Sleep disorders plague vets with head trauma or PTSD

New research shows high rates of sleep disorders among veterans of America's wars in Iraq and Afghanistan who have post-traumatic stress disorder (PTSD) or head injuries.

The study conducted at Walter Reed Army Medical Center in Washington, DC, found that among some 300 soldiers with PTSD, head injuries or both, more than half had sleep apnea - a serious interruption of breathing during sleep - and nearly half had insomnia.

"Sleep complaints were universal," wrote Dr. Jacob Collen and his colleagues in their research summary. Collen's team presented their findings this week at the annual meeting of the American College of Chest Physicians in Honolulu.

The researchers studied 135 soldiers with PTSD, 116 with traumatic brain injury and 66 with both conditions.

Sleep testing performed on most of the patients found obstructive sleep apnea in 56 percent of them and insomnia in 49 percent.

More than two-thirds (71 percent) of the soldiers had restless nights of fragmented sleep. Nearly nine in ten (87 percent) were "hypersomniacs," sleepy during waking hours, Collen said.

"We found that sleep disorders appear to break down by presence or absence of injury and by the type of injury," he noted.

In soldiers with traumatic brain injury, he said, "blast injuries appeared to be associated with insomnia and anxiety," and blunt head trauma was more closely linked to sleep apnea.

Among the traumatic brain injury victims, 63 percent with blast injuries had insomnia, compared to 40 percent of those with blunt trauma. But only 26 percent of those with blast injuries had sleep apnea, compared to 54 percent of those with blunt trauma.

Overall, sleep apnea was significantly more common (78 percent) in patients without traumatic brain injuries, the researchers found.

And in the PTSD patients, sleep apnea was more common in those who hadn't suffered any physical injuries. Among the soldiers with PTSD and sleep apnea, only about a third had battle injuries (37 percent), whereas more than two-thirds of veterans with PTSD but without sleep apnea had been injured in battle (71 percent).

The PTSD data "raise the question of whether having undiagnosed obstructive sleep apnea before you deploy could act as a risk factor for developing PTSD," Collen said. "We don't have data to support that, it was just an interesting question."

Dr. Brian Carlin, a pulmonologist and sleep medicine specialist at Allegheny General Hospital in Pittsburgh, who was not involved in the study, called the rates of sleep problems among the soldiers "inordinately high."

Insomnia among head-injury victims was not a surprise, Carlin said, but sleep apnea is. "Almost half of the soldiers who had blunt trauma had sleep apnea. In a presumably healthy and relatively fit population (similar to the soldiers), the rate of sleep apnea is probably four percent to five percent," Carlin said.