Abstract Objective Traumatic brain injury (TBI) and obstructive sleep apnea (OSA) are significant health concerns and highly prevalent in Veteran populations. Both conditions have been independently linked to a range of adverse clinical outcomes, specifically impaired cognitive and emotional functioning. We aimed to explore the interplay between TBI and OSA in relation to cognitive and mental health difficulties within a sample of Iraq/Afghanistan-era Veterans. Method This study included 16,452 Veterans (76% male, age: M=43.3 years SD=11.0) who enrolled in the VA Million Veteran Program and completed the TBI Clinical Reminder Screen and a comprehensive health history survey to assess probable history of TBI and OSA, respectively. The primary outcomes included: the Medical Outcomes Study Cognitive Functioning Scale-Revised (MOS-Cog-R) for cognitive symptoms and the Patient Health Questionnaire-4 (PHQ-4) for anxiety/depression symptoms. Results The sample included 5,656 with a probable TBI history (TBI+) and 10,796 without (TBI-), and 4,911 with probable OSA (OSA+) and 11,541 without (OSA-). Two-way analyses of covariance revealed significant main effects and interactions of TBI and OSA with subjective cognition; while OSA+ was associated with worse cognitive symptoms in both TBI groups, this pattern was more pronounced in the TBI+ group (p.001, ηp2 0.001). We also found similar effects with self-reported mental health symptoms; the OSA+ group was associated with increased anxiety/depression symptoms, particularly in the TBI+ group (p=.009, ηp2 0.001). Conclusion Our findings underscore a potential interaction between TBI and OSA leading to worse cognitive and mental health outcomes, suggesting that monitoring and addressing OSA may be crucial for Veterans with a TBI history.
Chang et al. (Fri,) studied this question.