Sleep and Breathing

, Volume 19, Issue 1, pp 175–182

Sleep disorders in combat-related PTSD

  • Scott G. Williams
  • Jacob Collen
  • Nicholas Orr
  • Aaron B. Holley
  • Christopher J. Lettieri
Original Article



We sought to assess the rate of sleep complaints and sleep disorders among active duty soldiers with deployment-related PTSD and to determine whether any clinical features differentiated those with sleep disorders.


Retrospective review of consecutive soldiers diagnosed with PTSD. We recorded subjective measures of sleep and polysomnographic data. We compared clinical and demographic variables including psychoactive medication use, psychiatric comorbidity, and combat-related traumatic injury with the presence of sleep disorders.


One hundred thirty patients were included (91.5 % male, mean age of 35.1 ± 10.6 years, mean body mass index (BMI) 28.9 ± 4.4 Kg/m2). About 88.5 % had comorbid depression, with the majority (96.2 %) taking psychoactive medications (mean 3.4 ± 1.6 medications per patient). Over half of the cohort suffered combat-related traumatic physical injuries (54.6 %). The obstructive sleep apnea syndrome (OSAS) was diagnosed in 67.3 % (80 % of the cohort underwent polysomnography), with a mean apnea hypopnea index of 24.1 ± 22.8 events/hour and a mean oxygen saturation nadir of 84.2 ± 5.7 %. OSAS was significantly more common in the non-injured soldiers (72.9 vs. 38.0 %, p < 0.001). In multivariate analysis, absence of physical injury showed a trend towards predicting OSAS.


Sleep complaints are common among soldiers with PTSD. We observed significantly higher rates of OSAS among those without physical injuries, raising the possibility that underlying sleep-disordered breathing is a risk factor for the development of PTSD. This potential association requires further validation.


Combat related sleep disorder Insomnia Obstructive sleep apnea Sleep-disordered breathing Post-traumatic stress disorder 



American Academy of Sleep Medicine


Diagnostic and statistical manual of mental disorders, 4th ed, text revision


Epworth sleepiness scale


Operation enduring freedom


Operation Iraqi freedom


PTSD checklist-military version

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Scott G. Williams
    • 1
    • 5
  • Jacob Collen
    • 2
  • Nicholas Orr
    • 3
  • Aaron B. Holley
    • 4
    • 5
  • Christopher J. Lettieri
    • 4
    • 5
  1. 1.Pulmonary, Critical Care, and Sleep MedicineWomack Army Medical CenterFort BraggUSA
  2. 2.Pulmonary, Critical Care, and Sleep Medicine, Pulmonary Diseases ServiceSan Antonio Military Medical CenterHoustonUSA
  3. 3.Department of CardiologyWalter Reed National Military Medical CenterBethesdaUSA
  4. 4.Pulmonary, Critical Care, and Sleep MedicineWalter Reed National Military Medical CenterBethesdaUSA
  5. 5.Department of MedicineUniformed Services UniversityBethesdaUSA

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