Prevalence of insomnia disorder and sleep apnea in a sample of veterans at risk for cardiovascular disease

J Clin Sleep Med. 2021 Mar 10. doi: 10.5664/jcsm.9228. Online ahead of print.


STUDY OBJECTIVES: To examine the proportion of study participants screening positive for insomnia disorder and/or sleep apnea in Veterans engaged in routine healthcare and known to be at risk for CVD, and to compare these proportions to those previously documented in medical records.

METHODS: Cross-sectional analysis of baseline data from a randomized clinical intervention trial for patients at risk of CVD and review of study participants’ medical records. Participants were Veterans ≥ 40 years of age, enrolled in VA primary care, and diagnosed with hypertension and/or hypercholesterolemia. Self-report outcomes were the proportion of patients screening positive for insomnia disorder and sleep apnea, self-reporting a sleep apnea diagnosis, and endorsing undertreated sleep apnea. Medical record outcomes were the proportion of patients diagnosed with insomnia and sleep apnea.

RESULTS: Participants (N=420) were Veterans (84.8% male) with mean age 61.1 years. More than half of the sample (52.1%) screened positive for sleep apnea without prior self-reported diagnosis. More than 1/3 of the sample (39%) screened positive for insomnia disorder. Medical records revealed considerably lower rates, with 3.8% diagnosed with insomnia, 20.5% diagnosed with sleep apnea; about 1% diagnosed with both conditions.

CONCLUSIONS: Undiagnosed and undertreated sleep disorders are common among Veterans at risk for CVD. Most of the sample (82%) screened positive for, or met, study criteria for sleep apnea or insomnia disorder. Limitations include the use of self-reported sleep apnea treatment adherence, insomnia disorder diagnosis based on questionnaire score, and a sample comprised primarily of male Veterans. Routine sleep disorders screening in Veterans at risk of CVD could help to identify those at even greater risk owing to the adverse effects of undiagnosed or undertreated sleep disorders.

TRIAL REGISTRATION: The research reported herein was collected as part of the Cardiovascular Intervention Improvement Telemedicine Study (NCT01142908:

PMID:33688827 | DOI:10.5664/jcsm.9228