Among post-9/11 veterans, moderate dyspnea severity was strongly associated with poorer sleep quality, resulting in 3-5 points higher PSQI scores compared to minimal symptoms (p<0.001).
Observational (n=155)
Yes
In post-9/11 veterans, subjective breathlessness and deployment-related toxicant exposures are strongly associated with poor sleep quality, independent of lung function or OSA diagnosis.
Effect estimate: 3-5 points higher PSQI score
p-value: p=<0.001
Abstract Background Symptoms of poor sleep and diagnoses of sleep disorders are common among post-9/11 deployers. Respiratory symptoms are also common in this group, though the etiology is often unclear. We hypothesized that among formerly deployed symptomatic veterans, a higher burden of respiratory symptoms would be associated with poorer sleep quality. Methods As part of a comprehensive clinical work-up, veterans in the Post-Deployment Cardiopulmonary Evaluation Network completed assessments inclusive of demographic and exposure questionnaires, The Pittsburgh Sleep Quality Index (PSQI), Dyspnea-12 scale (D-12), pulmonary lung function testing (PFTs), and polysomnography (PSG). We employed a generalized additive model (GAM) to examine the relationship between sleep quality and multiple predictors including age, sex, body mass index (BMI), D-12 total score (0-36), PTSD score (0-5), deployment-related exposure scores (0-100), select PFT indices (% predicted of FEV1, FVC, and TLC), and obstructive sleep apnea (OSA) (as diagnosed by PSG). Results A total of 155 veterans (85% male, 70% white; mean SD: age 45.96 8.57 years; BMI 31.55 5.30 kg/m²; PSQI 12.13 4.57) completed all aspects of the study. Majority had poor sleep quality (≥ 10 on the PSQI, a cut point used to identify disturbed sleep among military populations) and/or OSA (68% poor sleep quality, 72% OSA, 46% both). Using GAMs, we found that dyspnea severity was strongly associated with poor sleep quality (F = 1.68, p .001), showing the steepest effects at mild-to-moderate symptom levels (Figure 1). After adjusting for all covariates, individuals with a moderate dyspnea score (∼ 20) on the D-12 reported approximately 3-5 points higher PSQI scores compared to those with minimal symptoms. Exposure to toxicants (F = 0.72, p = .03) also showed significant linear dose-response relationship with sleep problems. Conclusions In this cohort of post-9/11 veterans, symptoms of dyspnea were associated with greater reports of poor sleep. Subjective breathlessness and specific deployment-related exposures showed stronger associations with sleep quality than demographic factors, lung function, and/or OSA diagnosis. While the directionality of the relationship remains unclear, addressing respiratory symptoms may improve the sleep health of this group overall. Further work is needed to better characterize the overlap and underlying mechanisms of both sleep apnea and dyspnea symptoms, particularly in the Veteran population. This abstract is funded by: None
Alexander et al. (Fri,) conducted a observational in Post-9/11 deployed veterans with respiratory and sleep symptoms (n=155). Dyspnea severity and deployment-related exposures vs. Minimal symptoms / lower exposures was evaluated on Sleep quality (Pittsburgh Sleep Quality Index [PSQI] score) (3-5 points higher PSQI score, p=<0.001). Among post-9/11 veterans, moderate dyspnea severity was strongly associated with poorer sleep quality, resulting in 3-5 points higher PSQI scores compared to minimal symptoms (p<0.001).