡眠呼吸暂停综合征也会导致更高的自杀未遂和自杀完成率。气道正压(PAP)是 OSA的黄金标准治疗对功能、生活质量、创伤后应激障碍等多个领域有很大影响 症状、身体功能、较低的抑郁和更好的情绪应对。不幸的是，筛选和 治疗OSA退伍军人不是SUD或PTSD治疗的临床实践的一部分；因此，平均 个人接受PAP治疗的等待时间超过两年。尽管广泛传播了 关于未经治疗的阻塞性睡眠呼吸暂停的有害影响和PAP令人难以置信的有效性的知识 治疗方面，阻塞性睡眠呼吸暂停综合征很少筛查或治疗，大约有80%到90%的患者患有SUD或PTSD 患有阻塞性睡眠呼吸暂停综合症的退伍军人仍未得到诊断和治疗。 方法论。我们的目标是检查PAP治疗对患有创伤后应激障碍和SUD的退伍军人的影响。 日间住宅单元。我们建议进行一项随机对照研究，比较两组：早期 干预性PAP治疗组在居住单元接受PAP治疗，与等待名单进行比较 对照组在出院后3个月接受PAP治疗，并进行随访。参赛者为194人 居住在SUD和PTSD病房的男性和女性退伍军人患有SUD、PTSD和OSA。我们的首要目标是 是确定PAP治疗在SUD/PTSD单元中的相对疗效，与等待名单对照相比， 减少有问题的物质使用、创伤后应激障碍症状和自杀念头，同时改善功能 在退伍军人中，在治疗后3个月的随访中，同时患有SUD/PTSD。我们还将比较PAP PAP治疗组内PTSD/SUD/功能结局的依从率(3个月)。最后，我们 治疗后6个月随访时比较两组依从率的计划 向上评估。 检查OSA对SUD和PTSD的治疗与RR&D和VA的目标高度相关 最大限度地提高退伍军人的治疗效果，并有可能改善功能和心理 为高度流行和高度受损的退伍军人群体提供恢复。这项研究将直接影响 患有SUD的脆弱退伍军人的功能结局、SUD恢复和创伤后应激障碍症状 和创伤后应激障碍。该项目的成功完成将有助于改进推动治疗的做法 患有创伤后应激障碍和创伤后应激障碍的退伍军人。这项研究的基本原理是改进证据 基础，告知SUD和PTSD患者如何从这两种疾病中获得持续的康复 精神错乱。 Colvonen-1

Objectives. Substance use disorder (SUD) and posttraumatic stress disorder (PTSD) frequently co-occur and having one condition worsens the course of the other. Individuals with both disorders exhibit worse functioning across a number of domains than individuals with either disorder alone. This is especially true in residential settings where both disorders are more severe than outpatient settings. Compared to Veterans with a single disorder, Veterans with SUD/PTSD also are more likely to have suicidal ideation and to have attempted suicide. Examining treatable conditions that are associated with improved SUD and PTSD outcomes, such as obstructive sleep apnea (OSA), can maximize treatment efficacy for Veterans at a critical time in recovery. OSA is highly comorbid with both PTSD and SUD with upwards of 67 to 83% of Veterans with SUD or PTSD also having OSA. Further, untreated OSA is associated with worse functional impairment across multiple domains, worse quality of life, worse PTSD, and higher substance use and relapse rates. Importantly, untreated OSA also contributes to higher suicide attempts and completion. Positive airway pressure (PAP) is the gold standard treatment for OSA with large effects on multiple domains of functioning, quality of life, PTSD symptoms, physical functioning, lower depression, and better emotional coping. Unfortunately, screening and treating Veterans for OSA is not a part of clinical practice for SUD or PTSD treatment; as such the average wait time for individuals to get PAP therapy is upward of two years. Despite the widespread dissemination of knowledge regarding the detrimental effects of untreated OSA and the incredible effectiveness of PAP treatment, OSA is rarely screened for or treated in patients with SUD or PTSD, with approximately 80% to 90% of Veterans with OSA remaining undiagnosed and untreated. Methodology. We aim to examine the effects of PAP treatment on Veterans with PTSD and SUD on a 28- day residential unit. We are proposing a randomized controlled study comparing two groups: an early intervention PAP treatment group receiving PAP treatment while on the residential unit, compared to a waitlist control group who will receive PAP treatment at 3-months post-discharge follow-up. Participants will be 194 male and female Veterans on the residential SUD and PTSD unit with SUD, PTSD, and OSA. Our primary aim is to determine the relative efficacy of PAP treatment on the SUD/PTSD unit, as compared to waitlist control, in reducing problematic substance use, PTSD symptoms, and suicidal ideation, while improving functioning among Veterans with comorbid SUD/PTSD at 3-months post-treatment follow-up. We will also compare PAP adherence rates on PTSD/SUD/functioning outcomes within the PAP treatment group (3-months). Finally, we plan on comparing adherence rates between the two treatment groups at the 6-months post-treatment follow- up assessment. Examining OSA treatment for SUD and PTSD is highly relevant to the goals of RR&D and the VA to maximize treatment efficacy for Veterans and has the potential to improve functional and psychological recovery for a highly prevalent and highly impaired population of Veterans. This research will directly impact functional outcomes, SUD recovery, and PTSD symptoms in already vulnerable Veterans struggling with SUD and PTSD. The successful completion of this project will help improve the practices that drive treatment for Veterans who have both SUD and PTSD. The fundamental rationale for this study is to improve the evidence base that informs how patients with SUD and PTSD can attain sustained recovery from both of these disorders. Colvonen - 1