The risk factors for insomnia and sleep-disordered breathing in military communities: A meta-analysis

Abstract

Background Many reviews and meta-analyses had been conducted to investigate risk factors for sleep disorders in the general population. However, no similar research has been performed in the military population though insomnia and sleep-disordered breathing are quite prevalent in that population. Objectives To investigate risk factors for insomnia and sleep-disordered breathing in military personnel. Methods A systematic literature search was performed from inception to March 2021 and 6496 records were produced. Two authors independently screened records for eligibility. Results were presented as odds ratios, and a random-effect model was used to pool results. Data analysis was performed respectively according to military personnel type (i.e., veteran, active-duty personnel). Risk factors were sorted into three categories: sociodemographic, army-specific, and comorbidity. This meta-analysis was registered in PROSPERO before data analysis (registration No: CRD42020221696). Results Twenty-seven articles were finally included in the quantitative analysis. For sleep-disordered breathing in active-duty personnel, four sociodemographic (i.e., overweight/obesity, higher body mass index, male gender, >35 years old) and one comorbidity (i.e., depression) risk factors were identified. For insomnia in active-duty personnel, four sociodemographic (i.e., aging, alcohol dependence, white race, and female gender), two army-specific (i.e., deployment experience, combat experience), and four comorbidity (i.e., depression, post-traumatic stress disorder, traumatic brain injury, and anxiety) risk factors were identified. For insomnia in veterans, one army-specific (i.e., combat experience) and one comorbidity (i.e., post-traumatic stress disorder) risk factor was identified. Conclusions Several risk factors were identified for insomnia and sleep-disordered breathing in the current meta-analysis. Risk factors for veterans and active-duty personnel were partially different. Research on sleep breathing disorders remains limited, and more convincing evidence would be obtained with more relevant studies in the future.

Prevalence and Factors Associated with Insomnia in Military Personnel: A Retrospective Study during the Second COVID-19 Epidemic Wave in Peru

“…These differences could be due to the times at which the surveys were measured, the characteristics of the population, and the difference in the instruments used. This may also be different due to particular factors in the military, such as post-traumatic stress disorder, increased risk of physical injury, and experience of traumatic events [ 21 ]. In addition, our result is higher than those reported in U.S. military members, who showed a prevalence of 11.5%, 16.3%, and 19.9% in pre-deployment military, veterans, and active military from three major services, respectively [ 41 , 42 , 43 ].…”

“…This result coincides with a study that reported that having a history of head injury and mental health outcomes increases the probability of developing insomnia [ 43 ]. Likewise, a systematic review showed that the combined outcome of four comorbidities increases the risk in active duty personnel by up to 53% [ 21 ]. This finding could be explained by the fact that sleep disorders such as insomnia may be due to a psychiatric disorder and may also predispose a serving military member to develop post-traumatic stress disorder and other psychiatric conditions [ 44 ].…”

“…Although this context has been associated with the development of mental disorders, little research has been conducted in the military population. According to a pre-pandemic meta-analysis, insomnia is more likely to develop with age, alcohol dependence, white race, female sex, deployment and combat experience, depression, post-traumatic stress disorder, traumatic brain injury, and anxiety [ 21 ]. However, current studies have not evaluated other variables such as tobacco use, personal mental health history, work time, food insecurity, eating disorder, physical activity, and fear of COVID-19 infection.…”

Marital status and living apart affect sleep quality in male military personnel: a study of the China’s Navy during COVID-19

“…The underlying sociodemographic risk factors for developing sleep disorders are critical because officials can know beforehand which populations are at a higher risk for certain sleep disorders and implement early interventions for those at risk ( 13 ). The effects of sociodemographic factors, such as age, sex, alcohol intake, and race on sleep, have been studied in the military population ( 4 , 14–16 ).…”

The role of the Berlin Questionnaire in assessing the frequency of obstructive sleep apnea syndrome in patients with risk factors and associated comorbidities

“…The main risk factors considered in the studies, with statistical significance, were: age, weight, height, body mass index (BMI), smoking history, neck circumference, abdominal circumference. Numerous reviews and meta-analyses have been conducted to investigate risk factors for sleep disorders in the general population 5,6 .…”