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 Those who were deployed were twice as likely as non-deployed
soldiers to be diagnosed with insomnia or sleep apnea, according to
the study published in Sleep. Combat exposure independently
increased the risk of insomnia, but not sleep apnea, the study
authors report.
"This study found extraordinary increases in insomnia and (sleep
apnea) in U.S. Army soldiers from 2003-2011 when the U.S. was
intensively engaged in multiple conflicts," write Harris R.
Lieberman, a researcher with the Military Nutrition Division at the
U.S. Army Research Institute of Environmental Medicine in Natick,
Massachusetts, and his colleagues.
"Given the substantial risk of insomnia and (sleep apnea) among
deployed soldiers it is essential to determine the underlying
mechanisms responsible," conclude the authors, who were not
available to comment on the report.
To get a sense of how deployment and combat might impact sleep, the
researchers analyzed data from the entire population of soldiers who
served in the U.S. Army from 1997 through 2011, a total of 1,357,150
men and women. The data came from the Total Army Injury and Health
Outcomes Database.
Evaluating sleep in soldiers is important, the researchers write,
because "insufficient and/or disordered sleep is associated with
numerous long-term physical- and mental-health problems, including
an increased risk of hypertension, diabetes, obesity, heart attack,
stroke, depression, anxiety, substance abuse, PTSD, suicide and
all-cause mortality."
Soldiers were deemed to have been deployed if they served outside
the U.S. at any time during their military service. They were
considered to have been exposed to combat if they were in a unit
that had a combat-related death.
The researchers determined that clinical diagnoses of insomnia
increased by 652 percent between 2003 and 2011, while sleep apnea
diagnoses increased by 600 percent during the same period. The
overall incidence of insomnia was 11.9 percent, while sleep apnea
was 5.1 percent.
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After accounting for factors such as gender, age, body mass,
race/ethnicity, marital status, military rank and time in the
service, the researchers determined that the risk of insomnia among
deployed soldiers was more than twice that of those who were not
deployed. And the risk was greatest, among soldiers who had been
deployed for a total of 11-20 months. They were 2.27 times more
likely to develop insomnia compared to those who were not deployed.
Deployed soldiers were also 2.14 times more likely than those not
deployed to develop sleep apnea. And among deployed soldiers, those
who saw combat were 1.2 times more likely to develop insomnia
compared to those not exposed to combat. Combat exposure did not
affect the likelihood of a soldier developing sleep apnea, the
researchers found.
The authors note that certain medical conditions, including
post-traumatic stress disorder and traumatic brain injury explained
some of the association between deployment and insomnia, but not all
of it. The increase in obstructive sleep apnea is "more difficult to
explain," they write, but the causes of the sharp rise in both
conditions should be studied further.
The new study is "fascinating" and "does a great job laying out the
problem," said Matthew R. Ebben, an associate professor of
psychology and clinical neurology at NewYork-Presbyterian and Weill
Cornell Medicine in New York City. "The percentage increases in
insomnia and sleep apnea over the time period are astounding."
The study, Ebben said, raises important questions: "Are these wars
necessary and what are we doing to the people engaged in them on our
behalf? What happens to these folks after they separate from the
military?"
SOURCE: https://bit.ly/2KcUYyQ Sleep, online May 18, 2019.
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