With more than one in 10 Americans facing an increased risk of stroke, heart attack and high blood pressure because of untreated sleep apnea, a new University of Maryland School of Medicine study shows active-duty military members face a far greater risk of suffering post-traumatic stress disorder or a traumatic brain injury when compared to those who don’t have the condition.
“Sleep apnea is associated with a very broad range of adverse psychiatric and medical outcomes, including increased risk of depression, increased risk of cardiovascular disease, and what are called musculoskeletal injuries, often broken bones,” said Emerson Wickwire, who holds a doctorate in psychology and is the section chief of sleep medicine at the University of Maryland School of Medicine.
The study found active-duty military members are more than four times more likely to experience PTSD and three times more likely to suffer a traumatic brain injury, compared to those who don’t have the condition.
Obstructive sleep apnea is a breathing disorder in which breathing stops and restarts throughout sleep, often dozens of times in an hour. Common symptoms can include chronic snoring and daytime sleepiness, as well as mood and behavior changes.
“It’s very common for patients with obstructive sleep apnea not to know that they suffer the condition, because, by definition, we are asleep when sleep apnea is occurring,” Wickwire told WTOP.
Wickwire is the lead author of research published in the journal CHEST that analyzes results of a study conducted in conjunction with the Uniformed Services University — the Bethesda-based schools and research centers where members of the military are trained to be doctors.
Previous research has found only one-third of active-duty service members get the minimum recommended seven or more hours of sleep per night. According to the new study, there’s been a growing awareness of sleep apnea in the military, with diagnoses increasing more than tenfold between 2005 and 2019, from 11 to 333 per 10,000 service members.
“There are many threats to healthy sleep, and adequate quantity and quality of sleep for service members,” Wickwire said. “There are job demands, time zone travel, let alone things like deployments and sleeping in austere environments.”
In addition, young, healthy members of the military have to prioritize their free time: “Do I spend more time with my children, for example, or do I go to bed earlier,” Wickwire said.
What are the risks, and what are the goals?
The study, using de-identified data from the Military Health System data repository, looked at the health of nearly 60,000 service members between the ages of 17 and 64.
In the findings, 5% of military members with sleep apnea developed PTSD, while only 1% of members without the sleep disorder had PTSD. Three percent of military members without sleep apnea were treated for anxiety, while another 10% of those with the sleep disorder reported having anxiety.
“This study underscores the growing importance of early intervention in sleep apnea and access to high quality, cost-effective sleep care for service members,” Wickwire said. “There is a shortage of trained sleep physicians and trained sleep health care providers in the military.”
Untreated sleep apnea puts military members at increased risk, in an already dangerous job.
“This study is a wake-up call,” said Col. Vincent Capaldi, chair of psychiatry at the Uniformed Services University, in a statement. “Sleep apnea is not just a medical condition — it’s a force readiness issue.”
The U.S. military health system has fewer than 40 active-duty sleep physicians. In an attempt to deal with the unmet need, the Maryland medical school and military university will soon launch a clinical trial to evaluate the clinical and cost-effectiveness of telehealth visits for military beneficiaries who are diagnosed with the condition.
“There is a clear need for better access to sleep physicians for our military personnel, and studies show providing CPAP treatment to those in need can reduce their risk of dying from heart-related causes by 55%, and from any cause by 37%,” said Dr. Mark Gladwin, dean of the University of Maryland School of Medicine.
“We must prioritize sleep health as a cornerstone of operational performance and long-term well-being for the force,” Capaldi said.
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