The effect of hyperbaric oxygen therapy on sleep quality across diverse patient populations

Sleep disturbances are common in aging, post-traumatic stress disorder (PTSD), and long COVID, often linked to neuroinflammation, autonomic dysregulation, and neurodegeneration. Hyperbaric oxygen therapy (HBOT) promotes neuroplasticity through the hyperoxic-hypoxic paradox, improving cerebral perfusion, mitochondrial function, and reducing inflammation. While HBOT benefits sleep in certain conditions, its general effects across clinical populations remain unclear.

This retrospective longitudinal study evaluated Pittsburgh Sleep Quality Index (PSQI) changes in patients undergoing 60 HBOT sessions (2.0 ATA, 100% oxygen, 90 min, 5 days/week) at the Sagol Center. Participants included individuals treated for healthy aging (n = 180), long COVID (n = 92), or PTSD (n = 123). Pre- and post-treatment PSQI total and component scores were compared using paired t-tests and Wilcoxon signed-rank test was used for PSQI components. Regression analysis identified predictors of improvement.

Among 395 patients (mean age at baseline 57.9 ± 14.6 years, 31% female), baseline PSQI scores were highest in PTSD. Post-HBOT, total PSQI scores improved significantly in all groups (p < 0.001; Cohen's d = 0.37-0.91). Significant gains were observed in subjective sleep quality, sleep latency, and disturbances in all groups; daytime dysfunction improved in aging and long COVID but not PTSD. Medication use was unchanged. Baseline PSQI was a strong predictor of improvement (B = 0.494, p < 0.001, r = 0.46). Those with disturbed sleep (PSQI>5) showed broad, statistically significant gains, while normal sleepers exhibited minimal changes.

HBOT was associated with improvement in sleep quality across diverse conditions, with greatest benefit in patients with poorer baseline sleep. Findings support HBOT's potential as a sleep-modulating therapy, warranting controlled trials to characterize the patients that can benefit the most and elucidate mechanisms.