Sleep, Daytime Symptoms, and Healthcare Resource Utilization in Military Personnel with Comorbid Insomnia and Obstructive Sleep Apnea

Introduction Comorbid insomnia and obstructive sleep apnea (COMISA) are prevalent conditions with significant physical and mental health comorbidities. Our study sought to estimate the effect of COMISA vs. obstructive sleep apnea (OSA) alone on subjective and objective sleep, daytime symptoms including cognition, and healthcare resource utilization (HCRU) among military service members (SMs). Materials and Methods Military SMs (n=201) completed research questionnaires and then an intensive 10-day remote monitoring assessment, including wearing a commercial sleep tracker, completing daily sleep diaries, and completing twice-daily symptom surveys via a mobile application. Subjective cognition was measured using 3 self-report items assessing memory, concentration, and executive function. Between-groups (COMISA vs. OSA) differences in subjective and objective sleep, daytime symptoms, and HCRU were examined using a series of one-way ANOVAs. Results Compared to participants with OSA alone (n=98; 48.8%), participants with COMISA (n=81; 40.3%) demonstrated poorer subjective sleep and daytime symptoms as measured by traditional questionnaires (i.e., Epworth Sleepiness Scale and Insomnia Severity Index) and twice-daily symptom surveys, as well as increased HCRU. No between-groups differences were observed in objectively measured sleep. Conclusions Among military SMs and relative to OSA alone, COMISA was associated with worsened subjective but not objective sleep, worsened daytime symptoms including cognition, and greater HCRU.