From the Guidelines
Military deployment can potentially contribute to the development of sleep apnea, though it is not a direct cause, as it exposes individuals to risk factors such as disrupted sleep patterns, stress, PTSD, and weight gain. According to the 2020 study published in the Annals of Internal Medicine 1, sleep disorders are more prevalent in military personnel and veterans than in the general civilian population, with 48.6% of military personnel surveyed having poor sleep quality. The study also found that the prevalence of insomnia symptoms is as high as 41% in service members deployed to combat, and 25% in noncombatants. Additionally, a study published in the Journal of Clinical Sleep Medicine 1 suggests that military personnel with sleep disorders often also have posttraumatic stress disorder (PTSD), symptoms of anxiety and depression, and traumatic brain injury, which can complicate diagnosis and management.
Some key points to consider include:
- The VA/DoD clinical practice guidelines recommend using the STOP questionnaire to stratify the risk of OSA in patients who report sleep complaints 1.
- The guidelines also suggest assessing for sleep-disordered breathing in patients with a history of cardiovascular or cerebrovascular events, congestive heart, and chronic prescription opioid use 1.
- Treatment options for OSA include CPAP therapy, oral appliances, lifestyle modifications, and in some cases, surgery to remove tissue that blocks airways 1.
- The VA recognizes sleep apnea as a potentially service-connected condition, meaning veterans may be eligible for disability benefits if their sleep apnea can be linked to their military service 1.
It is essential to note that while military deployment may contribute to the development of sleep apnea, it is not the sole cause, and other factors such as genetics, age, and lifestyle also play a role. Veterans who experience symptoms of sleep apnea, such as loud snoring, gasping for air during sleep, excessive daytime sleepiness, or morning headaches, should seek medical evaluation. A comprehensive sleep assessment, including the use of questionnaires such as the Insomnia Severity Index or Athens Insomnia Scale, can help diagnose sleep disorders and guide treatment decisions 1.
From the Research
Military Deployment and Sleep Apnea
- Military deployment can be a significant factor in the development of sleep apnea, as evidenced by studies that have examined the relationship between deployment and sleep disorders 2, 3.
- The incidence of sleep apnea has been found to increase with deployment, with one study showing a 600% increase in the incidence of obstructive sleep apnea (OSA) from 2003 to 2011 2.
- Another study found that the risk of sleep apnea was increased by deployment, with a hazard ratio of 1.89 (95% confidence interval, 1.86-1.92) 3.
- Combat exposure has also been found to be a risk factor for sleep apnea, although the relationship between the two is not as strong as the relationship between deployment and sleep apnea 2, 3.
Sleep Disorders in Military Personnel
- Sleep disorders, including insomnia and sleep apnea, are common among military personnel, with one study finding that 88.2% of subjects had a sleep disorder 4.
- The exclusive diagnoses of insomnia and OSA were present in 25.5% and 24.5% of subjects, respectively, while 38.2% had comorbid insomnia and OSA 4.
- Military personnel with comorbid insomnia and OSA were significantly more likely to meet criteria for depression and posttraumatic stress disorder (PTSD) compared to control subjects and those with OSA only 4.
Environmental Factors and Sleep
- Environmental factors, such as light, noise, temperature, and air pollution, can negatively impact sleep in the military operational context 5.
- Simple, feasible steps can be taken to reduce sleep disruptions caused by light and noise, but there is a need for research and development on tools to mitigate air pollution, extreme temperatures, and inhospitable sleeping surfaces 5.
- Leadership at military bases and training facilities should focus on improving the sleep environment for individuals under their command, as this could ultimately improve warfighter health, wellness, and operational performance 5.