Prevalence and Correlates of Sleep Apnea Among US Male Veterans, 2005–2014

The objective of this study was to assess the prevalence of and factors associated with sleep apnea among US male veterans. We used data from the 2005–2014 National Survey on Drug Use and Health to conduct survey-weighted descriptive, bivariate, and regression analyses. The prevalence of sleep apnea increased from 3.7% to 8.1% (P for trend <.001 for adjusted model) from 2005 through 2014. Increasing severity of psychological distress and unmet mental health care need were associated with increased odds of sleep apnea, as was a diagnosis of asthma. Increased screening of sleep health is critical to improve the health outcomes of veterans. Objective Healthy People 2020 (1) incorporated sleep health as an item on its agenda, calling attention to poor sleep health and its contribution to the national burden of chronic disease. The age-adjusted prevalence of sleep apnea, a chronic condition of disturbed breathing during sleep (2), among US veterans from 2000 to 2010 increased almost 6-fold (3). An evaluation of veterans of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn found that 69.2% of 159 veterans screened were at high risk for obstructive sleep apnea (4). Given that sleep apnea is more prevalent among men than among women and that most US veterans are men (5), we sought to assess the prevalence, trends, and risk factors of sleep apnea among US male veterans Methods We used the 2005–2014 National Survey on Drug Use and Health (NSDUH) public use files (6) to identify US male veteran respondents aged 18 years or older. Sleep apnea, our outcome variable, was defined by using the NSDUH questionnaire (7) that lists numerous health conditions and asks respondents, “Which, if any, of these conditions did a doctor or other medical professional tell you that you had in the past 12 months?” The list includes sleep apnea and asthma. Exposure variables were sociodemographic characteristics (age, race/ethnicity, marital status, federal poverty level, highest education level, and health insurance status) and other self-reported health and behavioral factors: past-year illicit drug use or alcohol dependency, past-year psychological distress, pastyear unmet mental health care need, and asthma diagnosed in the past year by a health care professional. Psychological distress, defined by the Kessler 6-scale score, a validated measure of assessing psychological distress (8), was categorized as none (score 0–7), mild to moderate (score 8–12), and serious (score ≥13). Unmet mental health care need was defined by NSDUH as a perceived need for mental health care treatment or counseling that was not received. We used SAS 9.4 (SAS Institute, Inc) for all statistical analyses; an α of.05 was used to determine significance. Our analytic sample size was 20,631. All data analyses included design-based values to account for the survey weights. First, we used surveyweighted descriptive statistics to evaluate study population characteristics and the prevalence of sleep apnea. We then conducted an analysis of P for trend to assess changes in prevalence of sleep apnea during the 10-year study period. We used survey-weighted χ 2 tests to evaluate the prevalence of sleep apnea by population characteristic. Finally, we conducted survey-weighted multivariable binary logistic regression to assess the relationship between exposure variables and sleep apnea and accounted for survey year. We assessed relevant interactions to identify effect modifiers. The study was approved by the institutional review board at California State University, San Bernardino. Results The average prevalence of sleep apnea was 5.9% during the study period (Table 1); proportions increased from 3.7% in 2005 to 8.1% in 2014 (P for trend <.001 for adjusted model), and the highest prevalence was in 2012 (8.3%)