A comprehensive evaluation of insomnia, obstructive sleep apnea and comorbid insomnia and obstructive sleep apnea in US military personnel

Abstract

Study Objectives The aim of this study was to characterize the sleep disorders of insomnia, obstructive sleep apnea (OSA), and comorbid insomnia and OSA (COMISA) in active duty military personnel. Methods Prospective observational study of 309 military personnel with a mean age of 37.17 years (SD = 7.27). Participants served in 4 branches of the US military (47.9% Air Force, 38.8% Army, 11.3% Navy, and 1.9% Marines). Sleep diagnoses were rendered after video-polysomnography and a clinical evaluation. Validated self-report measures assessed insomnia severity, excessive daytime sleepiness, sleep quality, disruptive nocturnal behaviors, nightmare disorder, shift work disorder, sleep impairment, fatigue, posttraumatic stress disorder (PTSD) symptoms, anxiety, depression, and traumatic brain injury (TBI). General linear models and Pearson chi-square tests were used for between-group differences in data analyses. Results Insomnia was diagnosed in 32.7%, OSA in 30.4% and COMISA in 36.9%. Compared to military personnel with OSA alone, those with insomnia only and COMISA had significantly greater insomnia severity, disruptive nocturnal behaviors, sleep-related impairment, rates of nightmare disorder, and poorer sleep quality (all Ps < .05). They also reported greater symptoms of fatigue, PTSD, anxiety, and depression (all Ps < .05). There were no significant differences among the 3 sleep disorder diagnostic groups on sleepiness, shift work disorder, or TBI. Conclusions Military personnel with insomnia only and COMISA overall report worsened symptoms of sleep disorders, sleep-related impairment, fatigue, and psychiatric disorders than those with OSA. Results highlight the importance of a comprehensive assessment for sleep-related impairment, sleep, and comorbid disorders in military personnel with clinically significant sleep disturbances.

Sleep Bruxism and Sleep Structure in Comorbid Insomnia and Obstructive Sleep Apnea (COMISA) Syndrome: A Polysomnographic Study

“…However, we did observe that, in comparison to the control group, respiratory PSG parameters characteristic for OSA (such as AHI, ODI, RDI, respiratory issues, or apnea arousals) were significantly higher than in the COMISA group. The opposite respiratory results were obtained in a study conducted by Mysliwiec et al [43], whose OSA patients had the highest levels for the above breathing parameters, followed by the COMISA participants. In other studies, only AHI differed between groups and, once again, this was higher in OSA than the COMISA groups [16].…”

Contemporary Concise Review 2022: Sleep

“…The two conditions can frequently co‐exist and the combined negative effects of both may be deleterious, particularly to cardiovascular health. The wide reaching effects have been demonstrated in differing cohorts such as military personnel with COMISA who showed increased sleep‐related impairment compared with those with OSA, 38 and patients with type 2 diabetes mellitus who demonstrated greater diabetes‐related stress with COMISA compared with those with OSA 39 . The negative effects of snoring and insomnia have also been explored as a precursor to the development of COMISA 40 …”

Performance of PROMIS Measures to Assess Fatigue and Sleep Symptom Severity Among African American Patients Newly Diagnosed With Obstructive Sleep Apnea

“…Patient-Reported Outcomes Measurement Information System (PROMIS) measures offer a standardized approach to systematically assess patient-reported outcomes and symptom severity in a succinct manner across studies and patient populations. Few researchers have utilized PROMIS Fatigue to assess symptom severity in adult patient populations living with OSA, and the performance of the measure compared to other longer measures has yet to be examined in diverse patient populations living with OSA (Mysliwiec et al, 2022). Research validating PROMIS measures across clinical and research settings, with racially and ethnically representative patient populations, helps ensure they are consistently and reliably measuring symptom severity.…”