Post Traumatic Stress Disorder (PTSD) and Obstructive Sleep Apnea (OSA): the issues for veterans seeking compensation and pension implicating one disorder caused the other disorder

November 14, 2017

Obstructive sleep apnea due to PTSD is an example of a disorder that is not universally accepted as causative. Recently, VA representatives have been seeking service connection for obstructive sleep apnea as secondary to PTSD, apparently based on a study done in 2015 with this reference: J Clin Sleep Med. 2015 May 15; 11(5):513–518.


A look at this study shows it included a total of 159 veterans with PTSD who had a mean BMI of 29.08. The conclusion of the authors was that veterans with PTSD “screen as high risk for OSA at much higher rates than those seen in community studies and may not show all classic predictors of OSA.” The recommendation was that “screening of younger veterans with PTSD for OSA should be standard care.” The study DID NOT indicate that PTSD caused OSA, only that there was an association. The authors themselves indicated that additional study was needed “to help parse out the temporal relationship of OSA and PTSD.” One possible mechanism mentioned was that “sleep disturbances of OSA increase the likelihood of getting PTSD,” the exact opposite of the claimed connection,


There are other studies as well (9 June 2008 Volume 12, Issue 3, Pages 169–184, Sleep Breath. 2011 Sep;15(3):283-94. doi: 10.1007/s11325-010-0379-7. Epub 2010 Jul 1, Sleep Breath. 2006 Jun;10(2):70-5). None claim a causative relationship between PTSD and OSA. 


Every month of so, I have a veteran or two who contacts me to complete an independent medical evaluation for their VA compensation and pension claim, stating that their PTSD caused their sleep apnea.  They are often disappointed or angered when I decline this evaluation and explain there is not an established causative relationship between PTSD and OSA.  I further explain that, with our current medical and psychological understanding of these disorders, one is clearly organic (OSA) and caused by physiological symptoms, the other in considered more psychological in nature (PTSD).  Although it is well documented that stress, anxiety and PTSD symptoms DO cause physiological changes within our bodies, these changes involve the hypothalamus/pituitary/adrenal axis.  Changes in the HPA axis have not been implicated as being causative in the development of OSA.  Therefore, it is impossible for me to complete C & P evaluations stating that PTSD caused OSA, as there is no medical evidence to substantiate this type of claim.



*Some information in this article was taken from the November 2017 Veteran Evaluation Services provider newsletter.

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