Clinical Management of Sleep Disturbances in Post-9/11 Men and Women Veterans: A 20-year Prospective Cohort Study

Sleep disorders and chronic conditions that are comorbid with disordered sleep represent a high burden to the U.S. population, and Veterans have a particularly high risk for disordered sleep. Sleep disorders also present differently by sex and there is a rapidly growing proportion of women Veterans. Among the most recent Veteran cohort (i.e., discharged post-9/11), the extent of sleep disorders and how those conditions are managed is unknown. The objectives were to characterize the frequency of sleep assessment, diagnosis, and treatment among post-9/11 Veterans served by the Veterans Health Administration (VA), the timing of sleep management, and to determine if there were sex-based disparities in all sleep care.

This prospective cohort study included all post-9/11 Veterans who enrolled in VA care, and completed ≥ 1 outpatient encounter, 10/1/2001-9/30/2021. Diagnostic and procedural codes, health factors, and dates were used to extract variables for assessment (e.g., behavioral, polysomnography), diagnoses (i.e., insomnia, sleep-related breathing [SRBD], comorbid insomnia and SRBD [COMISA], sleep-related movement [SRMD], or Other disorders), treatment of insomnia or SRBD, and time to sleep assessment, diagnosis, and treatment. Logistic regressions assessed likelihood of sleep care by sex.

The final sample included 1,113,633 patients (12% women, 61% White). Overall, 39% had sleep disorders - 27% with SRBD, 18% with insomnia, 8% with COMISA, 2% with SRMD, and 6% with Other. Men were more likely to have any diagnosis, especially SRBD. Women were assessed up to one year later than men and had greater odds of insomnia or SRMD. Women also had greater odds of insomnia treatment and those with SRBD were 31% less likely to receive treatment than men.

As managing sleep health is central to patient-centered care, concerted efforts are required to implement existing VA guidelines concerning sleep, bridging men and women Veteran's sleep needs with available resources.