Obstructive sleep apnea among survivors of combat-related traumatic injury: a retrospective cohort study

Zachary A. Haynes*, Ian J. Stewart, Eduard A. Poltavskiy, Aaron B. Holley, Jud C. Janak, Jeffrey T. Howard, Jessica Watrous, Lauren E. Walker, Emerson M. Wickwire, Kent Werner, Lee Ann Zarzabal, Alan Sim, Adi Gundlapalli, Jacob F. Collen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Study Objectives: Obstructive sleep apnea is prevalent among military members despite fewer traditional risk factors. We sought to determine the incidence and longitudinal predictors of obstructive sleep apnea in a large population of survivors of combat-related traumatic injury and a matched control group. Methods: Retrospective cohort study of military service members deployed to conflict zones from 2002–2016 with longitudinal follow-up in the Veterans Affairs and Military Health Systems. Two cohorts of service members were developed: (1) those who sustained combat injuries and (2) matched, uninjured participants. Results: 17,570 service members were retrospectively analyzed for a median of 8.4 years. After adjustment, traumatic brain injury (hazard ratio [HR] 1.39, 95% confidence interval [CI] 1.20–1.60), posttraumatic stress disorder (HR 1.24, 95% CI 1.05–1.46), depression (HR 1.52, 95% CI 1.30–1.79), anxiety (HR 1.40, 95% CI 1.21–1.62), insomnia (HR 1.71, 95% CI 1.44–2.02), and obesity (HR 2.40, 95% CI 2.09–2.74) were associated with development of obstructive sleep apnea. While combat injury was associated with obstructive sleep apnea in the univariate analysis (HR 1.25, 95% CI 1.17–1.33), the direction of this association was reversed in the multivariable model (HR 0.74, 95% CI 0.65–0.84). In a nested analysis, this was determined to be due to the effect of mental health diagnoses. Conclusions: The incidence of obstructive sleep apnea is higher among injured service members (29.1 per 1,000 person-years) compared to uninjured service members (23.9 per 1,000 person-years). This association appears to be driven by traumatic brain injury and the long-term mental health sequelae of injury.

Original languageEnglish
Pages (from-to)171-179
Number of pages9
JournalJournal of Clinical Sleep Medicine
Issue number1
StatePublished - 1 Jan 2022
Externally publishedYes


  • PTSD
  • TBI
  • injury
  • insomnia
  • sleep apnea
  • trauma
  • traumatic injury
  • veterans


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