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Haynes ZA, Stewart IJ, Poltavskiy EA, et al. Obstructive sleep apnea among survivors of combat-related traumatic injury: a retrospective cohort study. J Clin Sleep Med. 2021;doi: 10.5664/jcsm.9530.
Haynes, Z. A., Stewart, I. J., Poltavskiy, E. A., Holley, A. B., Janak, J. C., Howard, J. T., Watrous, J., Walker, L. E., Wickwire, E. M., Werner, K., Zarzabal, L. A., Sim, A., Gundlapalli, A., & Collen, J. F. (2021). Obstructive sleep apnea among survivors of combat-related traumatic injury: a retrospective cohort study. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, . https://doi.org/10.5664/jcsm.9530
Haynes, Zachary A, et al. "Obstructive sleep apnea among survivors of combat-related traumatic injury: a retrospective cohort study." Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine vol. (2021). doi: https://doi.org/10.5664/jcsm.9530
Haynes ZA, Stewart IJ, Poltavskiy EA, Holley AB, Janak JC, Howard JT, Watrous J, Walker LE, Wickwire EM, Werner K, Zarzabal LA, Sim A, Gundlapalli A, Collen JF. Obstructive sleep apnea among survivors of combat-related traumatic injury: a retrospective cohort study. J Clin Sleep Med. 2021 Jul 16; doi: 10.5664/jcsm.9530. Epub 2021 Jul 16. PMID: 34270410.
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J Clin Sleep Med. 2021 Jul 16; doi: 10.5664/jcsm.9530. Epub 2021 Jul 16.

Obstructive sleep apnea among survivors of combat-related traumatic injury: a retrospective cohort study.

Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine

Zachary A Haynes, Ian J Stewart, Eduard A Poltavskiy, Aaron B Holley, Jud C Janak, Jeffrey T Howard, Jessica Watrous, Lauren E Walker, Emerson M Wickwire, Kent Werner, Lee Ann Zarzabal, Alan Sim, Adi Gundlapalli, Jacob F Collen

Affiliations

  1. Walter Reed National Military Medical Center, Bethesda, MD.
  2. Uniformed Services University of the Health Sciences, Bethesda, MD.
  3. David Grant USAF Medical Center, Travis AFB, CA.
  4. Bexar Data, San Antonio, TX.
  5. University of Texas at San Antonio, San Antonio, TX.
  6. Leidos Inc, San Diego, CA.
  7. IUniversity of Maryland School of Medicine, Baltimore, MD.
  8. Defense Health Agency/J6, Randolph AFB, TX.
  9. VA Salt Lake City Health Care System, Salt Lake City, UT.

PMID: 34270410 DOI: 10.5664/jcsm.9530

Abstract

STUDY OBJECTIVES: Obstructive sleep apnea is prevalent among military members despite fewer traditional risk factors. We sought to determine the incidence and longitudinal predictors of obstructive sleep apnea in a large population of survivors of combat-related traumatic injury and a matched control group.

METHODS: Retrospective cohort study of military service members deployed to conflict zones from 2002-2016 with longitudinal follow-up in the Veterans Affairs and Military Health Systems. Two cohorts of service members were developed: (1) those who sustained combat injuries and (2) matched, non-injured participants.

RESULTS: 17,570 service members were retrospectively analyzed for a median of 8.4 years. After adjustment, traumatic brain injury (HR 1.39, 95% CI 1.20-1.60), posttraumatic stress disorder (HR 1.24, 95% CI 1.05-1.46), depression (HR 1.52, 95% CI 1.30-1.79), anxiety (HR 1.40, 95% CI 1.21-1.62), insomnia (HR 1.71, 95% CI 1.44-2.02), and obesity (HR 2.40, 95% CI 2.09-2.74) were associated with development of obstructive sleep apnea. While combat injury was associated with obstructive sleep apnea in the univariate analysis (HR 1.25, 95% CI 1.17-1.33), the direction of this association was reversed in the multivariable model (HR 0.74, 95% CI 0.65-0.84). In a nested analysis, this was determined to be due to the effect of mental health diagnoses.

CONCLUSIONS: The incidence of OSA is higher among injured service members (29.1 per 1000 person years) compared to uninjured service members (23.9 per 1000 person years). This association appears to be driven by traumatic brain injury and the long-term mental health sequelae of injury.

© 2021 American Academy of Sleep Medicine.

Keywords: PTSD; TBI; injury; insomnia; sleep apnea; trauma; traumatic injury; veterans

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