Helping Veterans with PTSD

The current ANS featured article is titled “Screening for Obstructive Sleep Apnea in Veterans Seeking Treatment of Posttraumatic Stress Disorder,” authored by Lauren Forbus, BSN, RN and Ursula A. Kelly, PhD, ANP-BC, PMHNP-BC. Their article is available for free download while it is featured on the ANS website. Ms. Forbus shared this information about their work with veterans:

Our team began to take a look at obstructive sleep apnea (OSA) among veterans with posttraumatic stress disorder as a result of some unexpected findings in another project, Project Stress Less. Project stress less was developed to establish the feasibility of conducting a trauma-sensitive yoga intervention for women

Lauren Forbus

veterans with posttraumatic stress disorder (PTSD) who experienced Military Sexual Trauma (MST). Because sleep was a primary outcome of this study, OSA was initially an exclusion criterion. We assessed for presence of OSA through medical chart review and self-report during phone screening; and we assessed for risk for OSA using a questionnaire in our phone screening process. The unexpected finding in the screening process for this study was that 14.6% of those screened had been diagnosed with OSA and 63.2% were at high risk for OSA – both numbers that are greater than in the general population.

As we moved forward with Project Stress Less, we simultaneously began to think about implementing a larger OSA risk screening study into an outpatient VA PTSD clinic to get a bigger snapshot of what this risk for OSA looks like in the Veteran population. The idea was eventually implemented as the study described in our published article. What we found was consistent with our initial findings in Project Stress Less – a great majority of veterans were screening at high risk for OSA, however, only a small portion of them had documentation of a formal evaluation for OSA in their medical records.

These findings were significant enough that our research team proposed and is in the process of implementing a clinical practice improvement in collaboration with our VA colleagues in the PTSD clinic. The common goal is to develop screening, referral and follow up processes for Veterans who screen at high risk for OSA. Because of this supportive relationship with our VA colleagues, we have had the unique opportunity to quickly turn our research findings into meaningful practice change. So far we have inserted an OSA screening tool into the clinic’s intake packet, which is currently used for clinical purposes at intake as well as for program evaluation. We are also working on developing a follow up plan for those who screen at high risk. As we move forward with this practice change in the short term, we are keeping our eye on the long-term goal of conducting further research. Our hope is that we can gain new insights to help alleviate some of the sleep complaints that often times plague our Veterans with PTSD. 

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