Sleep disorders in Operation Desert Storm (ODS) veterans

Excessive Daytime Sleepiness (EDS), fatigue and insomnia are complaints frequently reported by individuals who took part in ODS. To determine whether their complaints resulted from commonly recognized sleep disorders, we conducted a retrospective chart review of ODS Veterans from 1994 through 1995. Primary sleep related complaints included EDS-30%, fatigue-22%, insomnia 18%, snoring 23%. Methods: Ninety five patients were referred for Polysomnograms (PSGs) & Multiple Sleep Latency Tests (MSLTs) to the Walter Reed Sleep Disorders Center and/or The Greater Washington Sleep Disorders Center. The mean age was 35. There were 84 males. All patients completed a sleep history questionnaire prior to diagnostic sleep studies. A diagnostic nocturnal polysomnogram (PSG) was recorded on a multi-channel polygraph recorder. Standard recordings included EEC, EOG, EKC, submental EMG, nasal and oral airflow with thoracic and abdominal effort. On the morning following the PSG an MSLT was performed. If the patient had OSA, a CPAP titration study was done on a subsequent date. Results: Nocturnal PSGs demonstrated fragmented sleep architecture with increased arousals & awakenings in 59% of the subjects. Of the total patients studied 78 had MSLTs with a mean sleep latency of 7.7 minutes. Mean sleep latencies were 5.7 minutes in 20 OSA patients, 3 minutes in 8 CNS Hypersomnia patients, 3.9 minutes in 12 Narcoleptics and 9.8 minutes in 17 persistant snorers. Among 17 patients with symptoms of insomnia sleep diagnoses were: OSA 5, Persistent Snoring 7, Narcolepsy 1, CNS Hypersomnia 1 and chronic insomnia in 3 patients. The table shows primary and secondary sleep diagnoses for the entire group of 95 patients. Sleep Diagnosis Primary Secondary OSA 32 1 CNS Hypersomnia 8 6 Narcolepsy 12 Parasomnias 25 9 Sleep Misperception 2 1 Inadequate Sleep 4 6 Sleep Hygiene 3 4 Depression 1 4 Medication Abuse 1 Seizure disorder 1 Chronic Insomnia 3 No Sleep Disorder 3 Conclusions: Among this selected group of patients, the majority have complaints that are in part explained by commonly recognizable sleep disorders. Standard therapeutic interventions such as sleep hygiene, medications and other modalities such as nasal CPAP can improve somatic complaints and prevent future medical problems.