Prevalence rates and correlates of insomnia disorder in post-9/11 veterans enrolling in VA healthcare

Colvonen, Peter J.; Almklov, Erin; Tripp, Jessica C.; Ulmer, Christi S.; Pittman, James O. E.; Afari, Niloofar

doi:10.1093/sleep/zsaa119

Cited by 51 publications

(27 citation statements)

References 66 publications

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“…A cross sectional study also reported that of those military personnel who returned from deployment with sleep disturbances, 88.2% were identified to suffer from a clinically significant sleep disorder, with 63.6% meeting the diagnostic criteria for insomnia [ 91 ]. Insomnia disorder was also noted in 57.2% of post-9/11 veterans in another study [ 92 ]. Hughes et al .…”

Section: Dementia and Sleepmentioning

confidence: 86%

Dementia in military and veteran populations: a review of risk factors—traumatic brain injury, post-traumatic stress disorder, deployment, and sleep

Raza¹,

Hussain²,

Ftouni³

et al. 2021

Military Med Res

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The military population face a unique set of risk factors that may increase the risk of being diagnosed with dementia. Traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) have a higher prevalence in this group in comparison to the civilian population. By delving into the individual relationships between TBI and dementia, and PTSD and dementia, we are able to better explore dementia in the military and veteran populations. While there are some inconsistencies in results, the TBI-dementia association has become more widely accepted. Moderate-to-severe TBI has been found to increase the risk of being diagnosed with Alzheimer’s disease. A correlation between PTSD and dementia has been established, however, whether or not it is a causal relationship remains unclear. Factors such as blast, combat and chemical exposure may occur during a deployment, along with TBI and/or PTSD diagnosis, and can impact the risk of dementia. However, there is a lack of literature exploring the direct effects of deployment on dementia risk. Sleep problems have been observed to occur in those following TBI, PTSD and deployment. Poor sleep has been associated with possible dementia risk. Although limited studies have focused on the link between sleep and dementia in military and veteran populations, sleep is a valuable factor to study due to its association and interconnection with other military/veteran factors. This review aims to inform of various risk factors to the cognitive health of military members and veterans: TBI, PTSD, deployment, and sleep.

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Section: Dementia and Sleepmentioning

confidence: 86%

Dementia in military and veteran populations: a review of risk factors—traumatic brain injury, post-traumatic stress disorder, deployment, and sleep

Raza¹,

Hussain²,

Ftouni³

et al. 2021

Military Med Res

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“…Thus, the increasing trend in annual prevalence of insomnia diagnoses observed by Alexander and colleagues was also observed in the current study. Despite the relative increases in insomnia diagnoses documented in medical records over time, there remains a notable discrepancy between estimates of insomnia derived from medical records (1.5-3.4% [6,7]) and those derived from epidemiology studies based on interviews and/or surveys (22-57% [9,22]). In both the current analysis and that of Alexander et al, relatively conservative criteria were used to define an insomnia diagnosis (i.e., ≥2 ICD codes occurring greater than 30 days apart but within 390 and 365 days, respectively).…”

Section: Discussionmentioning

confidence: 97%

“…In contrast, administrative studies of VA electronic health records (EHR) estimate insomnia prevalence rates from 0.2% to 3.5% [6,7]. Though a 650% relative increase in the age-adjusted prevalence of insomnia was observed in veterans utilizing VA services between fiscal years 2000 and 2010 (from 0.2% to 1.5% [6]), there remains a notable discrepancy between reports of clinically significant insomnia symptoms [9] and expected diagnoses of insomnia in the medical record (7.4-11.8%; [7,10,11]).…”

Section: Introductionmentioning

confidence: 99%

“…Survey studies suggest that upwards of half of US Military service members and veterans experience clinically significant insomnia symptoms (see US Department of Veterans Affairs (VA)/Department of Defense (DOD) guidelines for review [8]). Notably, a recent study of post-9/11 veterans found that 57.2% scored ≥11 (clinical cutoff) on the Insomnia Severity Index and 40.5% scored ≥15 (moderate-severe cutoff), both scores indicative of increased risk for a diagnosis of insomnia disorder [9]. In contrast, administrative studies of VA electronic health records (EHR) estimate insomnia prevalence rates from 0.2% to 3.5% [6,7].…”

Section: Introductionmentioning

confidence: 99%

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Insomnia and Insomnia-Related Care in the Department of Veterans Affairs: An Electronic Health Record Analysis

Bramoweth

Tighe

Berlin

2021

IJERPH

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The objective was to examine insomnia and insomnia-related care within a regional network of Department of Veterans Affairs (VA) facilities since the VA roll-out of cognitive behavioral therapy for insomnia (CBT-I) in 2011. A retrospective analysis of VA electronic health records (EHR) data from 2011 to 2019 was conducted. The annual and overall prevalence of four insomnia indicators was measured: diagnoses, medications, consultations for assessment/treatment, and participation in CBT-I. Also examined were sociodemographic and clinical differences among veterans with and without an insomnia indicator, as well as differences among the four individual insomnia indicators. The sample included 439,887 veterans, with 17% identified by one of the four indicators; medications was most common (15%), followed by diagnoses (6%), consults (1.5%), and CBT-I (0.6%). Trends over time included increasing yearly rates for diagnoses, consults, and CBT-I, and decreasing rates for medications. Significant differences were identified between the sociodemographic and clinical variables across indicators. An evaluation of a large sample of veterans identified that prescription sleep medications remain the best way to identify veterans with insomnia. Furthermore, insomnia continues to be under-diagnosed, per VA EHR data, which may have implications for treatment consistent with clinical practice guidelines and may negatively impact veteran health.

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“…After additional adjustment for several mental health and medical comorbidities, insomnia remained positively associated with SA. Similarly, Colvonen et al (2020) found that post-9/11 US veterans (N = 5552) enrolling in care at a VHA who reported SI also had high rates (87.7%) of probable insomnia disorder.…”

mentioning

confidence: 88%

Self‐rated sleep quality predicts incident suicide ideation in US military veterans: Results from a 7‐year, nationally representative, prospective cohort study

McCarthy

DeViva

Southwick

et al. 2021

Journal of Sleep Research

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Summary Sleep disturbance is a risk factor for future suicidal behaviours (e.g. suicidal ideation, suicide attempt, death by suicide), and military veterans are at increased risk for both poor sleep and death by suicide relative to civilians. The purpose of this study was to evaluate whether self‐reported sleep quality was associated with risk of new‐onset suicidal ideation in a 7‐year prospective nationally representative cohort study of US military veterans. Multivariable logistic regression analyses were conducted to identify the relation between self‐rated sleep quality and incident suicidal ideation in 2,059 veterans without current suicidal ideation or lifetime suicide attempt history at baseline. Relative importance analyses were then conducted to identify the relative variance explained by sleep quality and other significant determinants of incident suicidal ideation. A total of 169 (weighted 8.9%, 95% confidence interval =7.7%–10.3%) veterans developed suicidal ideation over the 7‐year study period. Poor self‐rated sleep quality was associated with a more than 60% greater likelihood of developing suicidal ideation (relative risk ratio = 1.62, 95% confidence interval = 1.11–2.36), even after adjustment for well‐known suicide risk factors such as major depressive disorder. Relative importance analysis revealed that poor self‐rated sleep quality accounted for 44.0% of the explained variance in predicting incident suicidal ideation. These results underscore the importance of assessing, monitoring and treating sleep difficulties as part of suicide prevention efforts in military veterans.

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Prevalence rates and correlates of insomnia disorder in post-9/11 veterans enrolling in VA healthcare

Cited by 51 publications

References 66 publications

Dementia in military and veteran populations: a review of risk factors—traumatic brain injury, post-traumatic stress disorder, deployment, and sleep

Dementia in military and veteran populations: a review of risk factors—traumatic brain injury, post-traumatic stress disorder, deployment, and sleep

Insomnia and Insomnia-Related Care in the Department of Veterans Affairs: An Electronic Health Record Analysis

Self‐rated sleep quality predicts incident suicide ideation in US military veterans: Results from a 7‐year, nationally representative, prospective cohort study

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