title: Sleep Disturbance, Diabetes, and Cardiovascular Disease in Postmenopausal Veteran Women.
abstract: OBJECTIVE
  To compare the prevalence and cardiometabolic health impact of sleep disturbance among postmenopausal Veteran and non-Veteran participants in the Women's Health Initiative (WHI).
  
  
  METHODS
  The prevalence of five categories of sleep disturbance--medication/alcohol use for sleep; risk for insomnia; risk for sleep disordered breathing [SDB]; risk for comorbid insomnia and SDB (insomnia + SDB); and aberrant sleep duration [SLD]--was compared in 3,707 Veterans and 141,354 non-Veterans using logistic or multinomial regression. Cox proportional hazards models were used to evaluate the association of sleep disturbance and incident cardiovascular disease (CVD) and Type 2 diabetes in Veterans and non-Veterans.
  
  
  RESULTS
  Women Veterans were more likely to have high risk for insomnia + SDB relative to non-Veteran participants. However, prevalence of other forms of sleep disturbance was similar across groups. Baseline sleep disturbance was not differentially associated with cardiometabolic health outcomes in Veteran versus non-Veteran women. Risks for SDB and insomnia + SDB were both linked to heightened risk of CVD and diabetes; SLD was consistently linked with greater risk of CVD and diabetes in non-Veterans but less strongly and consistently in Veterans.
  
  
  CONCLUSIONS
  Efforts to identify and treat sleep disturbances in postmenopausal women are needed and may positively contribute to the attenuation of cardiometabolic morbidity risk. Increased awareness of women Veterans' vulnerability to postmenopausal insomnia + SDB may be particularly important for health care providers who treat this population.
authors.affiliation: Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham VA Medical Center, North Carolina. michelle.rissling@va.gov.
authors.forename: Michelle B
authors.initials: MB
authors.lastname: Rissling
authors.affiliation: Department of Veterans Affairs Puget Sound Health Care System, Health Services Research and Development, Seattle, Washington. Department of Health Services, University of Washington School of Public Health, Seattle.
authors.forename: Kristen E
authors.initials: KE
authors.lastname: Gray
authors.affiliation: Health Services R&D, Durham VA Medical Center, North Carolina. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, North Carolina.
authors.forename: Christi S
authors.initials: CS
authors.lastname: Ulmer
authors.affiliation: David Geffen School of Medicine, University of California Los Angeles. VA Sepulveda Ambulatory Care Center, Geriatric Research, Education and Clinical Center, North Hills, California.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Martin
authors.affiliation: Faculty of Health Sciences and Social Welfare, University of Haifa, Israel.
authors.forename: Oleg
authors.initials: O
authors.lastname: Zaslavsky
authors.affiliation: University of Washington School of Pharmacy, Seattle.
authors.forename: Shelly L
authors.initials: SL
authors.lastname: Gray
authors.affiliation: Program in Public Health, Stony Brook University School of Medicine, New York.
authors.forename: Lauren
authors.initials: L
authors.lastname: Hale
authors.affiliation: VA Palo Alto Health Care System, Sierra Pacific Mental Illness Research, Education and Clinical Center, California. Department of Psychiatry and Behavioral Sciences, Stanford University, California.
authors.forename: Jamie M
authors.initials: JM
authors.lastname: Zeitzer
authors.affiliation: College of Medicine, Division of Population Sciences, Department of Internal Medicine, Ohio State University.
authors.forename: Michelle
authors.initials: M
authors.lastname: Naughton
authors.affiliation: Seattle WHI Clinical Center, Biobehavioral Nursing, University of Washington.
authors.forename: Nancy F
authors.initials: NF
authors.lastname: Woods
authors.affiliation: Department of Epidemiology, University of California San Diego School of Medicine.
authors.forename: Andrea
authors.initials: A
authors.lastname: LaCroix
authors.affiliation: Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham VA Medical Center, North Carolina. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, North Carolina.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Calhoun
authors.affiliation: Stanford Prevention Research Center, Department of Medicine and Obstetrics and Gynecology, Stanford University, California.
authors.forename: Marcia
authors.initials: M
authors.lastname: Stefanick
authors.affiliation: VA Palo Alto Health Care System, Sierra Pacific MIRECC and Center for Innovation to Implementation, California. Department of Psychiatry & Behavioral Sciences and Stanford Cancer Institute, Stanford University, California.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Weitlauf
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D017698:Postmenopause; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000453:epidemiology*; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology*; D012893:Sleep Wake Disorders / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*
keywords: Postmenopausal Health; Sleep; Veterans; Women