These findings are a reanalysis of Orr and colleagues5 longitudinal PAP-use and PTSD paper. Our findings reaffirm the importance of PAP use among patients with co-morbid PTSD and sleep apnea, as well as the difficulty in achieving adherent PAP use in this population. Previous research showed lower rates of PAP use among patients with PTSD compared with those without PTSD. This study replicates that finding and builds on it by specifying the types of symptoms that are most associated with lower levels of PAP use. First, we found that higher levels of baseline PTSD re-experiencing and hype-arousal symptoms, but not avoidance, predicted reduced PAP adherence. Second, we found that the number of days using PAP was the strongest predictor of change in PTSD, with veterans tending to be either adherent, with 91.12% of days used in the past 6 months, or non-adherent, with only 18.04% of PAP use in the past 6 months. While, on average, PAP use predicted an 8.34-point decrease on the PCL-S over a 6-month period, when examining high vs low adherence the numbers are staggering; the high-adherent group showed a 14.36-point decrease on the PCL-S (a clinically meaningful change) while the low-adherent group averaged just a 3.66-point decrease. Third, we found that more PAP use over a 6-month period predicted significant decreases in PTSD avoidance and hyper-arousal, but not re-experiencing.
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