Sleep Apnea and Posttraumatic Stress After Traumatic Brain Injury (TBI): A Veterans Affairs TBI Model Systems Study

Objective: Traumatic brain injury (TBI) is a complex health problem in military veterans and service members (V/SM) that often co-occurs with psychological and medical conditions such as posttraumatic stress disorder (PTSD) and sleep apnea. We aimed to examine if sleep apnea is associated with the presence and severity of PTSD in V/SM with TBI of all severities. Research Method: The study examined participants at varying times since their TBI (N = 602) enrolled in the Veterans Affairs TBI Model Systems database. Frequency of self-reported sleep apnea diagnosis was calculated in a cross-sectional sample. Prevalence of co-occurring sleep apnea and probable PTSD was tested with a chi-square analysis. A multivariable regression model evaluated the association between sleep apnea and PTSD symptom severity while controlling for relevant covariates. Results: Almost 32% of the sample stated they had been diagnosed with sleep apnea. In those reporting sleep apnea, 32% also had probable PTSD; 19% of those without sleep apnea had probable PTSD. The regression demonstrated sleep apnea was significantly associated with PTSD symptom severity (p < .001). Greater number of TBIs, recent mental health treatment, being deployed to a combat zone, and greater years since TBI were also significant predictors of PTSD symptom severity (all p < .05). Conclusions: TBI, PTSD, and sleep apnea are often comorbid in V/SM. We expand the literature by demonstrating that sleep apnea was associated with PTSD severity. A multipronged approach to TBI rehabilitation that addresses sleep and psychological distress is recommended for enhancing health outcomes in this population. Impact and ImplicationsVeterans and service members (V/SM) who have sustained a traumatic brain injury (TBI) are frequently diagnosed with comorbid sleep apnea and posttraumatic stress disorder (PTSD). Sleep apnea was related to greater severity of PTSD symptoms while controlling for relevant covariates. Inpatient rehabilitation centers and outpatient providers who work with V/SM with TBI should screen them for sleep apnea and PTSD. If sleep apnea and PTSD are present, they should be treated concurrently to enhance the health outcomes in this population.