Prevalence of insomnia disorder and sleep apnea in a sample of veterans at risk for cardiovascular disease.
STUDY OBJECTIVES
The objectives of this study were to examine the proportion of study participants screening positive for insomnia disorder and/or sleep apnea in veterans engaged in routine health care and known to be at risk for cardiovascular disease and to compare these proportions with those previously documented in medical records.


METHODS
This was a cross-sectional analysis of baseline data from a randomized clinical intervention trial for patients at risk of cardiovascular disease and a review of study participants' medical records. Participants were veterans ≥ 40 years of age, enrolled in Veterans Affairs primary care, and diagnosed with hypertension and/or hypercholesterolemia. Self-report outcomes were the proportion of patients screening positive for an insomnia disorder and sleep apnea, self-reporting a sleep apnea diagnosis, and endorsing undertreated sleep apnea. Medical record outcomes were the proportion of patients diagnosed with insomnia and sleep apnea.


RESULTS
Participants (n = 420) were veterans (84.8% male) with a mean age of 61.1 years. More than half of the sample (52.1%) screened positive for sleep apnea without prior self-reported diagnosis. More than one-third of the sample (39%) screened positive for an insomnia disorder. Medical records revealed considerably lower rates, with 3.8% diagnosed with insomnia, 20.5% diagnosed with sleep apnea, and about 1% diagnosed with both conditions.


CONCLUSIONS
Undiagnosed and undertreated sleep disorders are common among veterans at risk for cardiovascular disease. Most of the sample (82%) screened positive for, or met, study criteria for sleep apnea or an insomnia disorder. Limitations include the use of self-reported sleep apnea treatment adherence, an insomnia disorder diagnosis based on questionnaire score, and a sample comprised primarily of male veterans. Routine sleep disorders screening in veterans at risk for cardiovascular disease could help to identify those at even greater risk because of the adverse effects of undiagnosed or undertreated sleep disorders.


CLINICAL TRIAL REGISTRATION
Registry; ClinicalTrials.gov; Name: Cardiovascular Intervention Improvement Telemedicine Study; URL: https://clinicaltrials.gov/ct2/show/NCT01142908; Identifier: NCT01142908.
['Ulmer|Christi S|CS|', 'McCant|Felicia|F|', 'Stechuchak|Karen M|KM|', 'Olsen|Maren|M|', 'Bosworth|Hayden B|HB|']
D002318:Cardiovascular Diseases D003430:Cross-Sectional Studies D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D015995:Prevalence D016032:Randomized Controlled Trials as Topic D012891:Sleep Apnea Syndromes D007319:Sleep Initiation and Maintenance Disorders D014728:Veterans
insomnia sleep apnea veterans cardiovascular disease