The prevalence of chronotype and associations with patient-reported outcomes among military veterans with obstructive sleep apnea, insomnia, and COMISA.

OBJECTIVE

Among military veterans, it is unclear whether insomnia, obstructive sleep apnea (OSA), and comorbid insomnia and sleep apnea (COMISA) carry disproportionate burden to patient-reported outcomes (PROs). Furthermore, differences in chronotype preference among these diagnostic groups and their contribution to PROs have not been explored.

METHODS

Veterans at risk for OSA were evaluated at the Miami VAHS Sleep Center across a year-long period. Home polysomnography (PSG) and questionnaires (demographics, insomnia severity index [ISI], patient-reported outcomes measurement information system [PROMIS-29]) were used to establish well-characterized diagnostic clinical groups. Chronotype preference was self-reported as morning, intermediate or evening type according to the Morningness-Eveningness Questionnaire.

RESULTS

The cohort consisted of 387 veterans (85 % male, Mage = 52 ± 15 yrs), identified with OSA alone (N = 60, 16 %), insomnia alone (N = 68, 18 %) or COMISA (N = 259, 67 %). The chronotype prevalence of morning, intermediate, and evening were 33 %, 50 %, 16 %, respectively. Evening chronotype frequency was more prevalent in those with insomnia alone (19 %) and COMISA (17 %) than in those with OSA alone (8 %). Insomnia alone and COMISA were associated with worse anxiety, depression, fatigue, sleep disturbance, social disruption, physical function, and pain interference than OSA alone. Evening chronotype was associated with greater depressive symptoms across all sleep disorder groups.

CONCLUSIONS

Veterans with COMISA and insomnia alone preferred evening chronotype and were more functionally impaired than those with OSA alone. Regardless of sleep disorder, evening chronotype was associated with active depressive symptoms. Incorporating chronotype assessment in military veterans with sleep disorders may have clinical implications for treatment planning.