CPAP Device Adherence has Little Impact on Cognitive Processing Therapy Efficacy Among Veterans With PTSD:

Cognitive processing therapy (CPT) was effective at improving symptoms of posttraumatic stress disorder (PTSD) among veterans, regardless of adherence to continuous positive airway pressure (CPAP) device use, according to results of a study presented at the 2022 Annual Meeting of the American Academy of Sleep Medicine and the Sleep Research Society, held from June 4 to 8, 2022, in Charlotte, North Carolina.

PTSD is associated with increased risk for sleep disorders, such as obstructive sleep apnea (OSA) and there is evidence to support the notion that OSA and PTSD can exacerbate each other. CPAP is a common treatment for OSA and has been associated with PTSD symptom improvement.

The first-line therapy for PTSD is CPT. In this study, medical records were sourced from the Veteran’s Affairs Health Care System to evaluate whether the use of a CPAP may complement PTSD symptom improvement among patients receiving CPT. Veterans (N = 25) who received 1-12 sessions of CPT and were issued a CPAP machine for OSA were evaluated for PTSD outcomes on the basis of CPAP adherence.

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The veterans were aged median 43 years, BMI was 35.6 kg / m:2:and residual apnea-hypopnea index was 2.4 events / h.

After a median CPT duration of 11.0 weeks, weekly PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5) and Patient Health Questionnaire-9 (PHQ-9) scores improved throughout CPT (both P: <.001).

Stratifying patients on the basis of CPAP adherence, as defined by 4 or more hours of nightly use on ≥70% of days, did not reveal any significant differences in CPT efficacy. Similarly, residual apnea-hypopnea index and mask leak were not associated with PTSD symptoms during CPT.

This study was limited by its small sample size and retrospective design. The findings should be confirmed in a larger, prospective study.

The study authors concluded, “While CPAP nonadherence appears to be a potential contributing factor to the reduced effectiveness of evidence-based treatments for veterans with PTSD, our study revealed significant improvement in PTSD symptoms during CPT regardless of CPAP adherence.”


Kunes K, Johnson C, Driscoll D, Walters R, Ramaswamy S. CPAP adherence and response to cognitive processing therapy for PTSD in veterans with obstructive sleep apnea. Presented at SLEEP 2022; June 4-8; Charlotte, North Carolina. Abstract 674.

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