Gaffey Allison E, Haskell Sally G, Burg Matthew M, Yaggi Henry K, Mattocks Kristin M, Bastian Lori A, Skanderson Melissa, DeRycke Eric C, Hermes Eric D A, Brandt Cynthia A
VA Connecticut Healthcare System, Yale School of Medicine, West Haven, CT, USA.
Department of Internal Medicine (Cardiovascular Medicine), Yale School of Medicine, New Haven, CT, USA.
J Gen Intern Med. 2025 May 6. doi: 10.1007/s11606-025-09534-2.
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.
睡眠障碍以及与睡眠紊乱共病的慢性疾病给美国人口带来了沉重负担，退伍军人出现睡眠紊乱的风险尤其高。睡眠障碍在性别上也有不同表现，并且退伍女军人的比例正在迅速增加。在最近一批退伍军人队列（即9·11事件后退役的军人）中，睡眠障碍的程度以及这些病症的管理方式尚不清楚。研究目的是描述退伍军人健康管理局（VA）为9·11事件后退伍军人提供服务时，睡眠评估、诊断和治疗的频率、睡眠管理的时间，并确定在所有睡眠护理方面是否存在基于性别的差异。
这项前瞻性队列研究纳入了所有在2001年10月1日至2021年9月30日期间登记接受VA护理并完成≥1次门诊就诊的9·11事件后退伍军人。使用诊断和程序代码、健康因素及日期来提取评估变量（如行为、多导睡眠图）、诊断结果（即失眠、睡眠相关呼吸障碍[SRBD]、共病失眠和SRBD[COMISA]、睡眠相关运动障碍[SRMD]或其他障碍）、失眠或SRBD的治疗情况以及睡眠评估、诊断和治疗的时间。逻辑回归分析评估了按性别接受睡眠护理的可能性。
最终样本包括1,113,633名患者（12%为女性，61%为白人）。总体而言，39%的人患有睡眠障碍——27%患有SRBD，18%患有失眠，8%患有COMISA，2%患有SRMD，6%患有其他障碍。男性更有可能被诊断出任何疾病，尤其是SRBD。女性接受评估的时间比男性晚一年，患失眠或SRMD的几率更高。女性接受失眠治疗的几率也更高，而患有SRBD的女性接受治疗的可能性比男性低31%。
由于管理睡眠健康是以人为本的医疗护理的核心，因此需要共同努力实施VA现有的睡眠指南，利用现有资源满足退伍军人男女不同的睡眠需求。
