0929 The Role of Insomnia, Sleep Apnea, and Psychological Distress on Quality-of-Life in Veterans with and Without PTSD

Abstract Introduction Obstructive sleep apnea (OSA), insomnia, and psychological distress have been independently linked to various negative outcomes, including poorer quality-of-life (QOL). However, prior literature has not investigated differences in QOL outcomes between veterans with and without PTSD that may be influenced by sleep apnea severity, insomnia, and psychological distress. This study aimed to investigate the relationships of sleep apnea severity, insomnia, and psychological distress with QOL (i.e. physical and social functioning) between veterans with and without PTSD. Methods Veterans presenting to the Miami VA Sleep Center who were at risk for OSA (n=645, M age=52 years, 84.5% male) completed the Insomnia Severity Index and the PROMIS-29. The social and physical functioning subscales from the PROMIS-29 were used. Questionnaires were completed the night prior to undergoing a home sleep apnea test. Multigroup structural equation modelling was used to compare the PTSD (n=210) and non-PTSD (n=435) groups, controlling for age, gender, race, education, and BMI. Results The final model met statistical criteria for good fit (CFI=0.951, RMSEA=.051). For those with PTSD, higher psychological distress was associated with both reduced social (β=-.54, p.001) and physical functioning (β=-.35, p.001). Neither insomnia nor sleep apnea was associated with QOL outcomes in those with PTSD. In those without PTSD, higher psychological distress and higher insomnia were associated with lower social (β=-.38, p.001; β=-.42, p.001) and physical functioning (β=-.30, p 001; β=-.29, p 001). Sleep apnea was not associated with QOL outcomes in those without PTSD. Conclusion The present findings suggest that for those without PTSD both insomnia and psychological distress, but not sleep apnea, are associated with QOL. However, for those with PTSD, only psychological distress was related to QOL. Neither insomnia nor sleep apnea was associated with QOL in those with PTSD. These results indicate that, in those without PTSD, QOL is influenced by both a sleep disorder (insomnia) and psychological distress. However, in those with PTSD, QOL appears to be primarily influenced, not by a sleep disorder, but by psychological distress. The current findings highlight importance of and the need to prioritize treatment for psychological distress in veterans with PTSD to improve their QOL. Support (if any)