Military Medical Research
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Military Medical Research · May 2019
Comment LetterOcular ultrasound evaluation of optic nerve sheath diameter in military environments.
In this letter to the Editor, we would like to comment on the article by Betcher et al., concerning the possibility of teaching military trainees to obtain accurate optic nerve sheath diameter measurements, using a brief didactic and a hands-on training session. In particular, this letter notes the importance of the measurement of optic nerve sheath diameter in detecting the eventual elevated intracranial pressure following traumatic brain injury, highlights several limitations in the use of B-scan for such a purpose and suggests a more accurate evaluation with the standardized A-scan.
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Military Medical Research · May 2019
Controlled Clinical TrialChanges in insomnia severity with advanced PAP therapy in patients with posttraumatic stress symptoms and comorbid sleep apnea: a retrospective, nonrandomized controlled study.
Sleep disorders frequently occur in posttraumatic stress disorder (PTSD) patients. Chronic insomnia is a common feature of and criteria for the diagnosis of PTSD. Another sleep disorder, obstructive sleep apnea (OSA), also occurs frequently in PTSD, and emerging research indicates OSA fuels chronic insomnia. Scant research has investigated the impact of OSA treatment on insomnia outcomes (Insomnia Severity Index, ISI) in trauma survivors. ⋯ In a retrospective, nonrandomized analysis of a select sample of sleep clinic patients with OSA and PTSD symptoms, advanced PAP therapy was associated with significant improvement in insomnia severity for both compliant and partial users. However, residual insomnia symptoms persisted, indicating that PAP therapy provides only limited treatment. RCTs are warranted to assess the effect of ABPAP and ASV modes of therapy on adherence and sleep outcomes, and their potential impact on posttraumatic stress symptoms. Treatment arms that combine PAP with CBT-I would be expected to yield the greatest potency.