Sleep Disorders and Associated Medical Comorbidities in Active Duty Military Personnel

Mysliwiec, Vincent; McGraw, Leigh; Pierce, Roslyn; Smith, Patrick; Trapp, Brandon; Roth, Bernard

doi:10.5665/sleep.2364

Cited by 231 publications

(149 citation statements)

References 46 publications

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“…32,35,38 The final study, Mysliwiec, was conducted in a military population where routine PSG is a postcombat requirement, which may increase the reporting bias for OSA. 26 Overall, 6 of the 8 clinic-based samples reported an elevated rate of OSA in MDD. In population based studies, Sharafkhaneh reported a prevalence of 7.4% in the VHA vs. 44% for a community population sample in Hrubos-Strom.…”

Section: Mood Disordersmentioning

confidence: 99%

“…25,26,39 The clinicbased sample in Mysliwiec reported a prevalence of anxiety disorders excluding PTSD as 47.5% for their time interval.…”

Section: Anxiety Disordersmentioning

confidence: 99%

“…studies (Table 1; Table S7, Appendix 2). [24][25][26]30,32,[35][36][37][38][39] The clinic-based studies range in prevalence from 0% to 66%. Seven studies were at high risk of selection bias, and one study was at moderate risk of selection bias.…”

Section: Mood Disordersmentioning

confidence: 99%

“…[24][25][26][39][40][41][42][43][44] The clinic-based studies reported a prevalence range of 0.7% to 83%.…”

mentioning

confidence: 99%

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Obstructive Sleep Apnea and Psychiatric Disorders: A Systematic Review

Gupta

Simpson

2015

Journal of Clinical Sleep Medicine

258

156

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Study Objectives: Obstructive sleep apnea (OSA) has been associated with psychiatric pathology. Psychiatric comorbidity in OSA may affect patient quality of life and adherence to CPAP. A focused evaluation of OSA in highly selected groups of primarily psychiatric patients may provide further insights into the factors contributing to comorbidity of OSA and psychopathology. The goal of this study is to examine the prevalence and treatment of OSA in psychiatric populations. Methods: A systematic review following the PRISMA guidelines was conducted to determine the prevalence of OSA in schizophrenia and other psychotic disorders, mood disorders, and anxiety disorders, and to examine potential interventions. The PubMed, EMBASE, and PsycINFO databases were searched (last search April 26, 2014) using keywords based on the ICD-9-CM coding for OSA and the DSM-IV-TR diagnostic groups. Results: The search retrieved 48 records concerning studies of OSA in the selected disorders. The prevalence studies indicate that there may be an increased prevalence of OSA in individuals with major depressive disorder (MDD) and posttraumatic stress disorder (PTSD), despite considerable heterogeneity and a high risk of bias. There was insuffi cient evidence to support increased OSA in schizophrenia and psychotic disorders, bipolar and related disorders, and anxiety disorders other than PTSD. Studies of treatment of OSA indicate an improvement in both OSA and psychiatric symptoms. CPAP adherence was reduced in veterans with PTSD. Conclusions: OSA prevalence may be increased in MDD and PTSD. In individuals with OSA and psychiatric illness, treatment of both disorders should be considered for optimal treatment outcomes. 1 According to a major US study of OSA diagnosed by polysomnography (PSG), the prevalence of OSA, as defi ned by an apnea-hypopnea index (AHI) ≥ 5 and without inclusion of a daytime sleepiness criterion, was reported as 24% for men and 9% for women under the age of 65 years; addition of a daytime sleepiness criterion reduced these estimates to 4% for men and 2% for women. 1,2 OSA is commonly associated with metabolic syndrome including comorbid obesity, hypertension, and diabetes.1 Upper airway obstruction may present as apneas, hypopneas, or respiratory effort-related arousals (RERAs), resulting in oxygen desaturation, repeated arousals and sleep fragmentation. Recently, there has been an increase in reports of comorbidity of OSA with psychological/psychiatric symptoms. Psychiatric comorbidity in OSA has been reported to adversely affect the quality of life of OSA patients and adherence to CPAP therapy. 3-5Psychological symptoms such as depression and anxiety are commonly reported in adults with OSA; however, the relationship between OSA and full psychiatric syndromes is less clear. Global prevalence studies and reviews have suggested that there are elevated rates of psychological symptoms in individuals with OSA. [17][18][19] Studies that have evaluated the prevalence of OSA in the highly selected groups of psychiatric popu...

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Section: Mood Disordersmentioning

confidence: 99%

“…25,26,39 The clinicbased sample in Mysliwiec reported a prevalence of anxiety disorders excluding PTSD as 47.5% for their time interval.…”

Section: Anxiety Disordersmentioning

confidence: 99%

Section: Mood Disordersmentioning

confidence: 99%

“…[24][25][26][39][40][41][42][43][44] The clinic-based studies reported a prevalence range of 0.7% to 83%.…”

mentioning

confidence: 99%

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Obstructive Sleep Apnea and Psychiatric Disorders: A Systematic Review

Gupta

Simpson

2015

Journal of Clinical Sleep Medicine

258

156

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“…Nightmares are more common among patients with sleep disturbances, sleep disorders, depression, anxiety, and posttraumatic stress disorder However, most research evaluating sleep disorders in active duty military personnel has focused on insomnia, obstructive sleep apnea (OSA), and PTSD, noting that a recent study focusing on OSA and PTSD did not evaluate nightmares. [18][19][20] Following traumatic experiences, sleep disturbances are frequently reported, including trauma-related nightmares (TRN). 21 The nightmares of trauma survivors tend to be more severe and distressing than idiopathic nightmares.…”

mentioning

confidence: 99%

Nightmares in United States Military Personnel With Sleep Disturbances

Creamer

Brock

Matsangas

et al. 2018

Journal of Clinical Sleep Medicine

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Study Objectives: Sleep disturbances are common in United States military personnel. Despite their exposure to combat and trauma, little is known about nightmares in this population. The purpose of this study was to describe the prevalence and associated clinical and polysomnographic characteristics of nightmares in United States military personnel with sleep disturbances. Methods: Retrospective review of 500 active duty United States military personnel who underwent a sleep medicine evaluation and polysomnography at our sleep center. The Pittsburgh Sleep Quality Index and the Pittsburgh Sleep Quality Index-Addendum were used to characterize clinically significant nightmares. Subjective and objective sleep attributes were compared between groups. Results: At least weekly nightmares were present in 31.2%; yet, only 3.9% reported nightmares as a reason for evaluation. Trauma-related nightmares occurred in 60% of those patients with nightmares. Patients with nightmares had increased sleep onset latency (SOL) and rapid eye movement (REM) sleep latency (mean SOL/REM sleep latency 16.6/145 minutes, P = .02 and P = .01 respectively) compared to those without (mean SOL/REM sleep latency 12.5/126 minutes I NTRO DUCTI O NNightmares are defined by repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that cause clinically significant distress or impairment in social, occupational, or other areas of functioning. 1 Occasional nightmares are part of a normal adaptive response to life stressors and are not pathologic, with 85% of adults reporting at least one nightmare per year. 2 The prevalence of clinically significant nightmares, which occur at least once per week, is estimated between 0.9% and 6.8%. [3][4][5][6][7][8][9] In the largest study to date (69,813 adults), the prevalence of nightmares was 3.5% in men and 4.8% in women. 10 Participants from the World War II generation had a significantly higher prevalence of 7.2% in men and 7% in women. Nightmares are more common among patients with sleep disturbances, sleep disorders, depression, anxiety, and posttraumatic stress disorder However, most research evaluating sleep disorders in active duty military personnel has focused on insomnia, obstructive sleep apnea (OSA), and PTSD, noting that a recent study focusing on OSA and PTSD did not evaluate nightmares. [18][19][20] Following traumatic experiences, sleep disturbances are frequently reported, including trauma-related nightmares (TRN). 21 The nightmares of trauma survivors tend to be more severe and distressing than idiopathic nightmares. 1,3 Though not exclusive to PTSD, TRN have been referred to as the "hallmark" of this disorder, with rates as high as 90%. 22,23 Addressing nightmares as a distinct sleep disorder following a BRIEF SUMMARY Current Knowledge/Study Rationale: The spectrum of sleep disorders in military personnel is varied and complicated by the presence of comorbidities and psychological disorders. Currently, little is known regarding nightmares, especially trauma-related nig...

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Internet-Guided Cognitive Behavioral Therapy for Insomnia Among Patients With Traumatic Brain Injury

Malarkey,

Fu,

Mannan

et al. 2024

JAMA Netw Open

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ImportanceMany military service members and veterans report insomnia after sustaining traumatic brain injury (TBI). Limitations of first-line treatment, cognitive-behavioral therapy for insomnia (CBT-I), include availability of qualified clinicians, low completion rates, and cost.ObjectiveTo investigate the feasibility and efficacy of internet-guided CBT-I (eCBT-I) in military service members and veterans with insomnia and a history of TBI.Design, Setting, and ParticipantsThis randomized clinical trial of fully remote internet-based interventions and evaluations was conducted from September 1, 2020, to June 30, 2021, with 3 months of follow-up. Participants included a volunteer sample of military service members and veterans aged 18 to 64 years with a history of mild TBI/concussion and at least moderately severe insomnia defined as an insomnia severity index (ISI) score of greater than 14 and Pittsburgh Sleep Quality Index of greater than 4. Self-reported race, ethnicity, and educational level were generally representative of the US military. Data were analyzed from October 21, 2021, to April 29, 2024.InterventionInternet-based CBT-I delivered over 6 weekly lesson modules with assigned homework activities.Main Outcomes and MeasuresThe prespecified primary outcome measure was change in ISI score over time. Prespecified secondary outcome measures included self-reported measures of depression symptoms, posttraumatic stress disorder (PTSD) symptoms, sleep quality, migraine impact, and fatigue.ResultsOf 204 people screened, 125 were randomized 3:1 to eCBT-I vs online sleep education, and 106 completed baseline evaluations (83 men [78.3%]; mean [SD] age, 42 [12] years). Of these, 22 participants (20.8%) were Hispanic or Latino and 78 (73.6%) were White. Fifty participants completed postintervention evaluations, and 41 completed the 3-month follow-up. Baseline mean (SD) ISI scores were 19.7 (4.0) in those randomized to eCBT-I and 18.9 (5.0) in those randomized to sleep education. After intervention, mean (SD) ISI scores were 13.7 (5.6) in those randomized to eCBT-I and 16.6 (5.7) in those randomized to sleep education. The difference in the extent of reduction in ISI scores between groups was 3.5 (95% CI,−6.5 to −0.4 [P = .03]; Cohen d, −0.32 [95% CI, −0.70 to −0.04]). In the eCBT-I group, the extent of insomnia improvement correlated with the extent of depressive symptom improvement (Spearman ρ = 0.68 [P &lt; .001]), PTSD symptoms (ρ = 0.36 [P = .04]), sleep quality (ρ = 0.54 [P = .001]), and fatigue impact (ρ = −0.58 [P &lt; .001]) but not migraine-related disability.Conclusions and RelevanceThe findings of this randomized clinical trial suggest that fully remote eCBT-I was moderately feasible and effective for self-reported insomnia and depression symptoms in military service members and veterans with a history of TBI. There is great potential benefit for eCBT-I due to low availability and cost of qualified CBT-I clinicians, although optimization of completion rates remains a challenge. Future studies may use home-based objective sleep assessments and should increase study retention.Trial RegistrationClinicalTrials.gov Identifier: NCT04377009

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Sleep Disorders and Associated Medical Comorbidities in Active Duty Military Personnel

Abstract: 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.

Cited by 231 publications

References 46 publications

Obstructive Sleep Apnea and Psychiatric Disorders: A Systematic Review

Obstructive Sleep Apnea and Psychiatric Disorders: A Systematic Review

Nightmares in United States Military Personnel With Sleep Disturbances

Internet-Guided Cognitive Behavioral Therapy for Insomnia Among Patients With Traumatic Brain Injury

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