title: Comorbid insomnia and obstructive sleep apnea in military personnel: correlation with polysomnographic variables.
abstract: OBJECTIVE
  Military personnel undergoing polysomnography are typically diagnosed only with obstructive sleep apnea (OSA). Comorbid insomnia with OSA is a well-established, underappreciated diagnosis. We sought to determine if military personnel with mild OSA met clinical criteria for insomnia and if there was a pattern of polysomnogram (PSG) variables that identified insomnia in these patients.
  
  
  METHODS
  Retrospective chart review of military personnel with mild OSA; cluster analysis to describe PSG variables.
  
  
  RESULTS
  206 personnel assessed, predominately male (96.6%), mean age 36.5 ± 8.14 years, body mass index 30.2 ± 3.66 kg/m(2) and apnea hypopnea index of 8.44 ± 2.92 per hour; 167 (81.1%) met criteria for insomnia. Cluster analysis identified a group of patients (N = 52) with PSG variables of increased wakefulness after sleep onset 77.3 minutes (27.7) (p < 0.001) and decreased sleep efficiency 82.6% (5.82) (p < 0.001) consistent with insomnia. Patients in this group were more likely to meet criteria for insomnia with an odds ratio 5.27 (1.20, 23.1), (p = 0.009).
  
  
  CONCLUSIONS
  The majority of military personnel with mild OSA meet criteria for insomnia. Roughly one-third of these patients can be identified by a pattern of PSG variables. Recognizing and treating both comorbid insomnia and OSA could improve clinical outcomes.
authors.affiliation: Department of Pulmonary, Sleep Medicine, Critical Care, Madigan Army Medical Center, 9040A Fitzsimmons Avenue, Tacoma, WA 98431.
authors.forename: Vincent
authors.initials: V
authors.lastname: Mysliwiec
authors.affiliation: Operations Research Department, Naval Postgraduate School, 1411 Cunningham Road, Monterey, CA 93943.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Matsangas
authors.affiliation: Department of Pulmonary, Sleep Medicine, Critical Care, Madigan Army Medical Center, 9040A Fitzsimmons Avenue, Tacoma, WA 98431.
authors.forename: Tristin
authors.initials: T
authors.lastname: Baxter
authors.affiliation: Department of Pulmonary, Sleep Medicine, Critical Care, Madigan Army Medical Center, 9040A Fitzsimmons Avenue, Tacoma, WA 98431.
authors.forename: Leigh
authors.initials: L
authors.lastname: McGraw
authors.affiliation: Department of Pulmonary, Sleep Medicine, Critical Care, Madigan Army Medical Center, 9040A Fitzsimmons Avenue, Tacoma, WA 98431.
authors.forename: Nici E
authors.initials: NE
authors.lastname: Bothwell
authors.affiliation: Department of Pulmonary, Sleep Medicine, Critical Care, Madigan Army Medical Center, 9040A Fitzsimmons Avenue, Tacoma, WA 98431.
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Roth
mesh_terms: D000328:Adult; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008889:Military Personnel; D017286:Polysomnography / Q000379:methods*; D012189:Retrospective Studies; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000453:epidemiology*; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology