Obstructive sleep apnea among survivors of combat-related traumatic injury: a retrospective cohort study.
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.
['Haynes|Zachary A|ZA|', 'Stewart|Ian J|IJ|', 'Poltavskiy|Eduard A|EA|', 'Holley|Aaron B|AB|', 'Janak|Jud C|JC|', 'Howard|Jeffrey T|JT|', 'Watrous|Jessica|J|', 'Walker|Lauren E|LE|', 'Wickwire|Emerson M|EM|', 'Werner|Kent|K|', 'Zarzabal|Lee Ann|LA|', 'Sim|Alan|A|', 'Gundlapalli|Adi|A|', 'Collen|Jacob F|JF|']
sleep apnea traumatic injury injury veterans insomnia PTSD TBI trauma