Substance use disorder (SUD) and posttraumatic stress disorder (PTSD) frequently co-occur and having both disorders is associated with greater psychological and functional impairment than having either disorder alone. This is especially true in residential settings where both disorders are more severe than outpatient settings. Obstructive sleep apnea (OSA) is highly comorbid with both disorders and untreated OSA is associated with worse functional impairment across multiple domains, worse quality of life, worse PTSD, higher suicidal ideation, and higher substance use and relapse rates. Treating OSA with evidence-based positive airway pressure (PAP) in Veterans with SUD/PTSD on a residential unit is a logical way to maximize treatment adherence and treatment outcomes. This study compares OSA treatment while on a SUD/PTSD residential unit to a waitlist control group. The investigators hypothesize that treating OSA on the residential unit, compared to the waitlist control, will have better functional, SUD, and PTSD outcomes.
a Veteran of the U.S. military or Reserve/National Guard member
have an Apnea Hypopnea Index (AHI) 5 per hour
experienced trauma that occurred in childhood or adulthood; at least one month post-trauma
have current DSM-5 diagnoses of substance use disorder (SUD) via Structured Clinical Interview for DSM-Substance Use Disorders (SCID-SUD) module with a minimum 20 days of substance use in the last 90 days (Timeline Follow-back)
have central sleep apnea (Apnea Hypopnea Index (AHI)>=5 and > 50% central apneas)
arrives on the Substance Abuse Residential Rehabilitation Treatment Program (SARRPT) unit already using a positive airway pressure (PAP) device (Veteran's previously diagnosed with OSA, but not using positive airway pressure (PAP) therapy will be eligible)
the Substance Abuse Residential Rehabilitation Treatment Program (SARRPT) medical staff advises against the study based on medical history and physical examination; d) history of severe cognitive impairment (via Montreal Cognitive Assessment (MOCA) < 26)
history of psychosis or mania independent of substance use will be excluded because the presence of these disorders can impede therapy progress
Parallel
Positive Airway Pressure Device
DeviceEach PAP treatment initiation meeting will include 1) mask fitting; 2) psycho-education to what to expect and reviewing PAP machine problem solving; and 3) setting up correct PAP treatment (e.g., auto PAP or in rare conditions, bi-level PAP).
Change in WHO Disability Assessment Schedule 2.0 (WHODAS 2.0)
Change in functional impairment across multiple domains. The WHODAS 2.0 is a 36-item questionnaire that assess functional impairment across 5 subscales: cognitions (understanding and communicating), mobility, self-care getting along with others, household responsibilities, work responsibilities, and community participation.
Change in Timeline Follow-Back (TLFB) % days drinking/using in last 90 days
Examining change in percentage of substance use in the past 90 days.
Change in Clinician Administered PTSD Scale (CAPS-5)
Change in PTSD symptom severity will be assessed using CAPS-5 in the past month. The CAPS-5 is a 30-item structured interview.
Change in the Columbia-Suicide Severity Rating Scale (C-SSRS)
Change in suicidal ideation severity using the C-SSRS. The C-SSRS is a standardized 8-point clinician-administered suicidal rating system designed to track suicidal adverse events across a treatment trial and covering the wide spectrum of suicidality
Positive airway pressure (PAP) adherence rates
Examining average number of nights used positive airway pressure is use over the last 30 days.
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