UM School of Medicine research reveals alarming health and resource burden of sleep apnea among U.S. active-duty military

With more than 1 in 10 Americans suffering from obstructive sleep apnea putting them at increased risk of heart problems and other health ills, a new study conducted by the University of Maryland School of Medicine (UMSOM) carefully analyzed the toll that this sleep disorder takes on U.S. active-duty military members, and their analysis was alarming: They found that soldiers with sleep apnea who are serving on the front lines are more than four times more likely to experience post traumatic stress disorder and three times more likely to suffer a traumatic brain injury compared to those who don’t have the condition.

Highlights of the comprehensive study were recently published in the journal CHEST. Conducted in conjunction with Uniformed Services University, the study marks the largest analysis of sleep apnea’s health effects and its burden on health resources in the U.S. military.

“This study underscores the growing importance of early intervention in sleep apnea and access to high quality, cost-effective sleep care for service members,” said Emerson M. Wickwire, PhD, lead study author and Section Chief of Sleep Medicine of the University of Maryland School of Medicine. “By quantifying the health and resource burden of this condition we hope to help guide the development and allocation of clinical resources within the military health system, including advancing provider education and patient screening, triage, and treatment.”

Obstructive sleep apnea is among the most common sleep disorders, causing sleep disruptions that raise the risk of type 2 diabetes, heart attack, stroke and depression. The condition is characterized as a breathing disorder in which breathing stops and restarts throughout sleep. Common symptoms can include chronic snoring, daytime sleepiness, as well as mood and behavior changes.

Due to the demanding nature of military work schedules and non-traditional hours, only one-third of active-duty service members obtain the minimum recommended seven or more hours of sleep per night, according to previous research. There is also a growing awareness of sleep apnea in the military with diagnoses increasing well over ten-fold between 2005 and 2019, from 11 to 333 cases per 10,000 service members.

To conduct the latest study, Dr. Wickwire and his colleagues utilized de-identified data from the Military Health System data repository to create two matched cohorts of individuals with and without obstructive sleep apnea, comprised of nearly 60,000 service members each, ages 17-64. Service members with newly diagnosed sleep apnea were matched with those without controlling for demographic, clinical and military characteristics. The researchers found that during the 12 months following diagnosis, service members with sleep apnea had an additional 170,511 outpatient visits to doctors compared to their counterparts and also an additional 1,852 emergency department visits per year and 66 hospitalizations.

They also had a higher risk and faster time to specific medical problems including:

“This study is a wake-up call. Sleep apnea is not just a medical condition—it’s a force readiness issue. The findings highlight how untreated sleep disorders contribute to mental health challenges, traumatic injuries, and increased health care utilization in our service members. Our collaboration with UMSOM underscores the urgent need to enhance access to timely, effective, and evidence-based sleep care throughout the Military Health System. We must prioritize sleep health as a cornerstone of operational performance and long-term wellbeing for the force,” said Col. Vincent F. Capaldi, II, ScM, MD, Chair of Psychiatry at the Uniformed Services University.

With the hopes to address the documented shortage of sleep specialists in the military health system, UMSOM and USU are working together to launch a new clinical trial called “Tele-Sleep OSA” to evaluate the clinical and cost-effectiveness of tele-health visits for military beneficiaries who are diagnosed with the condition.

“We are eager to begin enrolling patients in this important study to help improve overall health outcomes in our U.S. military population,” said Mark T. Gladwin, MD, Dean of the University of Maryland School of Medicine, Vice President for Medical Affairs, University of Maryland, Baltimore (UMB), and the John Z. and Akiko K. Bowers Distinguished Professor. “With fewer than 40 active-duty sleep physicians in the military health system, there is a clear need for better access to sleep physicians for our military personnel, and studies show providing CPAP treatment to those in need can reduce their risk of dying from heart-related causes by 55 percent and from any cause by 37 percent.”

Funding for the study was provided by the Military Health Services Research Program (DoD HT94022210006) and conducted independently by a multidisciplinary team from the University of Maryland, Uniformed Services University, Yale School of Medicine, and other institutions. This study used fully de-identified data and received an exempt determination from the Institutional Review Board at the Walter Reed Army Institute of Research (protocol #2985). Military members across all branches, Army, Navy, Air Force, Marines, Space Force, Coast Guard, Public Health Service, were analyzed in the study.