TY  - JOUR
PY  - 2021//
TI  - Obstructive sleep apnea among survivors of combat-related traumatic injury: a retrospective cohort study
JO  - Journal of clinical sleep medicine
A1  - Haynes, Zachary A.
A1  - Stewart, Ian J.
A1  - Poltavskiy, Eduard A.
A1  - Holley, Aaron B.
A1  - Janak, Jud C.
A1  - Howard, Jeffrey T.
A1  - Watrous, Jessica
A1  - Walker, Lauren E.
A1  - Wickwire, Emerson M.
A1  - Werner, Kent
A1  - Zarzabal, Lee Ann
A1  - Sim, Alan
A1  - Gundlapalli, Adi
A1  - Collen, Jacob F.
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - 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. <br><br>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. <br><br>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. <br><br>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.<p />  <p>Language: en</p>
LA  - en
SN  - 1550-9389
UR  - http://dx.doi.org/10.5664/jcsm.9530
ID  - ref1
ER  -