Can Military Service Cause Sleep Apnea?
While military service itself does not directly cause obstructive sleep apnea through a unique physiological mechanism, the evidence demonstrates that military service is strongly associated with dramatically increased rates of OSA diagnosis, driven by deployment-related factors, combat exposure, mental health sequelae, and weight gain during service.
Epidemiological Evidence of Association
The relationship between military service and OSA is striking based on population-level data:
A 600% increase in OSA incidence occurred among U.S. Army soldiers from 1997 to 2011, representing an unprecedented epidemic-like rise that coincided with sustained combat operations 1.
OSA encounters increased 517% in the total U.S. military population from 2005 to 2014 (from 44 per 1,000 to 273 per 1,000 personnel), with rates continuing to climb linearly across nearly all demographic subgroups 2.
Military personnel have substantially higher OSA rates than the general civilian population, with 62.7% of service members referred for sleep evaluation meeting diagnostic criteria for OSA 3.
Deployment and Combat as Risk Factors
The evidence clearly links deployment and combat exposure to OSA development:
Deployment doubles the risk of OSA (risk ratio 2.14,95% CI 2.11-2.17) even after controlling for other factors 4.
Combat-injured service members have higher OSA incidence (29.1 per 1,000 person-years) compared to uninjured service members (23.9 per 1,000 person-years) 5.
However, combat exposure itself does not independently increase OSA risk (RR 1.00,95% CI 0.98-1.02) when analyzed separately from deployment 4.
Mediating Mechanisms
The association between military service and OSA appears mediated through several pathways rather than direct causation:
Mental Health Conditions
PTSD increases OSA risk 7.6-fold in veterans, representing one of the strongest associations 1.
Depression increases OSA risk (HR 1.52,95% CI 1.30-1.79) among service members 5.
Anxiety increases OSA risk (HR 1.40,95% CI 1.21-1.62) 5.
Military personnel with comorbid insomnia and OSA are significantly more likely to have PTSD and depression compared to those with OSA alone (P < 0.01) 3.
Traumatic Brain Injury
TBI increases OSA risk by 39% (HR 1.39,95% CI 1.20-1.60) among combat-injured survivors 5.
TBI and mental health diagnoses together explain much of the association between combat injury and OSA development 5.
Weight Gain During Service
Enlistment BMI predicts future OSA development, with the heaviest individuals (BMI > 35) at nearly 4-fold increased risk (HR 3.93,95% CI 3.35-4.62) 6.
Obesity during service increases OSA risk 2.4-fold (HR 2.40,95% CI 2.09-2.74) 5.
The military environment may contribute to weight gain through irregular schedules, stress, limited healthy food options during deployment, and reduced physical activity due to injury 6.
Insomnia as a Mediating Factor
Insomnia increases OSA risk by 71% (HR 1.71,95% CI 1.44-2.02) 5.
38.2% of military personnel with sleep disturbances have comorbid insomnia and OSA, a particularly difficult-to-treat combination 3.
Insomnia itself increased 652% in the military from 2003-2011, suggesting shared underlying mechanisms 4.
High-Risk Military Subpopulations
Certain groups within the military experience disproportionate OSA rates:
Men have higher OSA rates than women across all military services 2.
Personnel ≥40 years of age show the greatest increases 2.
Black service members have higher rates compared to other racial groups 2.
Senior officers and senior enlisted personnel have elevated rates 2.
Army personnel experience higher rates compared to other military branches 2.
Clinical Implications
Screening Priorities
Military personnel and veterans warrant aggressive OSA screening, particularly those with:
- History of deployment or combat exposure 4
- PTSD, depression, anxiety, or TBI diagnoses 5, 3
- Comorbid insomnia 3
- Weight gain during or after service 6
- Refractory mental health symptoms despite treatment 3
Common Pitfall
Do not attribute OSA solely to obesity in military populations. While BMI is a risk factor, the mental health and deployment-related factors play substantial independent roles that require concurrent management 5, 3.
Treatment Considerations
The high rate of comorbid insomnia and OSA (38.2%) in military populations means that CPAP therapy alone may be insufficient, and concurrent insomnia treatment is often necessary 3.