The bi-directional relationship between post-traumatic stress disorder and obstructive sleep apnea and/or insomnia in a large U.S. military cohort

Evan D Chinoy; Felicia R Carey; Claire A Kolaja; Isabel G Jacobson; Adam D Cooper; Rachel R Markwald

doi:10.1016/j.sleh.2022.07.005

The bi-directional relationship between post-traumatic stress disorder and obstructive sleep apnea and/or insomnia in a large U.S. military cohort

Sleep Health. 2022 Dec;8(6):606-614. doi: 10.1016/j.sleh.2022.07.005. Epub 2022 Sep 24.

Authors

Evan D Chinoy¹, Felicia R Carey², Claire A Kolaja², Isabel G Jacobson², Adam D Cooper³, Rachel R Markwald⁴

Affiliations

¹ Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, California, USA; Leidos, Inc., San Diego, California, USA.
² Leidos, Inc., San Diego, California, USA; Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA.
³ Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, California, USA; Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA; Innovative Employee Solutions, San Diego, California, USA.
⁴ Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, California, USA. Electronic address: rachel.r.markwald.civ@health.mil.

PMID: 36163136
DOI: 10.1016/j.sleh.2022.07.005

Abstract

Objectives: Determine if a bi-directional relationship exists between the development of sleep disorders (obstructive sleep apnea [OSA] and/or insomnia) and existing post-traumatic stress disorder (PTSD), and vice versa; and examine military-related factors associated with these potential relationships.

Design: Longitudinal analyses of a prospective representative U.S. military cohort.

Participants: Millennium Cohort Study responders in 2011-2013 (Time 1 [T1]) and 2014-2016 (Time 2 [T2]) without insomnia or OSA at T1 (N = 65,915) or without PTSD at T1 (N = 71,256).

Measurements: Provider-diagnosed OSA, self-reported items for insomnia, provider-diagnosed PTSD, and current PTSD symptoms were assessed at T1 and T2. Adjusted multivariable models identified military-related factors associated with new-onset PTSD in those with OSA and/or insomnia, and vice versa.

Results: Self-reported history of provider-diagnosed PTSD without current symptoms at T1 was associated with new-onset OSA only and comorbid OSA/insomnia at T2, while current PTSD symptoms and/or diagnosis was associated with new-onset insomnia only. OSA/insomnia at T1 was consistently associated with newly reported PTSD symptoms or diagnosis except that insomnia only was not associated with newly reported provider-diagnosed PTSD. Military-related risk factors significantly associated with the bi-directional relationship for new-onset PTSD or OSA/insomnia included prior deployment with higher combat exposure and recent separation from the military; being an officer was protective for both outcomes.

Conclusions: In this large military cohort, findings suggest that PTSD and OSA and/or insomnia are bi-directionally predictive for their development, which was sometimes revealed by health care utilization. Relevant military-related risk factors should be considered in efforts to prevent or treat PTSD and/or sleep disorders.

Keywords: Insomnia; Military; Obstructive sleep apnea; Post-traumatic stress disorder; Sleep; Veterans.

MeSH terms

Cohort Studies
Humans
Prospective Studies
Sleep Apnea, Obstructive* / therapy
Sleep Initiation and Maintenance Disorders* / complications
Sleep Initiation and Maintenance Disorders* / epidemiology
Stress Disorders, Post-Traumatic* / complications
Stress Disorders, Post-Traumatic* / epidemiology