Journal of Behavioral Medicine

, Volume 38, Issue 3, pp 544–555 | Cite as

Associations between sleep difficulties and risk factors for cardiovascular disease in veterans and active duty military personnel of the Iraq and Afghanistan conflicts

  • Christi S. UlmerEmail author
  • Hayden B. Bosworth
  • Anne Germain
  • Jennifer Lindquist
  • Maren Olsen
  • Mira Brancu
  • the VA Mid-Atlantic Mental Illness Research Education and Clinical Center Registry Workgroup
  • Jean C. Beckham


Recent evidence suggests that sleep disturbance may play an important role in the development of cardiovascular disease (CVD). Despite the prevalence of sleep complaints among service members of recent military conflicts, few studies have examined associations between sleep and risk factors for CVD in this population. Symptom checklist items regarding distress about “trouble falling asleep” and “restless/disturbed sleep” were used as proxies for sleep onset and maintenance difficulties to examine these associations in US military service members of recent conflicts. Veterans having both sleep onset and maintenance difficulties had greater odds of being a current smoker and having psychiatric symptoms and diagnoses. Increased odds of a self-reported hypertension diagnosis and elevated systolic blood pressure were also found in certain subsets of this sample. Findings highlight the need for greater recognition of sleep difficulties as a CVD risk factor in a population known to be at increased risk for this condition.


Sleep Cardiovascular disease Hypertension Veterans Insomnia 



Christi S. Ulmer was supported by a Veterans Affairs Research Career Development Award (CDA 09-218) while preparing this manuscript. This project was supported by the Mid-Atlantic Mental Illness Research, Education and Clinical Center (VISN 6 MIRECC) of the Department of Veterans Affairs Office of Mental Health Services, the VA Mid-Atlantic Healthcare Network (VISN 6), the Durham, NC Veterans Affairs Medical Center, and the Department of Veterans Affairs Office of Research and Development. The views expressed are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or any of the institutions with which the authors are affiliated. The Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup for this manuscript includes: Patrick S. Calhoun, Eric B. Elbogen, John A. Fairbank, Jeffrey M. Hoerle, Christine E. Marx, Scott D. Moore, Rajendra A. Morey, Kristy A. Straits-Tröster, Larry A. Tupler, Richard D. Weiner, and H. Ryan Wagner from the Durham (NC) VA Medical Center; Marinell Miller-Mumford from the Hampton (VA) VA Medical Center; Antony Fernandez, Scott D. McDonald, and Treven C. Pickett from the Richmond (VA) VA Medical Center; Robin A. Hurley, Katherine H. Taber, and Ruth E. Yoash-Gantz from the Salisbury (NC) VA Medical Center; and Gregory McCarthy, from Yale University.

Conflict of interest

Christi S. Ulmer, Hayden B. Bosworth, Anne Germain, Jennifer Lindquist, Maren Olsen, Mira Brancu, the VA Mid-Atlantic Mental Illness Research Education and Clinical Center Registry Workgroup, and Jean C. Beckham all declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all participants included in the study.


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Copyright information

© Springer Science+Business Media New York (outside the USA) 2015

Authors and Affiliations

  • Christi S. Ulmer
    • 1
    • 2
    Email author
  • Hayden B. Bosworth
    • 1
    • 2
  • Anne Germain
    • 4
  • Jennifer Lindquist
    • 1
  • Maren Olsen
    • 1
    • 2
  • Mira Brancu
    • 3
  • the VA Mid-Atlantic Mental Illness Research Education and Clinical Center Registry Workgroup
  • Jean C. Beckham
    • 2
    • 3
  1. 1.HSR&D (152)Durham Veterans Affairs Medical CenterDurhamUSA
  2. 2.Department of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamUSA
  3. 3.VISN 6 Mental Illness Research, Education, and Clinical Center SDurhamUSA
  4. 4.Departments of Psychiatry and PsychologyUniversity of PittsburghPittsburghUSA

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