Residual sleepiness in veterans with post-traumatic stress disorder and obstructive sleep apnea.

PURPOSE: The causes of residual excessive sleepiness (RES) in patients with post-traumatic stress disorder (PTSD) and obstructive sleep apnea (OSA) are multifactorial and modulated by comorbid conditions. The aim of the present study was to elucidate clinical and polysomnographic determinants of RES in continuous positive airway pressure (CPAP)-adherent OSA veterans with PTSD. METHODS: The study protocol consisted of a retrospective analysis of consecutive cases of patients with PTSD who presented to the Veterans Affairs sleep clinics with adequately treated OSA between June 1, 2017 and October 15, 2021. Based on the Epworth Sleepiness Scale (ESS), patients were categorized into RES (ESS ≥ 11) and no RES (ESS < 11) groups. Demographic and PSG data were subjected to univariate and multivariate analyses to ascertain predictive factors of RES. RESULTS: Out of 171 veterans with PTSD who were adherent to CPAP, 59 (35%) continued to experience RES. The RES group had a decrease in mean ESS score of 1.2 ± 4.5 after CPAP treatment compared with 4.6 ± 4.9 for the no RES group (< 0.001). A dose-response was observed between CPAP use and RES (p = 0.003). Multivariate regression analysis identified higher baseline ESS (OR 1.30; 95% CI 1.16-1.44), greater percentage of time spent in REM sleep (OR 0.91; 95% CI 0.85-0.96), CPAP use less than 6 h (OR 2.82; 95% CI 1.13-7.01), and a positive screen for depression (OR 1.69; 95% CI 1.03-4.72) as independent predictors of RES in patients with PTSD and OSA. CONCLUSION: RES is highly prevalent in patients with PTSD and OSA despite adherence to CPAP and is independently associated with percentage time spent in REM, duration of CPAP utilization, and symptoms of depression.

Cardiovascular events in insomnia patients with post-traumatic stress disorder.

BACKGROUND: Both post-traumatic stress disorder (PTSD) and insomnia are independently associated with a greater risk of cardiovascular mortality. The objective of this study is to determine whether PTSD plus insomnia is associated with a higher risk of major adverse cardiovascular events (MACEs) than either condition alone in a large cohort of veterans. METHODS: We conducted a retrospective analysis of the national Veterans Health Administration (VHA) electronic medical records covering veterans 18 years or older with the diagnosis of PTSD, insomnia, or both from January 1, 2015, to December 31, 2020. MACE was defined as new-onset myocardial infarction (MI), transient ischemic attack (TIA) or stroke, based on ICD-9 and ICD-10 diagnosis codes from inpatient or outpatient encounters. RESULTS: A total of 19,080 veterans, 1840 with PTSD plus insomnia and 17,240 with either PTSD or insomnia, were included in the analysis. Baseline mean (SD) age was 46.3 (11.5) years. During median follow-up of 3.9 (interquartile range, 2.4-5.1) years, 206 (1%) veterans developed incident MACE. Cumulative incidence for MI, TIA and/or stroke was larger in veterans with PTSD plus insomnia compared to PTSD and insomnia alone (p=0.008). In a Cox proportional hazards model, PTSD plus insomnia was significantly associated with greater risk of developing MACEs (hazard ratio [HR], 1.44; 95% CI, 1.38-1.50, p=0.01) than either condition after adjusting for multiple covariates including age, gender, smoking, hypertension, depression, and burden of comorbidities. CONCLUSIONS: This cohort study found that PTSD plus insomnia is a risk factor for MACEs of greater magnitude than PTSD- or insomnia-alone.

Associations between Parental and Child Screen Time and Quality of the Home Environment: A Preliminary Investigation.

(1) Background: The recommendation for screen use among preschool-aged children is ≤ 1 h per day. We aimed to assess the relationship between parental and child screen use and home environment characteristics. (2) Methods: Thirty-six 3-to-4-year-old healthy children were recruited. Parents reported their own and their child's weekday and weekend daytime screen use. The child's home environment and parent-child interactions were assessed using the Infant-Toddler Home Observation for Measurement of the Environment (IT-HOME). Analyses were run to identify relationships between parental and child screen use and the six subscales of the IT-HOME: Responsivity, Acceptance, Organization, Learning Materials, Involvement and Variety. (3) Results: Parents' weekend screen use was correlated to parental responsivity and variety of people and events at home. These relationships remained significant after adjusting for maternal education and number of children at home (Responsivity ß = 7.30 (95% CI: 1.75, 12.86), p = 0.012) and (Variety ß = -2.45, (95% CI: -4.58, -0.31), p = 0.026). There was a trend level association between low child's weekend screen use and high presence of learning materials. Other aspects of screen time were not associated with home environment characteristics. (4) Conclusions: Higher parental screen use predicted lower variety and greater parental responsivity, the latter of which was an unexpected finding. Administering the IT-HOME alongside a screen use questionnaire may offer the opportunity for a more comprehensive representation of home environments in today's society. Future research can also clarify facets of parental screen use (e.g., co-viewing, timing) that are more vs. less likely to impact children.