Post-traumatic stress disorder with comorbid obstructive sleep apnea after the Great East Japan Earthquake: A case...

Post-traumatic stress disorder (PTSD) is frequently accompanied by sleep disturbance, and obstructive sleep apnea (OSA) is an important potential comorbidity. Although PTSD-OSA coexistence has been reported mainly in military veterans, reports after natural disasters remain limited. We describe a patient who developed PTSD after the Great East Japan Earthquake (GEJE) and was subsequently diagnosed with severe OSA.

A 55-year-old man with hypertension and dyslipidemia, but no prior psychiatric illness, experienced temporary burial under rubble during the GEJE. He subsequently developed persistent trauma-related nightmares, depressed mood, and panic responses to disaster-related cues and was diagnosed with PTSD. Paroxetine and alprazolam improved mood and panic symptoms, whereas nightmares, excessive daytime sleepiness, and impaired concentration persisted. Polysomnography later demonstrated severe OSA (apnea-hypopnea index, 41.6 events/h; rapid eye movement (REM) AHI, 47.6 events/h; minimum oxygen saturation, 79%). Continuous positive airway pressure (CPAP) was initiated without changes to psychiatric treatment. Daytime sleepiness improved, and nightmare frequency decreased from almost daily to approximately weekly during the period of CPAP treatment, although adherence was low and symptoms later recurred after treatment interruption.

This case illustrates that persistent nightmares, sleepiness, and impaired daytime functioning in a patient with PTSD may coexist with clinically significant OSA. Because longitudinal standardized PTSD measures were unavailable and CPAP adherence was limited, the observed improvement cannot be attributed to CPAP alone. Systematic assessment for sleep disorders, including OSA, should be considered when sleep-related or daytime symptoms persist during psychiatric treatment.