Sleep apnea is a common sleep disorder characterized by pauses in breathing or shallow breaths during sleep. This condition affects a significant portion of the general population, yet it is observed at a disproportionately higher rate among military veterans.
Understanding Sleep Apnea
The two primary types are Obstructive Sleep Apnea (OSA) and Central Sleep Apnea (CSA). OSA, the more common form, occurs when throat muscles relax, blocking the airway, while CSA happens when the brain fails to send proper signals to the muscles controlling breathing.
Common symptoms of sleep apnea include loud snoring, gasping for air, and observed episodes of stopped breathing during sleep. Individuals often experience daytime fatigue, morning headaches, difficulty concentrating, and irritability. Untreated sleep apnea can lead to serious health issues such as high blood pressure, increased risk of stroke, heart disease, diabetes, and impaired cognitive function.
Military Service and Sleep Apnea Risk
Veterans face specific conditions and exposures that contribute to their higher risk of developing sleep apnea. A study found that sleep apnea diagnosis was more than twice as prevalent among veterans (21%) compared to nonveterans (9%). Deployment itself was associated with higher odds of OSA among veterans.
Post-Traumatic Stress Disorder (PTSD) and other mental health conditions are highly prevalent among veterans and have a strong correlation with sleep disturbances, including sleep apnea. Research indicates that up to 75% of individuals with PTSD may meet the diagnostic criteria for OSA. The severity of PTSD symptoms can directly influence the risk and severity of sleep apnea.
Traumatic Brain Injury (TBI), a signature injury from modern conflicts, is also linked to sleep apnea. TBI can disrupt the neurological control of breathing during sleep, contributing to the development of sleep-disordered breathing.
Chronic pain, common in veterans, can exacerbate sleep apnea, with some studies estimating a prevalence of chronic pain among OSA patients ranging from 55.4% to 76.2%. Additionally, certain environmental exposures during service, such as burn pits, have raised concerns regarding potential links to respiratory issues that might contribute to sleep apnea development. However, some studies have not found a significant direct link between burn pit exposure and OSA prevalence or severity.
Connecting the Dots: How Factors Contribute
The factors prevalent in the veteran population often interact in complex ways to contribute to sleep apnea. The hyperarousal associated with PTSD can impact sleep architecture, leading to lighter sleep stages more prone to airway collapse. This heightened state of alertness makes individuals more susceptible to repeated awakenings due to airway obstruction. Studies show a bidirectional relationship where PTSD can worsen sleep apnea, and sleep apnea can exacerbate PTSD symptoms.
Certain medications commonly prescribed to veterans, such as opioids for pain management or sedatives for anxiety, can depress respiratory drive. This may worsen or even induce sleep apnea.
Weight gain and obesity are significant risk factors for sleep apnea, and these can be exacerbated by lifestyle changes post-service, stress, and certain medications. Increased neck circumference, often associated with higher body fat, contributes to airway obstruction.
Many of these conditions do not act in isolation but instead interact synergistically, creating a complex vulnerability for veterans. For instance, chronic pain can lead to medication use that impacts breathing, while PTSD can contribute to weight gain, both of which are independent risk factors for sleep apnea. This interplay of physical injuries, mental health conditions, and their treatments can significantly increase the likelihood of developing or worsening sleep apnea in the veteran population.