Sleep disorders and associated medical comorbidities in active duty military personnel

Abstract

Study objectives: Describe the prevalence of sleep disorders in military personnel referred for polysomnography and identify relationships between demographic characteristics, comorbid diagnoses, and specific sleep disorders.

Design: Retrospective cross-sectional study.

Setting: Military medical treatment facility.

Participants: Active duty military personnel with diagnostic polysomnogram in 2010.

Measurements: Primary sleep disorder rendered by review of polysomnogram and medical record by a board certified sleep medicine physician. Demographic characteristics and conditions of posttraumatic stress disorder (PTSD), mild traumatic brain injury (mTBI), anxiety, depression, and pain syndromes determined by medical record review.

Results: Primary sleep diagnoses (n = 725) included: mild obstructive sleep apnea (OSA), 207 (27.2%); insomnia, 188 (24.7%); moderate-to-severe OSA, 183 (24.0 %); and paradoxical insomnia,39 (5.1%); behaviorally induced insufficient sleep syndrome, 68 (8.9%) and snoring, 40 (5.3%) comprised our control group. Short sleep duration (< 5 h) was reported by 41.8%. Overall 85.2% had deployed, with 58.1% having one or more comorbid diagnoses. Characteristics associated with moderate-to-severe OSA were age (adjusted odds ratio [OR], 1.03 [95% confidence interval {CI}, 1.0-1.05], sex (male) (adjusted OR, 19.97 [95% CI, 2.66-150.05], anxiety (adjusted OR, 0.58 [95% CI, 0.34-0.99]), and body mass index, BMI (adjusted OR 1.19 [95% CI, 1.13-1.25]; for insomnia, characteristics included PTSD (adjusted OR, 2.12 [95% CI, 1.31-3.44]), pain syndromes (adjusted OR, 1.48 [95%CI, 1.01-2.12]), sex (female) (adjusted OR, 0.22 [95% CI, 0.12-0.41]) and lower BMI (adjusted OR, 0.91 [95% CI, 0.87, 0.95]).

Conclusions: Service-related illnesses are prevalent in military personnel who undergo polysomnography with significant associations between PTSD, pain syndromes, and insomnia. Despite having sleep disorders, almost half reported short sleep duration. Multidisciplinary assessment and treatment of military personnel with sleep disorders and service-related illnesses are required.

Citation: Mysliwiec V; McGraw L; Pierce R; Smith P; Trapp B; Roth BJ. Sleep disorders and associated medical comorbidities in active duty military personnel. SLEEP 2013;36(2):167-174.

Figure 1

Other sleep disorders in military personnel. Parasomnia: three military personnel with somnambulism, two with nightmare disorder, one with sleep sex disorder. Hypersomnias: three military personnel with posttraumatic hypersomnia, two with idiopathic hypersomnia, one with narcolepsy without cataplexy. PLMD, periodic limb movement disorder; SWSD, shift work sleep disorder; CSA, central sleep apnea; RBD, rapid eye movement behavior disorder.

Figure 2

Primary sleep disorders in military personnel. Mild OSA (obstructive sleep apnea): apnea-hypopnea index (AHI) = 5–15/h. Moderate-to-severe OSA: AHI > 15/h. BIISS, behaviorally induced insufficient sleep syndrome. Other diagnoses presented in Figure 1.

Figure 3

Comparison of self-reported home sleep duration per night between military personnel and US civilians. *Adapted from Krueger PM, Wallander JL: Sleep duration in the United States: a cross-sectional population-based study. Am J Epidemiol 2009;169:1054.