Risk Assessment of Sleep Disorder and Disease Co-Morbidity Across Army Installations from OTSG Health of the Force Report
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The impact of sleep disorders on active duty Soldiers’ medical readiness is clinically significant. Sleep disorders present high comorbidity with disease states directly impacting medical readiness, ranging from musculoskeletal injury (MSK-I), obesity, and drug dependence. Patient data generated from military health databases can be accessed to examine such relationships. The current study performed a risk assessment of sleep disorder comorbidity with MSK-I, obesity, and drug dependence across active duty United States Army installations through a comprehensive analysis of the Office of the Surgeon General Health of the Force (HoF) report, specifically for Fiscal Year (FY) 2017. Health incidences (percent active duty per installation) were queried from the HoF FY 2017 (n = 471,000; 85.5% male, > 70% between 18 -34). Nonparametric ranked tests identified active duty Army installations at low risk (green; < 25% percentile relative to mean rank), moderate risk (amber; 25% - 50% percentile relative to mean rank), and high risk (red; > 75% percentile relative to mean rank). Linear regressions determined extent of comorbidity of sleep disorders with MSK-I, obesity, and drug dependence (tobacco use and substance abuse). Mean rank comparisons for sleep disorders vs. injury index (p=0.499), obesity (p=0.306), tobacco use (p=0.378), and substance abuse (p=0.591) did not differ for each installation. Further, there was a high degree of co-morbidity for mean percentage of diagnosed sleep disorder with injury index (p<0.001; r2 = 0.517), obesity (p<0.001; r2 = 0.963), tobacco use (p<0.001; r2 = 0.928), and substance abuse (p<0.001; r2 = 0.968). In general, large infantry and artillery training units located in the Southeastern United States were “in the red” for not meeting medical readiness standards. A few exceptions include Virginia-Maryland triangle which has daily work commutes averaging > 1 h each day. These risk assessments mirror geographical risk data from the Center for Disease Control (CDC) which is surprising because there is a large degree of inter-individual variability in geographical origin, race/ethnicity, and socioeconomic statuses within a single Army installation. Nevertheless, these data demonstrate strong geographical influences on health risk comorbidity in active duty Soldiers comparable to civilian sectors.