
Stay Alert to Sleep Apnea Burden in the Military
OSA and other clinical sleep disorders are common among military personnel, driven in part by demanding, nontraditional work schedules that can exacerbate sleep problems, but OSA's impact in this population has not been well-studied, Emerson M. Wickwire, PhD, of the University of Maryland School of Medicine, Baltimore, and colleagues wrote in a new paper published in Chest .
In the current health economic climate of increasing costs and limited resources, the economic aspects of sleep disorders have never been more important, Wickwire said in an interview. The data in this study are the first to quantify the heath and utilization burden of OSA in the US military and can support military decision-makers regarding allocation of scarce resources, he said.
To assess the burden of OSA in the military, they reviewed fully de-identified data from 59,203 active-duty military personnel with diagnoses of OSA and compared them with 59,203 active-duty military personnel without OSA. The participants ranged in age from 18 to 64 years; 7.4% were women and 64.5% were white individuals. Study outcomes included new diagnoses of physical and psychological health conditions, as well as healthcare resource use in the first year after the index date.
Approximately one third of the participants were in the Army (38.7%), 25.6% were in the Air Force, 23.5% were in the Navy, 5.8% were in the Marines, 5.7% were in the Coast Guard, and 0.7% were in the Public Health Service.
Over the 1-year study period, military personnel with OSA diagnoses were significantly more likely to experience new physical and psychological adverse events than control individuals without OSA, based on proportional hazards models. The physical conditions with the greatest increased risk in the OSA group were traumatic brain injury and cardiovascular disease (which included acute myocardial infarction, atrial fibrillation, ischemic heart disease, and peripheral procedures), with hazard ratios (HRs) 3.27 and 2.32, respectively. The psychological conditions with the greatest increased risk in the OSA group vs control individuals were posttraumatic stress disorder (PTSD) and anxiety (HR, 4.41, and HR, 3.35, respectively).
Individuals with OSA also showed increased use of healthcare resources compared with control individuals without OSA, with an additional 170,511 outpatient visits, 66 inpatient visits, and 1,852 emergency department visits.
Don't Discount OSA in Military Personnel
'From a clinical perspective, these findings underscore the importance of recognizing OSA as a critical risk factor for a wide array of physical and psychological health outcomes,' the researchers wrote in their discussion.
The results highlight the need for more clinical attention to patient screening, triage, and delivery of care, but efforts are limited by the documented shortage of sleep specialists in the military health system, they noted.
Key limitations of the study include the use of an administrative claims data source, which did not include clinical information such as disease severity or daytime symptoms, and the nonrandomized, observational study design, Wickwire told Medscape Medical News .
Looking ahead, the researchers at the University of Maryland School of Medicine and the Uniformed Services University, Bethesda, Maryland, are launching a new trial to assess the clinical effectiveness and cost-effectiveness of telehealth visits for military beneficiaries diagnosed with OSA as a way to manage the shortage of sleep specialists in the military health system, according to a press release from the University of Maryland.
'Although the association between poor sleep and traumatic stress is well-known, present results highlight striking associations between sleep apnea and posttraumatic stress disorder, traumatic brain injury, and musculoskeletal injuries, which are key outcomes from the military perspective,' Wickwire told Medscape Medical News .
'Our most important clinical recommendation is for healthcare providers to be on alert for signs and symptoms of OSA, including snoring, daytime sleepiness, and morning dry mouth,' said Wickwire. 'Primary care and mental health providers should be especially attuned,' he added.
Results Not Surprising, but Research Gaps Remain
'The sleep health of active-duty military personnel is not only vital for optimal military performance but also impacts the health of Veterans after separation from the military,' said Q. Afifa Shamim-Uzzaman, MD, an associate professor and a sleep medicine specialist at the University of Michigan, Ann Arbor, Michigan, in an interview.
The current study identifies increased utilization of healthcare resources by active-duty personnel with sleep apnea, and outcomes were not surprising, said Shamim-Uzzaman, who is employed by the Veterans' Health Administration, but was not involved in the current study.
The association between untreated OSA and medical and psychological comorbidities such as cardiovascular disease, diabetes, and mood disorders such as depression and anxiety is well-known, Shamim-Uzzaman said. 'Patients with depression who also have sleep disturbances are at higher risk for suicide — the strength of this association is such that it led the Veterans' Health Administration to mandate suicide screening for Veterans seen in its sleep clinics,' he added.
'We also know that untreated OSA is associated with excessive daytime sleepiness, slowed reaction times, and increased risk of motor vehicle accidents, all of which can contribute to sustaining injuries such as traumatic brain injury,' said Shamim-Uzzaman. 'Emerging evidence also suggests that sleep disruption prior to exposure to trauma increases the risk of developing PTSD. Therefore, it is not surprising that patients with sleep apnea would have higher healthcare utilization for non-OSA conditions than those without sleep apnea,' he noted.
In clinical practice, the study underscores the importance of identifying and managing sleep health in military personnel, who frequently work nontraditional schedules with long, sustained shifts in grueling conditions not conducive to healthy sleep, Shamim-Uzzaman told Medscape Medical News . 'Although the harsh work environments that our active-duty military endure come part and parcel with the job, clinicians caring for these individuals should ask specifically about their sleep and working schedules to optimize sleep as best as possible; this should include, but not be limited to, screening and testing for sleep disordered breathing and insomnia,' he said.
The current study has several limitations, including the inability to control for smoking or alcohol use, which are common in military personnel and associated with increased morbidity, said Shamim-Uzzaman. The study also did not assess the impact of other confounding factors, such as sleep duration and daytime sleepiness, that could impact the results, especially the association of OSA and traumatic brain injury, he noted. 'More research is needed to assess the impact of these factors as well as the effect of treatment of OSA on comorbidities and healthcare utilization,' he said.
This study was supported by the Military Health Services Research Program.
Wickwire's institution had received research funding from the American Academy of Sleep Medicine Foundation, Department of Defense, Merck, National Institutes of Health/National Institute on Aging, ResMed, the ResMed Foundation, and the SRS Foundation. Wickwire disclosed serving as a scientific consultant to Axsome Therapeutics, Dayzz, Eisai, EnsoData, Idorsia, Merck, Nox Health, Primasun, Purdue, and ResMed and is an equity shareholder in Well Tap.
Hashtags

Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Yahoo
8 minutes ago
- Yahoo
Almost half of people do not think 10-year plan will boost GP access
Almost half of people think that Government plans to improve the health of the nation will have no difference, or make it harder to get a GP appointment, according to a survey. More than four in 10 also believe the 10-year plan will make no difference or will not improve waiting times in A&E. However, there is huge support for some of the ideas included in the blueprint, with the overwhelming majority backing the creation of neighbourhood health centres, the expansion of the NHS app and more mental health support in schools and colleges. The 10-year health plan was unveiled by Prime Minister Sir Keir Starmer earlier this month, and set out a series of shifts to bring care much closer to people's homes, reducing the reliance on hospitals and A&E. Key reforms include an enhanced NHS app, giving patients more control over their care, new neighbourhood health centres open six days a week and at least 12 hours a day, and new laws on food and alcohol to prevent ill health. A survey of 1,023 adults in Britain, conducted by Ipsos for the PA news agency, asked people how they think the plan will impact access to healthcare, such as getting a GP appointment, A&E waiting times and waiting times for routine hospital treatment. Some 35% said the plan will have no impact on getting a GP appointment, while 14% believe it will make things harder. This compares with the 29% of people who said they think it will make getting an appointment easier. More than a third (37%) said it will make no difference to waiting times in emergency departments, while almost one in 10 (9%), said they believe it could worsen waiting times, compared with 30% who said it will improve them. Meanwhile, 31% said the plan will have no impact on waiting times for hospital treatment, 11% believe the plan will worsen waiting times and 34% said they think the measures will help. However, a number of proposals outlined in the plan were strongly backed by the public. Some 84% said they supported the creation of a single patient record, while 78% backed the creation of neighbourhood health centres, 73% support the expansion of the NHS app and 72% are in favour of more mental health support in schools and colleges. However, more than a quarter (27%) of people do not support making hospitals fully AI enabled, compared with 44% who would back the move. Almost one in five (18%) said they would not support so-called 'patient power payments', which would allow patients to hold back some of the payment for their care if they are not satisfied, while 42% would support the measure. Some proposals aimed at helping people to lead healthier lives were also strongly supported. A ban on the sale of high-caffeine energy drinks was backed by 78% of people, while 69% back plans to restrict junk food advertising. However, almost one in five (18%) tended to disagree with measures that could see alcoholic drinks labelled with nutritional information, although 57% backed the move. One in four people think the measures included in the plan will make no difference to patients, the poll found. Almost one in 10 (9%) said they think the changes will make things worse, while 35% believe it will improve the health service. A similar proportion, 23%, said the 10-year health plan will make no difference to NHS staff, while 13% said it could make things worse and 33% believe it will have a positive effect. A Department of Health and Social Care spokesperson said: 'We're getting on with the job of delivering for patients, with NHS waiting lists falling by 260,000 since July 2024, delivering more than 4.6 million additional appointments since the general election and recruiting over 1,900 extra GPs to fix the front door of the NHS. 'Backed by an additional £29 billion, our 10-year health plan will seize the opportunities provided by new technology, medicines and innovation to deliver better care for all patients, no matter where they live or how much they earn, and better value for taxpayers. 'It is no surprise the plan is popular with patients, it was the result of the biggest conversation with staff, patients and the public since the formation of the NHS, with more than a quarter of a million contributions.'


Bloomberg
10 minutes ago
- Bloomberg
How Climate Change Is Raising Your Grocery Bill
A 300% spike in Australian lettuce prices. A 50% rise for European olive oil and 80% for US vegetables. Researchers from the Barcelona Supercomputing Center and the European Central Bank have traced back those price jumps to extreme weather they say is linked to climate change. The group analyzed 16 weather events around the world between 2022 and 2024. Many were so unusual that a given region had experienced nothing like it prior to 2020, according to the analysis, which was published in the peer-reviewed journal Environmental Research Letters on Monday in Europe.


Forbes
2 hours ago
- Forbes
6 Ways Investing In Mental Health Pays Off For Business And People
The business case for mental health is compelling. Mental health challenges are intense and increasing both in the US and globally. They have huge costs for people and business, but there are also significant benefits when organizations invest in improving mental health. The business case is compelling. Making investments in mental health is the right thing to do for people, and also for business. The Business Case for Mental Health Investment Making investments in people is the right thing for employers to do for plenty of reasons, but among them are compelling benefits for the business. Here's why. Mental health issues are extensive today. Over one billion people globally live with mental health conditions, according to the World Health Organization. The issue is prevalent in the US as well, with 60 million Americans experienced a mental illness in the past year, based on data from Mental Health America. Stress is also a big issue among the workforce. Fully 50% of employees feel stressed during the workday, based on data from the American Psychological Association. And according to a survey of 3,000 people by Stress in America, 27% of people said they struggled to function most days because of their stress. A survey by LIMRA found that 75% of US workers say they have experienced at least one mental health challenge in the past year. These include suffering like depression, anxiety, grief or suicidal thoughts. In addition, 37% of people say they deal with mental health issues often. Investments in mental health are relevant to large numbers of people generally, and in the workforce, in particular. While mental health issues affect all age groups, young people are hit especially hard. According to Mental Health America, one in five young people ages 12-17 experienced a depressive episode in the past year. And more than half of them did not receive mental health treatment. In addition, 91% of Gen Zs reported they were stressed and 98% said they were burned out, according to a survey by Cigna. Investments in mental health are relevant to younger generations, especially. And Gen Z represents the future of the workforce. Mental health challenges also have broad negative impacts from lost productivity and absenteeism to presenteeism and increased medical costs. One day per month of poor mental health was associated with a 1.84% drop in the per capita real income growth rate, resulting in $53 billion less total income each year. This was according to a study by Penn State, published in the Review of Regional Studies. Specifically, A meta-analysis published in the Applied Health Economics and Health Policy journal looked at 38 different studies over 12 years and found that when people struggle with mental health, they are more likely to be absent and disengaged and they tend to be less productive. In addition, estimates suggest that depression costs US employers about $105 billion annually based on treatment expenses, healthcare, turnover and absenteeism. This is according to McKinsey. Investments in mental health help avert the significant negative effects that arise from mental health challenges. But the good news is that when companies invest in mental health, they see a positive return. A study by the Workforce Institute at UKG which included 3,400 people across 10 countries, found when people have positive mental health, 63% say they are committed to their work and 80% say they're energized. In addition, a study published in PLOS One found that when organizations offered training for mangers and leaders in mental health, there was an improvement in attraction, retention, customer service and business performance. In addition, they saw a reduction in long term absence due to mental health issues. In a meta-analysis, employers that invested in both physical and emotional wellbeing experienced a 5% increase in productivity based on a study by the University of California, Riverside. And each dollar spent on wellness programs saved $3.27 in health care costs and $2.73 in absenteeism costs. According to an article published in the Journal of Occupational and Environmental Medicine (JOEM), when organizations offered support for both mental helath and physical health, they saw reduced absenteeism, reduced presenteeism (people who were present at work, but not productive) and increased job performance. Investments in mental health are linked with significant positive outcomes for business. Mental health is also a good investment when you consider ROI more generally. A study published in JAMA Open Network found that for almost 14,000 participants, every $100 invested in behavioral health offered a return of $190 in reduced medical claims costs. In addition, a Deloitte study, demonstrated ROI of $1.62 in the shorter term, and $2.18 when mental health support programs were in place for three years or more, because they delivered increasing returns as they matured. Investments in mental health deliver ROI. Finally, when we consider scaling mental health interventions across nations, McKinsey estimates the impact is $4.4 trillion in GDP by 2050. Further, they expect scaling mental health solutions to enhance the ability of 60 million people to participate in the labor force, globally. Strategies such as increasing access to mental health support can reduce absences and also result in decreased morbidity and mortality. Scaling mental health solutions can also positively impact caregivers. Investments in mental health at scale positively impact GDP and expand opportunities for people. Invest in Mental Health for Business Pay Offs With the mental health challenges people face in both their personal and professional lives, employers have an increasing role to play. Strategies like thinking long term; delivering comprehensive wellness offerings; intervening early with preventative approaches; maintaining and sustaining efforts over time; and tracking, monitoring and continuously improving outcomes all have a positive impact. We can choose to implement mental health programs and policies because it's the right thing to do for people. And we can also choose to invest in mental health because of the compelling business case for employers and economies.