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Cited by 184Sleep and related disordersObstructive Sleep Apnea ResearchSleep and Work-Related Fatigue

Sleep Disorders in US Military Personnel

Open access
Mysliwiec, Vincent, Gill, Jessica, Lee, Hyunhwa, Baxter, Tristin, Pierce, Roslyn, Barr, Taura L., Krakow, Barry, Roth, Bernard J.·2013·Chest
DOI 10.1378/chest.13-0088PMC PMC4694100
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Abstract

Background Sleep disturbances are among the most common symptoms of military personnel who return from deployment. The objective of our study was to determine the presence of sleep disorders in US military personnel referred for evaluation of sleep disturbances after deployment and examine associations between sleep disorders and service-related diagnoses of depression, mild traumatic brain injury, pain, and posttraumatic stress disorder (PTSD).Methods This was a cross-sectional study of military personnel with sleep disturbances who returned from combat within 18 months of deployment. Sleep disorders were assessed by clinical evaluation and polysomnogram with validated instruments to diagnose service-related illnesses.Results Of 110 military personnel included in our analysis, 97.3% were men (mean age, 33.6 ± 8.0 years; mean BMI, 30.0 ± 4.3 kg/m2), and 70.9% returned from combat within 12 months. Nearly one-half (47.3%) met diagnostic criteria for two or more service-related diagnoses. Sleep disorders were diagnosed in 88.2% of subjects; 11.8% had a normal sleep evaluation and served as control subjects. Overall, 62.7% met diagnostic criteria for obstructive sleep apnea (OSA) and 63.6% for insomnia. The exclusive diagnoses of insomnia and OSA were present in 25.5% and 24.5% of subjects, respectively; 38.2% had comorbid insomnia and OSA. Military personnel with comorbid insomnia and OSA were significantly more likely to meet criteria for depression (P < .01) and PTSD (P < .01) compared with control subjects and those with OSA only.Conclusions Comorbid insomnia and OSA is a frequent diagnosis in military personnel referred for evaluation of sleep disturbances after deployment. This diagnosis, which is difficult to treat, may explain the refractory nature of many service-related diagnoses.

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Crossref · 10.1378/chest.13-0088

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  • The available literature on insomnia prevalence in obstructive sleep apnea has significant shortcomings.

    “The available literature addressing the prevalence of insomnia in patients with OSA (Table VII.I.1)588,943–956 suffers from several significant shortcomings.”

    From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [949]

    The Discussion (page unavailable) raises concern that comorbid insomnia and OSA may be underreported in military personnel, as noted in civilian studies. That supports a possible limitation in prevalence reporting, but the paper does not assess the available prevalence literature as a whole or say it has several significant shortcomings. Its explicit discussion of study limitations concerns its own study. (LLM, conf=0.76)

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  • Reported rates of insomnia disorder diagnosis in patients with obstructive sleep apnea range from 6.4% to 74%.

    “The reported rates of an insomnia disorder diagnosis in patients with OSA ranged from 6.4% to 74%.”

    From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [949]

    The Results (page unavailable) report that 42 of 110 military personnel had both insomnia and OSA, confirming that the paper addresses insomnia diagnoses in patients with OSA. The paper does not report the claimed range of 6.4% to 74%; its 38.2% figure describes the proportion of the entire cohort with both diagnoses, not a range across OSA populations. (LLM, conf=0.82)

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  • Most studies found insomnia disorder rates in obstructive sleep apnea clustered between 29% and 50%.

    “Notably, the majority of studies found rates that were clustered in the range of 29%–50%.”

    From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [949]

    The Results report that 38.2% of this study’s 110 military personnel had comorbid insomnia and OSA, a figure within the quoted range. But that percentage is of the entire cohort, not the insomnia rate among people with OSA, and the paper does not establish that most studies found rates of 29%–50%. (LLM, conf=0.84)

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  • Reported prevalence of insomnia symptoms in obstructive sleep apnea varies from 7% to 68%, with most estimates between 36% and 58%.

    “For insomnia symptoms, the prevalence varied from 7% to 68% with most estimates being in the range of 36%–58%.”

    From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [949]

    The Results report that 38.2% of this study’s military cohort had both insomnia and obstructive sleep apnea. The cited paper does not report a 7%–68% range or say that most estimates fall between 36% and 58% (searched those figures and prevalence in patients with obstructive sleep apnea). (LLM, conf=0.72)

    Experimental — accuracy not yet measured

  • Studies with the lowest insomnia prevalence rates tended to be general population studies.

    “Notably, the studies with the lowest prevalence rates tended to be the general population studies.”

    From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [949]

    The Study Design section describes a study of active-duty military personnel referred for sleep evaluation, and the Results report insomnia diagnoses in that cohort. Searches for general-population studies and comparisons of insomnia prevalence found no passage stating that general-population studies tended to have the lowest rates. The paper’s military cohort does not establish the claimed pattern across studies. (LLM, conf=0.76)

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Cites

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Research works printed but not linked: 3

  1. [5]5. Hoge CW , McGurk D , Thomas JL , Cox AL , Engel CC , Castro CA . Mild traumatic brain injury in US soldiers return- ing from Iraq . N Engl J Med . 2008 ; 358 ( 5 ): 453 -463 .
  2. [19]19. Armed Forces Health Surveillance Center . Insomnia, active component, US Armed Forces, January 2000-December 2009 . Medical Surveillance Monthly Report . 2010 ; 17 ( 5 ): 12 -15 .
  3. [20]20. Armed Forces Health Surveillance Center . Obstructive sleep apnea, active component, US Armed Forces, January 2000- December 2009 . Medical Surveillance Monthly Report . 2010 ; 17 ( 5 ): 8 -11 .

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Authors
Mysliwiec, V., Gill, J., Lee, H., Baxter, T., Pierce, R., Barr, T. L., Krakow, B., & Roth, B. J.
Affiliations
  • Madigan Army Medical Center (US)
  • National Institutes of Health (US)
  • West Virginia University (US)
  • Sleep and Human Health Institute (US)
Corresponding author
Mysliwiec, Vincent
ORCID
Venue
Chest
Publisher
Elsevier BV
Published
2013-08
Volume
144
Issue
2
Pages
549-557
ISSN
0012-3692 (ISSN-L)
DOI
10.1378/chest.13-0088
PMC
PMC4694100
OpenAlex
W2154732472
Semantic Scholar
d8142b73fe6df032fd8df8f7725fa830ee9efb62
Cited by
184
References
61
Citations by year
2026: 9 · 2025: 13 · 2024: 6 · 2023: 16 · 2022: 12 · 2021: 20 · 2020: 16 · 2019: 17 · 2018: 20 · 2017: 14 · 2016: 10 · 2015: 15 · 2014: 12 · 2013: 3
FWCI
18.06
Type
journal article
Language
en
Open access
Licence
Locations
  • CHEST Journal (acceptedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
Center for Neuroscience and Regenerative Medicine (Grant 60855)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
Keywords
sleep disorders, military personnel, combat deployment, obstructive sleep apnea, insomnia, comorbidities, depression, post-traumatic stress disorder, mild traumatic brain injury, chronic pain, polysomnography
MeSH terms
Adult, Brain Injuries, Cross-Sectional Studies, Depression, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Pain Measurement, Stress Disorders, Post-Traumatic, United States, Polysomnography, Sleep Apnea, Obstructive

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