A randomized cross over trial of two treatments for OSA in Veterans with PTSD

对患有 PTSD 的退伍军人进行两种 OSA 治疗的随机交叉试验

• 批准号: 8595158
• 负责人: Ali A El Solh
• 金额: --
• 依托单位: VA WESTERN NEW YORK HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-10-01 至 2015-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8595158
• 关键词: Acute; Adherence; Adverse effects; Alternative Therapies; Anxiety; Anxiety Disorders; Arousal; Attention; Behavior; Behavioral; Blood Vessels; Cardiac; Cardiovascular Diseases; Categories; Cognition; Cognitive; Comorbidity; Continuous Positive Airway Pressure; Coronary Arteriosclerosis; Cross-Over Studies; Development; Devices; Diagnosis; Disease; Effectiveness; Epidemiologic Studies; Evaluation; Event; Feasibility Studies; Frequencies; Functional disorder; Future; General Population; Hypertension; Hypoxia; Incidence; Individual; Inferior; Inflammation; Insulin Resistance; Limb structure; Link; Mandible; Measures; Mental Depression; Mental Health; Mental disorders; Modality; Mood Disorders; Moods; Neurocognitive; Newly Diagnosed; Nightmare; Obstructive Sleep Apnea; Operative Surgical Procedures; Outcome; Outpatients; Oxidative Stress; Participant; Pathology; Patients; Performance; Phenotype; Polysomnography; Population; Post-Traumatic Stress Disorders; Quality of life; Randomized; Reporting; SF-36; Sleep; Sleep Apnea Syndromes; Sleep Architecture; Sleep disturbances; Stress; Stroke; Symptoms; Therapeutic; Thrombophilia; Treatment Efficacy; Veterans; base; body system; clinical efficacy; comparative efficacy; depressive symptoms; endothelial dysfunction; falls; functional disability; head-to-head comparison; hemodynamics; indexing; mortality; physical conditioning; psychologic; public health relevance; response; restoration; treatment duration

DESCRIPTION (provided by applicant): Obstructive sleep apnea (OSA) is a prevalent disorder associated with poor neurocognitive performance and organ system dysfunction due to intermittent hypoxia and repeated arousals. The repetitive hemodynamic stresses are implicated in the increased incidence of systemic hypertension and cardiovascular diseases. Insufficient and disrupted sleep has similar negative impact on mood, attention, cognition, and behavior. In Veterans with post traumatic stress disorder (PTSD), the disturbed sleep can worsen further the cognitive-behavioral manifestations of PTSD and contributes to poor mental and physical health outcomes. Recent epidemiologic studies largely support the association of higher rates of OSA in patients with PTSD compared with the general population. Treatment of the underlying obstructive sleep disturbances with continuous positive airway pressure (CPAP) has resulted in restoration of sleep architecture, decrease daytime sleepiness, and reduction in nightmares frequency and intensity. However, adherence to treatment with CPAP is less than optimal in Veterans with PTSD. Mandibular advancing devices (MADs) are considered non surgical alternatives to CPAP and are preferred in a head to head comparison to CPAP in OSA subjects without PTSD. However, there has been no study to our knowledge that has assessed MAD in terms of clinical efficacy, compliance, and quality of sleep compared to CPAP in OSA patients with PTSD. Therefore, we hypothesize that MAD is not inferior to CPAP in treating OSA effectively in Veterans with PTSD and OSA. To that end, we propose to conduct a feasibility study using a randomized crossover trial of 12 weeks of CPAP and MAD in 42 consecutive outpatients with PTSD newly diagnosed with OSA separated by 2 weeks washout period. The primary endpoint of the trial is to compare the treatment efficacy of CPAP and MAD in Veterans with PTSD and OSA. Secondary endpoints aim at: 1) comparing change in the Epworth Sleepiness Scale, SF-36, and the Pittsburgh Sleep Quality Index at end of treatment following use of CPAP versus MAD, 2) comparing adherence and short-term side effects between using CPAP and MAD in PTSD patients with OSA, and 3) determining anthropomorphic, polysomnographic, and cephalometric predictors of successful MDA response. Assessments at the end of both limbs comprise evaluation of quality of sleep, daytime sleepiness, quality of life, and side effects of treatment. Compliance with each therapy will be measured at the end of each treatment period. The results of the trial are pivotal in determining the efficacy, tolerability, and adherence to MAD compared to CPAP in Veterans with PTSD and OSA. This feasibility study would form the basis of a future trial examining the effectiveness of various therapeutic modalities for OSA on PTSD symptomatology and progression.

描述（由申请人提供）：