From the Guidelines
Treatment of sleep apnea in post-deployment military personnel should prioritize continuous positive airway pressure (CPAP) therapy as the first-line treatment, with a focus on adherence and integrated care addressing both physical and psychological factors, as recommended by the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guidelines 1. The management of sleep apnea in this population is crucial due to its high prevalence and association with significant morbidity and mortality. According to the guidelines, CPAP therapy should be used for the entirety of the sleep period, with educational, behavioral, and supportive interventions to improve adherence, especially in patients with posttraumatic stress disorder, anxiety, or insomnia 1. Key considerations in the treatment of sleep apnea in post-deployment military personnel include:
- The use of auto-titrating PAP devices to improve compliance and effectiveness
- Oral appliances like mandibular advancement devices as an alternative to CPAP for mild to moderate cases
- Positional therapy and weight loss for overweight individuals to reduce symptoms
- Lifestyle modifications such as avoiding alcohol and sedatives before bedtime and maintaining regular sleep schedules
- Integrated care addressing both physical and psychological factors, including PTSD and TBI, to ensure optimal treatment outcomes. It is essential to note that treatment adherence is critical for effectiveness, with CPAP requiring at least 4 hours of use per night on 70% of nights for optimal benefits, as suggested by the guidelines 1. In terms of diagnosis and assessment, the guidelines recommend using the STOP questionnaire to stratify the risk of OSA and assessing for sleep-disordered breathing in patients with a history of cardiovascular or cerebrovascular events, congestive heart, and chronic prescription opioid use 1. Overall, the treatment of sleep apnea in post-deployment military personnel requires a comprehensive and multidisciplinary approach, prioritizing CPAP therapy, adherence, and integrated care to address the unique challenges faced by this population, as supported by the guidelines 1.
From the Research
Treatment Options for Sleep Apnea in Individuals after Military Deployment
The treatment options for sleep apnea in individuals after military deployment are crucial to address the high prevalence of sleep disorders in this population. Some key points to consider include:
- Continuous Positive Airway Pressure (CPAP) therapy is a common treatment for obstructive sleep apnea (OSA) 2
- Lifestyle modifications, such as weight loss and exercise, can also help alleviate symptoms of OSA 3
- Cognitive Behavioral Therapy for Insomnia (CBT-I) may be effective in treating comorbid insomnia and OSA 4
- Aeromedical disposition management is essential to reduce OSA numbers and maintain aviator health in military personnel 5
Comorbidities and Sleep Apnea
Comorbidities, such as posttraumatic stress disorder (PTSD), depression, and anxiety, are common among military personnel with sleep apnea. Key points to consider include:
- Comorbid insomnia and OSA is a frequent diagnosis in military personnel referred for evaluation of sleep disturbances after deployment 2
- Traumatic brain injury, PTSD, depression, anxiety, and insomnia are associated with the development of OSA in military personnel 3
- Recognizing and treating both comorbid insomnia and OSA could improve clinical outcomes in military personnel 4
Prevalence of Sleep Apnea in Military Personnel
The prevalence of sleep apnea in military personnel is a significant concern. Some key points to consider include: