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Shaha DP, Ee JS, Pham CK, Choi LS, Dogbey GY, Pogorzelski N. Predictors of Positive Airway Pressure Therapy Adherence Among U.S. Active Duty Military Personnel With Obstructive Sleep Apnea. Mil Med 2024; 189:373-380. [PMID: 39160818 DOI: 10.1093/milmed/usae133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/29/2024] [Accepted: 03/08/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is prevalent among U.S. military personnel, but adherence to positive airway pressure (PAP) treatment is suboptimal. This study sought to identify factors that predict the adherence to PAP therapy of active duty military patients newly diagnosed with OSA. MATERIALS AND METHODS The study was a retrospective cross-sectional analysis of 239 active duty military patients (94% men, mean age 40.0 ± 7.8 years), who were admitted into PAP therapy and participated in a single 90-minute behavioral intervention session. The session included a self-assessment of sleep trouble, sleep distress, impact of sleep on functioning, emotional difficulty from sleep, stress appraisal, and beliefs about OSA and PAP. PAP usage data of the patients were analyzed at 30-, 60-, and 180 days post-intervention using descriptive statistics and multivariable linear regression analysis. RESULTS Positive airway pressure adherence of at least 4 hours nightly usage decreased slightly over the course of the study; mean number of days used over a 30-day timeframe at the 30-, 60-, and 180-day mark were 15.6, 14.9, and 14.1 days, respectively. On nights used, PAP usage remained consistent at 4.8 to 5.0 hours over the 30-, 60-, and 180-day mark. Age, apnea-hypopnea index, readiness, self-efficacy or confidence in treatment implementation, and worries about sleep were statistically significant predictors of adherence. Furthermore, worries about sleep negatively affected PAP usage hours on nights used, regardless of meeting adherence criterion, in the early phase of treatment and in the long run at the 180-day mark. CONCLUSIONS Readiness for therapy, self-efficacy, confidence in putting into action the treatment plan, and worries about sleep are modifiable variables that may be targeted in programs to boost PAP adherence and usage among the military population. Future studies should explore the predictive aspects of each of these variables and identify interventions to improve them.
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Affiliation(s)
- David P Shaha
- Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Juliana S Ee
- Department of Family Medicine, Womack Army Medical Center, Fort Liberty, NC 28310, USA
| | - Christopher K Pham
- Department of Family, Community, and Preventive Medicine, Drexel University College of Medicine, Philadelphia, PA 19104, USA
| | - Lea S Choi
- Department of Family Medicine, Womack Army Medical Center, Fort Liberty, NC 28310, USA
| | - Godwin Y Dogbey
- Department of Research and Medical Education, Campbell University, Jerry M. Wallace School of Osteopathic Medicine, Lillington, NC 27546, USA
| | - Nina Pogorzelski
- Department of Allergy and Immunizations, Lackland Air Force Base, San Antonio, TX 78236, USA
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Schkade I, Sadeghi-Bahmani D, Lang UE, Blais RK, Stanga Z, Ülgür II, Brand S, Annen H. Military Values, Military Virtues, and Vulnerable Narcissism among Cadets of the Swiss Armed Forces-Results of a Cross-Sectional Study. Eur J Investig Health Psychol Educ 2024; 14:2074-2086. [PMID: 39056653 PMCID: PMC11275259 DOI: 10.3390/ejihpe14070138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/22/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Background: For military leaders, military values and virtues are important psychological prerequisites for successful leadership and for ethical and moral military behavior. However, research on predictors of military values and virtues is scarce. Given this background, we investigated whether Organizational Citizenship Behavior (OCB), resilience, and vulnerable narcissism might be favorably or unfavorably associated with military values and virtues, and whether vulnerable narcissism could moderate the association between the OCB-by-resilience-interaction, and military virtues. Methods: A total of 214 officer cadets (mean age: 20.75 years; 96.8% males) of the Swiss Armed Forces (SAF) volunteered to take part in this cross-sectional study. They completed a booklet of self-rating scales covering dimensions of military values and military virtues, OCB, resilience, and vulnerable narcissism. Results: Higher scores for military virtues were associated with higher scores for military values, OCB, and resilience, and with lower scores for vulnerable narcissism. Multiple regression models showed that higher scores for OCB and resilience were associated with military values and virtues. Vulnerable narcissism moderated the association between military virtues, and the OCB-by-resilience-interaction: the higher the vulnerable narcissism, the more the OCB-by-resilience-interaction was associated with lower scores for military virtues. Conclusions: Among cadets of the SAF, the associations between military values, military virtues, OCB, and resilience were highly intertwined, while vulnerable narcissism appeared to attenuate the association between military virtues, OCB, and resilience.
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Affiliation(s)
- Immanuel Schkade
- Psychiatric Hospital of the University of Basel, 4002 Basel, Switzerland; (I.S.); (U.E.L.)
| | - Dena Sadeghi-Bahmani
- Department of Psychology, Stanford University, Stanford, CA 94305, USA;
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA 94305, USA
| | - Undine E. Lang
- Psychiatric Hospital of the University of Basel, 4002 Basel, Switzerland; (I.S.); (U.E.L.)
| | - Rebecca K. Blais
- Psychology Department, Arizona State University, Tempe, AZ 85287, USA;
| | - Zeno Stanga
- Centre of Competence for Military and Disaster Medicine, Swiss Armed Forces, 3008 Bern, Switzerland; (Z.S.); (I.I.Ü.)
- Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, University Hospital and University of Bern, 3010 Bern, Switzerland
| | - Ismail I. Ülgür
- Centre of Competence for Military and Disaster Medicine, Swiss Armed Forces, 3008 Bern, Switzerland; (Z.S.); (I.I.Ü.)
| | - Serge Brand
- Center of Affective, Stress and Sleep Disorders (ZASS), Psychiatric Clinics of the University of Basel, 4002 Basel, Switzerland
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise, and Health, Department of Medicine, University of Basel, 4052 Basel, Switzerland
- Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah 6715847141, Iran
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 6715847141, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran 1416634793, Iran
- Center for Disaster Psychiatry and Disaster Psychology, Psychiatric Clinics of the University of Basel, 4002 Basel, Switzerland
| | - Hubert Annen
- Military Academy, Swiss Federal Institute of Technology ETH Zurich, 8903 Birmensdorf, Switzerland;
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Moore BA, Brager A, Judkins J, Mysliwiec V. Nightmare disorder in active-duty US military personnel. Sleep Health 2023; 9:283-287. [PMID: 36774213 DOI: 10.1016/j.sleh.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 11/29/2022] [Accepted: 12/22/2022] [Indexed: 02/11/2023]
Abstract
STUDY OBJECTIVES Military personnel experience high rates of traumatic experiences. Despite this, few studies have examined the presence of nightmare disorder in military personnel. The primary aim of this study was to examine diagnoses of nightmare disorder across the 4 largest branches of the active-duty US military. DESIGN & PARTICIPANTS Data and service branch densities used to derive the expected rates of diagnoses of nightmare disorder were drawn from the Defense Medical Epidemiology Database. The branches examined included all active-duty services members in the US Army, Navy, Marine Corps, and Air Force, who served between 2016 and 2021. Single-sample chi-square goodness of fit tests were conducted to examine within-variable differences for military relevant variables. RESULTS Between 2016 and 2019, the incidence rates of nightmare disorder (per 10,000 service members) in the US Department of Defense ranged from 11.3 in 2016 to a low of 6.9 in 2018. Service members who were classified as non-white, female, over the age of 35, married, in the Army, and/or a noncommissioned officer, were diagnosed at greater rates relative to their representation in the military population (p < .001). CONCLUSION Our findings of higher than expected rates of nightmare disorder in older, senior service members as well as those in the Army align with the known precipitant of nightmares, and trauma. However, the reason for the finding that female and Black service members have higher than expected rates is not readily apparent.
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Affiliation(s)
- Brian A Moore
- Department of Psychological Science, Kennesaw State University, Kennesaw, Georgia, USA.
| | - Allison Brager
- Marketing & Engagement Brigade, United States Army Recruiting Command, Fort Knox, Kentucky
| | - Jason Judkins
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Vincent Mysliwiec
- Department of Psychiatry and Behavioral Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Carlson GC, Sharifian N, Jacobson IG, LeardMann CA, Rull RP, Martin JL. Contribution of post-trauma insomnia to depression and posttraumatic stress disorder in women service members: findings from the Millennium Cohort Study. Sleep 2023; 46:zsac313. [PMID: 36546353 PMCID: PMC9995785 DOI: 10.1093/sleep/zsac313] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/11/2022] [Indexed: 12/24/2022] Open
Abstract
STUDY OBJECTIVES We examined whether women service members and veterans who reported recent combat and/or sexual trauma experiences had a greater risk of insomnia compared with women who did not report these recent experiences, and whether insomnia would be associated with a greater risk of mental health outcomes. METHODS We analyzed two waves of survey data (2011-2013, Time 1 [T1] and 2014-2016, Time 2 [T2]) from 26 443 current and former women service members from the Millennium Cohort Study. We assessed recent traumas in the past 3 years, and probable insomnia at T1 and probable post-traumatic stress disorder (PTSD) and depression at T2. A longitudinal mediation model was used to quantify separate indirect effects of recent traumas on mental health outcomes through probable insomnia. RESULTS Women who had experienced recent sexual assault (odds ratio [OR] = 1.68; 95% CI = 1.24-2.10), sexual harassment (OR = 1.22; 95% CI = 1.05-1.41), and combat (OR = 1.34; 95% CI = 1.20-1.49) at T1 had a greater risk of probable insomnia at T1 compared with women who had not recently experienced these events. Probable insomnia at T1, in turn, was associated with probable depression (OR = 2.66; 95% CI = 2.31-3.06) and PTSD (OR = 2.57; 95% CI = 2.27-2.90) at T2. Recent combat experience did not moderate the associations of recent sexual trauma with insomnia or mental health outcomes. CONCLUSIONS Insomnia contributes to the risk of subsequent mental health conditions following trauma. The diagnosis and treatment of post-trauma insomnia should be prioritized to mitigate the development of posttraumatic mental health conditions.
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Affiliation(s)
- Gwendolyn C Carlson
- Department of Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Neika Sharifian
- Leidos, Inc., San Diego, CA, USA
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
| | - Isabel G Jacobson
- Leidos, Inc., San Diego, CA, USA
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
| | - Cynthia A LeardMann
- Leidos, Inc., San Diego, CA, USA
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
| | - Rudolph P Rull
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
| | - Jennifer L Martin
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Mysliwiec V, Brock MS, Pruiksma KE, Straud CL, Taylor DJ, Hansen S, Foster SN, Mithani S, Zwetzig S, Gerwell K, Young-McCaughan S, Powell T, Blue Star JA, Cassidy DG, Mintz J, Peterson AL. A comprehensive evaluation of insomnia, obstructive sleep apnea and comorbid insomnia and obstructive sleep apnea in US military personnel. Sleep 2022; 45:6675630. [PMID: 36006786 DOI: 10.1093/sleep/zsac203] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/08/2022] [Indexed: 12/14/2022] Open
Abstract
STUDY OBJECTIVES The aim of this study was to characterize the sleep disorders of insomnia, obstructive sleep apnea (OSA), and comorbid insomnia and OSA (COMISA) in active duty military personnel. METHODS Prospective observational study of 309 military personnel with a mean age of 37.17 years (SD = 7.27). Participants served in four branches of the U.S. military (47.9% Air Force, 38.8% Army, 11.3% Navy, and 1.9% Marines). Sleep diagnoses were rendered after video-polysomnography and a clinical evaluation. Validated self-report measures assessed insomnia severity, excessive daytime sleepiness, sleep quality, disruptive nocturnal behaviors, nightmare disorder, shift work disorder (SWD), sleep impairment, fatigue, posttraumatic stress disorder (PTSD) symptoms, anxiety, depression, and traumatic brain injury (TBI). General linear models and Pearson chi-square tests were used for between-group differences in data analyses. RESULTS Insomnia was diagnosed in 32.7%, OSA in 30.4% and COMISA in 36.9%. Compared to military personnel with OSA alone, those with insomnia only and COMISA had significantly greater insomnia severity, disruptive nocturnal behaviors, sleep-related impairment, rates of nightmare disorder, and poorer sleep quality (all Ps < .05). They also reported greater symptoms of fatigue, PTSD, anxiety, and depression (all Ps < .05). There were no significant differences among the three sleep disorder diagnostic groups on sleepiness, SWD, or TBI. CONCLUSIONS Military personnel with insomnia only and COMISA overall report worsened symptoms of sleep disorders, sleep-related impairment, fatigue, and psychiatric disorders than those with OSA. Results highlight the importance of a comprehensive assessment for sleep-related impairment, sleep, and comorbid disorders in military personnel with clinically significant sleep disturbances.
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Affiliation(s)
- Vincent Mysliwiec
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Matthew S Brock
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX, USA
| | - Kristi E Pruiksma
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Casey L Straud
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Daniel J Taylor
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Shana Hansen
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX, USA
| | - Shannon N Foster
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX, USA
| | - Sara Mithani
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Sarah Zwetzig
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Kelsi Gerwell
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Tyler Powell
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX, USA
| | - John A Blue Star
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX, USA
| | - Daniel G Cassidy
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX, USA
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA
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Who sleeps more and who works longer in the US Navy: Officers or enlisted personnel? Sleep Health 2022; 8:387-390. [PMID: 35729004 DOI: 10.1016/j.sleh.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To determine whether United States Navy (USN) officers and enlisted personnel have different sleep and work patterns while underway on USN surface ships. METHODS Variables of interest were assessed by actigraphy, activity logs, and validated questionnaires. RESULTS The 2 groups had similar daily sleep (officers: 6.41 ± 0.95 hrs/day; enlisted: 6.57 ± 0.97 hrs/day) and work duration. Enlisted personnel, however, were more likely to report excessive daytime sleepiness-EDS (41% more likely), clinically relevant insomnia (105%), to have both EDS and elevated insomnia (121%), to be classified as poor sleepers (17%), to use nicotine products (174%), and to forego routine exercise (57%). Enlisted personnel were 487% more likely to report all 3 of these behaviors: drink caffeinated beverages, use nicotine/tobacco products, forego routine exercise. CONCLUSIONS Even though the work and sleep hours do not differ significantly, the state of well-being of enlisted personnel is in general lower than officers. Our findings can provide insight to Navy leadership towards improving sailor well-being and crew endurance.
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