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. 2025 Oct;168(4):1023-1033.
doi: 10.1016/j.chest.2025.05.007. Epub 2025 May 12.

Health and Utilization Burden of OSA Among US Active-Duty Military Personnel

Emerson M Wickwire  1 , Vincent F Capaldi 2nd  2 , Jeph Herrin  3 , Benoit Stryckman  4 , Connie Thomas  5 , Scott G Williams  2 , J Kent Werner Jr  6 , Wendy Funk  7 , Thomas Nassif  2 , Jennifer S Albrecht  8
Affiliations

Health and Utilization Burden of OSA Among US Active-Duty Military Personnel

Emerson M Wickwire et al. Chest. 2025 Oct.

Abstract

Background: Despite the significant health and economic burden associated with OSA among civilians, little is known about this burden among active-duty military personnel.

Research question: What is the health and utilization burden of OSA among active-duty service members in the United States?

Study design and methods: Data were derived from the Military Data Repository (2016-2021). Participants included active-duty service members aged < 65 years with 12 months of continuous enrollment prior to and following a new OSA diagnosis and no evidence of prior OSA or OSA treatment. They were matched 1:1 on demographic, clinical, and military characteristics to those without OSA. OSA and medical and psychiatric comorbidities were defined based on International Classification of Diseases, 10th Revision, codes. The impact of newly diagnosed OSA on psychiatric and medical outcomes was examined by using time-to-event models. The impact on 12-month health care resource utilization was examined by using generalized linear models.

Results: A total of 59,203 service members with OSA were matched to 59,203 service members without OSA. Participants were 83% male and 65% White, with most < 44 years old (81%). OSA was associated with an increased risk for all physical and psychological health outcomes; relative to those without OSA, service members with OSA exhibited a fourfold increased risk for posttraumatic stress disorder (hazard ratio, 4.41; 95% CI, 4.04-4.82). In terms of utilization, OSA was associated with an additional 170,511 outpatient, 66 inpatient, and 1,852 emergency department encounters per year.

Interpretation: Our findings show that among US active-duty military personnel, OSA is associated with substantially increased risk for adverse physical and psychological health outcomes, as well as utilization burden over 12 months. Screening, triage, and treatment efforts could have broad impact in this population.

Keywords: economics; health outcomes; military; sleep; sleep apnea.

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Conflict of interest statement

Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: E. M. W.’s institution has received research funding from the AASM Foundation, Department of Defense, Merck, National Institutes of Health/National Institute on Aging, ResMed, the ResMed Foundation, and the SRS Foundation. E. M. W. has served as a scientific consultant to Axsome Therapeutics, dayzz, Eisai, EnsoData, Idorsia, Merck, Nox Health, Primasun, Purdue, and ResMed; and is an equity shareholder in WellTap. None declared (V. F. C., J. H., B. S., C. T., S. G. W., J. K. W., W. F., T. N., J. S. A.).

Figures

Figure 1
Figure 1
Adjusted HRs based on time-to-event models, reflecting risk for psychological and physical health outcomes based on OSA status. HRs reflect the increased risk associated with OSA for each individual outcome, with higher HRs indicating greater risk. HR = hazard ratio; MSKI = musculoskeletal injury; PTSD = posttraumatic stress disorder; SUD = substance use disorder; TBI = traumatic brain injury.
Figure 2
Figure 2
Average number of inpatient, outpatient, and ED encounters over 12 months, based on OSA status. ED = emergency department.
e-Figure
e-Figure
See this image and copyright information in PMC

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