Burn Pit Smoke Exposure and Sleep Apnea in US Veterans: A Retrospective Cohort Study

Burn pit smoke exposure (BPSE) during military deployment has been linked to long-term cardiorespiratory conditions, but its relationship with sleep apnea (SA) remains unclear. This study examines the association between BPSE and SA using Veterans Health Administration (VHA) electronic medical records (EMR) and the Airborne Hazards and Open Burn Pit Registry (AHOBPR).

We conducted a retrospective cohort study of veterans from AHOBPR with VHA sleep study data. BPSE was classified into quartiles based on the duration of exposure, and SA severity was measured using the Apnea-Hypopnea Index (AHI). Logistic regression models and Cox proportional hazards models were used to evaluate the association between BPSE and SA, adjusting for confounders such as age, body mass index, smoking status, post-traumatic stress disorder (PTSD), and comorbid disease burden.

The study included 17,064 veterans (mean age 40.2 y; 89.6% male; 58.3% with PTSD). Veterans in the highest BPSE quartile (≥245 d) had an unadjusted OR of 1.13 for SA, which became nonsignificant after adjustment (aOR: 1.10, P=0.058). The median time to SA diagnosis was 8.8 years in the highest BPSE group versus 11.1 years in the lowest. The adjusted Hazard Ratio for earlier SA diagnosis in the highest BPSE quartile was 1.16 (95% CI: 1.10, 1.22).

Although BPSE was not associated with SA prevalence, it was linked to earlier diagnosis. BPSE-related airway inflammation or increased health care use among exposed veterans may explain this pattern. Findings support early surveillance and screening for SA in highly exposed veterans.