1. In this prospective cohort study, military members who reported a post-traumatic stress disorder (PTSD) diagnosis at the first timepoint were significantly more likely to develop obstructive sleep apnea (OSA) alone, or the combination of OSA and insomnia, at the second timepoint.
2. Furthermore, a diagnosis of OSA and/or insomnia at the first timepoint significantly increased the likelihood of a new PTSD diagnosis or the development of PTSD symptoms at the second timepoint.
Evidence Rating Level: 2 (Good)
Post-traumatic stress disorder (PTSD) is very common among military members. Many people with PTSD experience other medical problems, many of which may impair sleep. However, the relationship between PTSD and sleep may be bi-directional, with poor sleep quality being known to precipitate mental health disorders. To date, no studies have looked at the relationship between PTSD and sleep disorders, such as obstructive sleep apnea (OSA) and insomnia, over time in military populations. Thus, the purpose of this prospective cohort study was to investigate the potential of a bi-directional relationship between sleep disorders and PTSD in this population over time.
The study included 82,432 participants from the Millennium Cohort Study, a longitudinal U.S military study, who completed surveys at two time points. The first timepoint was from 2011-2013 and the second was from 2014-2016. Participants were excluded if data regarding PTSD, OSA, and insomnia were missing at either time point. OSA was assessed via self-reporting, insomnia was assessed using a 7-item insomnia severity index, and PTSD was measured with the 17-item PTSD Checklist-Civilian Version. The primary outcome was the prevalence of PTSD and OSA/insomnia at either time point.
The results found that those who had a PTSD diagnosis at the first timepoint were significantly more likely to develop OSA alone, or the combination of OSA and insomnia, at the second time point than those who did not report a PTSD diagnosis. Furthermore, those with OSA and/or insomnia at the first time point were more likely to develop PTSD symptoms and/or report a diagnosis at the second timepoint. Certain military factors also significantly increased the likelihood of a new PTSD diagnosis, such as being deployed before the second timepoint. The study was limited by the use of self-reported data which may have caused inaccuracies in the medical diagnoses studied. Nonetheless, the study demonstrated a bi-directional nature between PTSD and sleep-related disorders in a military population over time.
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