August 07, 2025
3 min read
Key takeaways:
- The risk for 10 physical and six psychological adverse health outcomes went up with OSA.
- Per year, service members with OSA experience 170,511 more outpatient encounters due to the sleep disorder.
The risk for several adverse health outcomes, including PTSD, traumatic brain injury and anxiety, was heightened among active-duty service members with vs. without obstructive sleep apnea, according to results published in CHEST.
“Obstructive sleep apnea can cause bad things to happen,” Emerson M. Wickwire, PhD, section chief of sleep medicine at the University of Maryland School of Medicine, told Healio.
“From a clinical perspective, our findings indicate that OSA is a major risk factor for numerous adverse medical and psychiatric outcomes among military personnel,” he continued. “From a health systems perspective, OSA increases utilization burden, stressing the system and drawing scarce resources.”
Using 2016 to 2021 data from the Military Data Repository, Wickwire and colleagues assessed 118,406 U.S. active-duty service members (92.6% men; 64.5% white) aged younger than 65 years (80.9% < 44 years) to compare differences in physical and psychiatric health outcomes, as well as health care utilization among 59,203 propensity score-matched service members with newly diagnosed OSA vs. 59,203 service members without OSA.
Propensity score matching factored in demographic, clinical and military characteristics, according to the study.
Of the six psychological health outcomes included in this study, researchers found that the risk for each one was heightened among those with vs. without OSA in a Cox proportional hazards model. These included:
- PTSD (HR = 4.41; 95% CI, 4.04-4.82);
- anxiety (HR = 3.35; 95% CI, 3.16-3.55);
- other mood disorders, meaning “bipolar disorder and mood disorders not specific elsewhere” (HR = 3.34; 95% CI, 3.16-3.53);
- adjustment disorder (HR = 3.04; 95% CI, 2.85-3.23);
- depression (HR = 2.95; 95% CI, 2.74-3.18); and
- alcohol/substance use disorder (HR = 1.73; 95% CI, 1.59-1.87).
The above pattern continued when researchers evaluated the risks for 10 different physical health outcomes in the two sets of service members. Notably, the outcome with the largest increased risk in service members with vs. without OSA was traumatic brain injury (HR = 3.27; 95% CI, 2.78-3.85), followed by:
- cardiovascular disease (HR = 2.32; 95% CI, 1.99-2.71);
- fibromyalgia (HR = 2.26; 95% CI, 2.16-2.37);
- asthma (HR = 2.11; 95% CI, 1.89-2.37);
- diabetes (HR = 2.11; 95% CI, 1.8-2.48);
- fracture (HR = 2.1; 95% CI, 1.55-2.85);
- COPD (HR = 1.88; 95% CI, 1.63-2.16);
- hyperlipidemia (HR = 1.82; 95% CI, 1.73-1.92);
- hypertension (HR = 1.79; 95% CI, 1.32-2.44); and
- musculoskeletal injuries (HR = 1.66; 95% CI, 1.57-1.76).
“These are the first systems-level data to highlight the association between obstructive sleep apnea and key military outcomes including PTSD, traumatic brain injury and musculoskeletal injuries,” Wickwire told Healio.
Vincent F. Capaldi II, ScM, MD, DFAPA, FACP, FAASM, colonel, professor and chair of psychiatry at Uniformed Services University and program director of the National Capital Consortium internal medicine and psychiatry residency training program, added that these findings underscore the value of early detection and comprehensive care in service members with OSA.
Shifting to health care utilization, the group with OSA had 1,469,539 non-OSA outpatient encounters, whereas the group without OSA had 787,496 encounters of this type (adjusted RR = 1.76; 95% CI, 1.76-1.77). The number of non-OSA inpatient encounters was also significantly elevated among those with vs. without OSA (1,807 vs. 1,543; aRR = 1.14; 95% CI, 1.07-1.22), according to the study.
Similarly, researchers observed 22,375 non-OSA ED encounters among service members with OSA, and this was significantly greater than the 14,969 encounters among service members without OSA (aRR = 1.42; 95% CI, 1.39-1.45).
Per year, the study reported that service members with OSA experience 170,511 more outpatient encounters, 66 more inpatient encounters and 1,852 more ED encounters than service members without OSA due to the sleep disorder.
“This important study highlights the critical link between untreated obstructive sleep apnea and overall health, emphasizing its impact on force readiness,” Capaldi told Healio.
“Addressing OSA within military populations serves not only to enhance individual well-being but also to strengthen the overall resilience and readiness of our forces,” he added.
Looking ahead, Wickwire said further research is warranted.
“From a health systems perspective, key questions remain unanswered including subgroup analyses, regional differences and effect of treatment,” Wickwire told Healio.
“From a clinical perspective, we are excited to launch a major OSA telehealth clinical trial to increase access to cost-effective OSA care and improve outcomes among military beneficiaries,” Wickwire said.
Reference:
For more information:
Vincent F. Capaldi, II, ScM, MD, DFAPA, FACP, FAASM, can be reached at vincent.capaldi@usuhs.edu.
Emerson M. Wickwire, PhD, can be reached at ewickwire@som.umaryland.edu.
Perspective
This research article outlines a strong argument that military personnel with OSA perform more poorly and cost the disability system more than physically fit service members. A question becomes then, why are they allowed into the military?
The military has had for many years enlistment and retention standards. Many potential recruits are barred from enlisting as enlisted persons or officers because they do not meet these standards. However, the standards may be waived, especially in times of difficulties in recruiting. This is a controversial issue.
Asthma, obesity, a mental health history and many other conditions are barriers to recruitment. If a service member is deployed to the field or to another country in a warzone, can we meet their needs?
This article argues for a re-look at the enlistment standards, waiver practices and retention standards for recruiting people with OSA.
Elspeth Cameron Ritchie, MD, MPH
Disclosures: Ritchie reports no relevant financial disclosures.
Sources/Disclosures
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Disclosures:
Wickwire reports that his institution has received research funding from the AASM Foundation, Department of Defense, Merck, NIH/National Institute on Aging, ResMed, the ResMed Foundation and the SRS Foundation. Wickwire also reports serving as a scientific consultant to Axsome Therapeutics, Dayzz, Eisai, EnsoData, Idorsia, Merck, Nox Health, Primasun, Purdue and ResMed and being an equity shareholder in WellTap. The other authors report no relevant financial disclosures.
