Associations between sleep difficulties and risk factors for cardiovascular disease in veterans and active duty military personnel of the Iraq and Afghanistan conflicts
- 390 Downloads
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.
KeywordsSleep 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.
- Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck depression inventory manual (2nd ed.). San Antonio, TX: Psychological Corporation.Google Scholar
- Centers for Disease Control and Prevention. (2010). Current depression among adults—United States, 2006 and 2008. Morbidity and Mortality Weekly Report, 59, 1229–1235.Google Scholar
- Crum-Cianflone, N., Bagnell, M. E., Schaller, E., Boyko, E. J., Smith, B., Maynard, C., et al. (2014). Impact of combat deployment and posttraumatic stress disorder on newly reported coronary heart disease among US active duty and reserve forces. Circulation, 129, 1813–1820.CrossRefPubMedGoogle Scholar
- Dave, G., Bibeau, D. L., Schulz, M. R., Aronson, R. E., Ivanov, L. L., Black, A., & Spann, L. (2013). Predictors of congruency between self-reported hypertension status and measured blood pressure in the stroke belt. Journal of the American Society of Hypertension, 7, 370–378.CrossRefPubMedGoogle Scholar
- Derogatis, L. R. (1994). SCL-90-R symptom checklist 90-R administration, scoring and procedures manual. Minneapolis, MN: National Computer Systems.Google Scholar
- Dozois, D. J. A., & Covin, R. (2004). The Beck Depression Inventory-II (BDI-II), Beck Hopelessness Scale (BHS), and Beck Scale for Suicidal Ideation (BSS). In M. Hersen (Ed.), Comprehensive handbook of psychological assessment. Hoboken, NJ: Wiley.Google Scholar
- First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1996). Structured clinical interview for the DSM-IV axis I disorders. New York: Biometrics Research, New York State Psychiatric Institute.Google Scholar
- Ikehara, S., Iso, H., Date, C., Kikuchi, S., Watanabe, Y., Wada, Y., et al. (2009). Association of sleep duration with mortality from cardiovascular disease and other causes for Japanese men and women: The JACC Study. Sleep, 32, 259–301.Google Scholar
- Kim, Y., Wilkens, L. R., Schembre, S. M., Henderson, B. E., Kolonel, L. N., & Goodman, M. T. (2013). Insufficient and excessive amounts of sleep increase the risk of premature death from cardiovascular and other diseases: The Multiethnic Cohort Study. Preventive Medicine, 57, 377–385.CrossRefPubMedCentralPubMedGoogle Scholar
- Kulka, R. A., Schlenger, W. E., Fairbank, J. A., Hough, R. L., Jordan, B. K., Marmar, C. R., & Weiss, D. S. (1990). Trauma and the Vietnam war generation: Report of findings from the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel.Google Scholar
- Lauderdale, D., Knutson, K. L., Rathouz, P. J., Yan, L. L., & Hulley, S. B. (2009). Cross-sectional and longitudinal associations between objectively measured sleep duration and body mass index: The CARDIA Sleep Study. American Journal of Epidemiology, 170, 805–813.CrossRefPubMedCentralPubMedGoogle Scholar
- Neylan, T. C., Marmar, C. R., Metzler, T. J., Weiss, D. S., Zatzick, D. F., Delucchi, K. L., et al. (1998). Sleep disturbances in the Vietnam generation: Findings from a nationally representative sample of male Vietnam veterans. American Journal of Psychiatry, 155, 929–933.CrossRefPubMedGoogle Scholar
- Okura, Y., Urban, L. H., Mahoney, D. W., Jacobsen, S. J., & Rodeheffer, R. J. (2004). Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure. Journal of Clinical Epidemiology, 57, 1096–1103.CrossRefPubMedGoogle Scholar
- Scherrer, J., Chrusciel, T., Zeringue, A., Garfield, L. D., Hauptman, P. J., Lustman, P. J., et al. (2010). Anxiety disorders increase risk for incident myocardial infarction in depressed and nondepressed Veterans administration patients. American Heart Journal, 159, 772–779.CrossRefPubMedGoogle Scholar
- Tanielian, T., & Jaycox, L. H. (2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica: CA, RAND Corporation.Google Scholar
- Whang, W., Kubzansky, L. D., Kawachi, I., Rexrode, K. M., Kroenke, C. H., Glynn, R. J., et al. (2009). Depression and risk of sudden cardiac death and coronary heart disease in women: Results from the Nurses’ Health Study. Journal of the American College of Cardiology, 53, 950–958.CrossRefPubMedCentralPubMedGoogle Scholar
- Wheaton, A., Perry, G. S., Chapman, D. P., McKnight-Eily, L. R., Presley-Cantrell, L. R., & Croft, J. B. (2011). Relationship between body mass index and perceived insufficient sleep among U.S. adults: An analysis of 2008 BRFSS data. BMC Public Health, 11, 295.CrossRefPubMedCentralPubMedGoogle Scholar