title: Sleep and Health Resilience Metrics in a Large Military Cohort.
abstract: OBJECTIVE
  Examine the relationship between self-reported sleep parameters and indicators of resilience in a US military population (n = 55,021).
  
  
  METHODS
  Longitudinal analyses (2001-2008) were conducted using subjective data collected from Millennium Cohort Study questionnaires and objective data from military records that included demographics, military health, and deployment information. Subjective sleep duration and insomnia symptoms were collected on the study questionnaire. Resilience metrics included lost work days, self-rated health, deployment, frequency and duration of health care utilization, and early discharge from the military. Generalized estimating equations and survival analyses were adjusted for demographic, military, behavioral, and health covariates in all models.
  
  
  RESULTS
  The presence of insomnia symptoms was significantly associated with lower self-rated health, more lost work days, lower odds of deployment, higher odds of early discharge from military service early, and more health care utilization. Those self-reporting < 6 h (short sleepers) or > 8 h (long sleepers) of sleep per night had similar findings, except for the deployment outcome in which those with the shortest sleep were more likely to deploy.
  
  
  CONCLUSIONS
  Poor sleep is a detriment to service members' health and readiness. Leadership should redouble efforts to emphasize the importance of healthy sleep among military service members, and future research should focus on the efficacy of interventions to promote healthy sleep and resilience in this population.
  
  
  CONCLUSIONS
  A commentary on this article appears in this issue on page 963.
authors.affiliation: Naval Health Research Center, San Diego, CA.
authors.forename: Amber D
authors.initials: AD
authors.lastname: Seelig
authors.affiliation: Naval Health Research Center, San Diego, CA.
authors.forename: Isabel G
authors.initials: IG
authors.lastname: Jacobson
authors.affiliation: Naval Health Research Center, San Diego, CA.|Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD.
authors.forename: Carrie J
authors.initials: CJ
authors.lastname: Donoho
authors.affiliation: Naval Health Research Center, San Diego, CA.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Trone
authors.affiliation: Naval Health Research Center, San Diego, CA.|Naval Medical Center San Diego, San Diego, CA.
authors.forename: Nancy F
authors.initials: NF
authors.lastname: Crum-Cianflone
authors.affiliation: Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Balkin
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008887:Military Medicine / Q000706:statistics & numerical data; D008889:Military Personnel / Q000523:psychology* / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D057566:Self Report; D012890:Sleep / Q000502:physiology*; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: cohort; military; resilience; sleep