Vets with PTSD experience decreased effectiveness of esketamine due to severe obstructive sleep apnea

Esketamine treatment for PTSD less effective in patients with sleep apnea.

A recent study presented at the American Thoracic Society International Conference suggests that veterans with high obstructive sleep apnea (OSA) severity may experience less improvement in symptoms of post-traumatic stress disorder (PTSD) when taking esketamine. The study, conducted by Brandon Nokes, MD, and colleagues at the University of California, San Diego, found that untreated OSA may interfere with the effectiveness of esketamine treatment for PTSD symptoms.

The researchers analyzed data from 24 veterans with symptoms of PTSD who were treated with esketamine (Spravato, Janssen Pharmaceuticals). The impact of OSA severity, as measured by the apnea-hypopnea index (AHI) scores, on the effectiveness of PTSD treatment was assessed.

To be included in the study, patients had to have completed a Type III home sleep test, a PTSD Checklist for DSM-5 (PCL-5), and have tried at least two different medications for depression or PTSD with no improvement in the two years prior to the study.

During the first four weeks of treatment, the veterans received esketamine twice a week. After this initial period, the dose was reduced to once a week. The researchers used PCL-5 scores to track changes in PTSD symptoms throughout the treatment.

The results showed that with each dose of esketamine, PCL-5 scores significantly decreased, indicating an improvement in PTSD symptoms. However, when considering a patient's baseline AHI score, those with higher scores indicating greater OSA severity showed fewer changes in PCL-5 scores over the course of treatment.

The researchers concluded that screening and treating OSA prior to esketamine treatment may be a beneficial intervention for improving clinical outcomes in veterans with PTSD. They also noted that further research is needed to better understand the complex relationship between OSA severity, esketamine, and PTSD symptoms.

Overall, this study highlights the potential impact of untreated OSA on the effectiveness of esketamine treatment for PTSD symptoms in veterans. By addressing OSA before starting esketamine therapy, healthcare providers may be able to improve clinical outcomes for these patients. Further research is necessary to fully understand the relationship between OSA severity, esketamine, and PTSD symptoms.

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