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CC BY-NC-ND 4.0 · Sleep Sci 2022; 15(03): 356-362
DOI: 10.5935/1984-0063.20220063
REVIEWS

The nexus between sleep disturbances and mental health outcomes in military staff: a systematic review

Negin Farhadian
1   Kermanshah University of Medical Sciences, Sleep Disorders Research Center, Health Institute, Kermanshah, Iran
,
Alireza Moradi
2   Kharazmi University, Department of Clinical Psychology - Tehran - Iran
,
Mohammad Nami
3   Shiraz University of Medical Sciences, Department of Neuroscience - Shiraz - Iran
,
Kamran Kazemi
4   Shiraz University of Technology, Department of Electrical and Electronics Engineering - Shiraz - Iran
,
Mohammad Rasoul Ghadami
1   Kermanshah University of Medical Sciences, Sleep Disorders Research Center, Health Institute, Kermanshah, Iran
,
Alireza Ahmadi
5   Kermanshah University of Medical Sciences, Department of Anesthesiology - Kermanshah - Iran
6   Karolinska Institute, Department of Caring Science and Society - Huddinge - Sweden
,
Reza Mohammadi
6   Karolinska Institute, Department of Caring Science and Society - Huddinge - Sweden
,
Mohammad Naseh Talebi
7   Institute for Cognitive Science Studies, Cognitive Science Studies - Tehran - Iran
,
Prasun Chakrabarti
8   Techno India NJR Institute of Technology, Technology - Rajasthan - India
,
Babak Kateb
9   National Center for NanoBioElectoronics, Brain Technology and Innovation Park - Los Angeles - United States
,
Habibolah Khazaie
1   Kermanshah University of Medical Sciences, Sleep Disorders Research Center, Health Institute, Kermanshah, Iran
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Objectives Military personnel are unique occupational groups who happen to frequently experience sleep insuffciencies. Since sleep disorders are known to be linked to many psychiatric symptoms, sleep disturbance is a salient concern among active duty service members and veterans. Existing evidence indicates that although sleep disturbances co-occur with mental illnesses, there is a tendency to particularly label them as consequences of certain mental health issues.

Material and Methods This review focuses on the emerging evidence which identifies sleep disturbances as a precursor for mental illnesses. In this regard, the impact of sleep disturbance on the development of mental health outcomes including post-traumatic stress disorder (PTSD), depression, and anxiety has been thoroughly scrutinized. A systematic search was conducted using PubMed, Scopus, and Web of Science academic databases using appropriate keywords.

Results Reviewed evidence substantiates the predicting role of sleep complaints and disorders to herald PTSD, depression, and anxiety among military staff.

Conclusion Early diagnosis of sleep disturbances and properly addressing them in active-duty service members and veterans should be then sought to prevent the development and progression of consequent mental health- related comorbidities in this study group.

Depression - Anxiety - Stress Disorders - Post-Traumatic - Military Personnel - Sleep


Publication History

Received: 14 September 2021

Accepted: 10 November 2021

Article published online:
01 December 2023

© 2023. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • REFERENCES

  • 1 Acheson DT, Kwan B, Maihofer AX, Risbrough VB, Nievergelt CM, Clark JW, et al. Sleep disturbance at pre-deployment is a significant predictor of post-deployment reexperiencing symptoms. Eur J Psychotraumatol. 2019 Oct;10(1):1679964. DOI: https://doi.org/10.1080/20008198.2019.1679964
  • 2 Bliese PD, Wright KM, Adler AB, Thomas JL, Hoge CW. Timing of postcombat mental health assessments. Psychol Serv. 2007;4(3):141-8. DOI: https://doi.org/10.1037/1541-1559.4.3.141
  • 3 Hoge CW, McGurk D, Thomas JL, Cox AL, Engel CC, Castro CA. Mild traumatic brain injury in US soldiers returning from Iraq. N Engl J Med 2008 May;358(5):453-63. DOI: https://doi.org/10.1056/NEJMc086083
  • 4 Khazaie H, Nasouri M, Ghadami MR. Prazosin for trauma nightmares and sleep disturbances in combat veterans with post-traumatic stress disorder. Iran J Psychiatry Behav Sci. 2016 Jul;10(3):e2603. DOI: https://doi. org/10.17795/ijpbs-2603
  • 5 Raskind MA, Peskind ER, Hoff DJ, Hart KL, Holmes HA, Warren D, et al. A parallel group placebo controlled study of prazosin for trauma nightmares and sleep disturbance in combat veterans with post-traumatic stress disorder. Biol Psychiatry. 2007 Apr;61(8):928-34. DOI: https:// doi.org/10.1016/j.biopsych.2006.06.032
  • 6 Klingaman EA, Brownlow JA, Boland EM, Mosti C, Gehrman PR. Prevalence, predictors and correlates of insomnia in US army soldiers. J Sleep Res. 2018 Oct;27(3):e12612. DOI: https://doi.org/10.1111/ jsr.12612
  • 7 Taylor DJ, Pruiksma KE, Hale WJ, Kelly K, Maurer D, Peterson AL, et al. Prevalence, correlates, and predictors of insomnia in the US Army prior to deployment. Sleep 2016 Oct;39(10):1795-806. DOI: https://doi. org/10.5665/sleep.6156
  • 8 Kong FY, Li Q, Liu SX. Poor sleep quality predicts decreased cognitive function independently of chronic mountain sickness score in young soldiers with polycythemia stationed in Tibet. High Alt Med Biol. 2011 Sep;12(3):237-42. DOI: https://doi.org/10.1089/ham.2010.1079
  • 9 Van Dongen H, Maislin G, Mullington JM, Dinges DF. The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep. 2003 Mar;26(2):117-26. DOI: https://doi. org/10.1093/sleep/26.2.117
  • 10 Lentino CV, Purvis DL, Murphy KJ, Deuster PA. Sleep as a component of the performance triad: the importance of sleep in a military population. US Army Med Dep J. 2013 Oct/Dec;98-108.
  • 11 Miller MA, Cappuccio FP. Inflammation, sleep, obesity and cardiovascular disease. Curr Vasc Pharmacol. 2007;5(2):93-102. DOI: https://doi. org/10.2174/157016107780368280
  • 12 Mysliwiec V, McGraw L, Pierce R, Smith P, Trapp B, Roth BJ. Sleep disorders and associated medical comorbidities in active duty military personnel. Sleep. 2013 Feb;36(2):167-74. DOI: https://doi.org/10.5665/ sleep.2364
  • 13 Boscarino JA. Posttraumatic stress disorder and mortality among US Army veterans 30 years after military service. Ann Epidemiol. 2006 Apr;16(4):248-56. DOI: https://doi.org/10.1016/j.annepidem.2005.03.009
  • 14 O’Toole BI, Catts SV. Trauma, PTSD, and physical health: an epidemiological study of Australian Vietnam veterans. J Psychosom Res. 2008 Jan;64(1):33-40. DOI: https://doi.org/10.1016/j.jpsychores.2007.07.006
  • 15 Cohen BE, Gima K, Bertenthal D, Kim S, Marmar CR, Seal KH. Mental health diagnoses and utilization of VA non-mental health medical services among returning Iraq and Afghanistan veterans. J Gen Intern Med. 2010 Sep;25(1):18-24. DOI: https://doi.org/10.1007/s11606-009-1117-3
  • 16 Dobie DJ, Kivlahan DR, Maynard C, Bush KR, Davis TM, Bradley KA. Posttraumatic stress disorder in female veterans: association with self-reported health problems and functional impairment. Arch Intern Med. 2004 Feb;164(4):394-400. DOI: https://doi.org/10.1001/ archinte.164.4.394
  • 17 Killgore WD, Kahn-Greene ET, Lipizzi EL, Newman RA, Kamimori GH, Balkin TJ. Sleep deprivation reduces perceived emotional intelligence and constructive thinking skills. Sleep med 2008 Jul;9(5):517-26. DOI: https://doi.org/10.1016/j.sleep.2007.07.003
  • 18 Wickwire EM, Shaya FT, Scharf SM. Health economics of insomnia treatments: the return on investment for a good night’s sleep. Sleep Med Rev. 2016 Dec;30:72-82. DOI: https://doi.org/10.1016/j. smrv.2015.11.004
  • 19 Benca RM, Obermeyer WH, Thisted RA, Gillin JC. Sleep and psychiatric disorders: a meta-analysis. Arch Gen Psychiatry. 1992;49(8):651-68. DOI: https://doi.org/10.1001/archpsyc.1992.01820080059010
  • 20 Seelig AD, Jacobson IG, Smith B, Hooper TI, Boyko EJ, Gackstetter GD, et al. Sleep patterns before, during, and after deployment to Iraq and Afghanistan. Sleep. 2010 Nov;33(12):1615-22. DOI: https://doi. org/10.1093/sleep/33.12.1615
  • 21 Luxton DD, Greenburg D, Ryan J, Niven A, Wheeler G, Mysliwiec V. Prevalence and impact of short sleep duration in redeployed OIF soldiers. Sleep. 2011 Sep;34(9):1189-95. DOI: https://doi.org/10.5665/ SLEEP.1236
  • 22 Gehrman P, Seelig AD, Jacobson IG, Boyko EJ, Hooper TI, Gackstetter GD, et al. Predeployment sleep duration and insomnia symptoms as risk factors for new-onset mental health disorders following military deployment. Sleep. 2013 Jul;36(7):1009-18. DOI: https://doi. org/10.5665/sleep.2798
  • 23 Swinkels CM, Ulmer CS, Beckham JC, Buse N, VA Mid-Atlantic MIRECC Registry Workgroup, Calhoun PS. The association of sleep duration, mental health, and health risk behaviors among US Afghanistan/Iraq era veterans. Sleep. 2013 Jul;36(7):1019-25. DOI: https://doi.org/10.5665/ sleep.2800
  • 24 Koffel E, Polusny MA, Arbisi PA, Erbes CR. Pre-deployment daytime and nighttime sleep complaints as predictors of post-deployment PTSD and depression in National Guard troops. J Anxiety Disord. 2013 Jun;27(5):512-9. DOI: https://doi.org/10.1016/j.janxdis.2013.07.003
  • 25 Taylor MK, Hilton SM, Campbell JS, Beckerley SE, Shobe KK, Drummond SP, et al. Prevalence and mental health correlates of sleep disruption among military members serving in a combat zone. Mil Med. 2014 Jul;179(7):744-51. DOI: https://doi.org/10.7205/ MILMED-D-13-00551
  • 26 McLay RN, Klam WP, Volkert SL. Insomnia is the most commonly reported symptom and predicts other symptoms of post-traumatic stress disorder in US service members returning from military deployments. Mil Med. 2010 Oct;175(10):759-62. DOI: https://doi.org/10.7205/ milmed-d-10-00193
  • 27 Wright KM, Britt TW, Bliese PD, Adler AB, Picchioni D, Moore D. Insomnia as predictor versus outcome of PTSD and depression among Iraq combat veterans. J Clin Psychol. 2011 Nov;67(12):1240-58. DOI: https://doi.org/10.1002/jclp.20845
  • 28 Mysliwiec V, Gill J, Lee H, Baxter T, Pierce R, Barr TL, et al. Sleep disorders in US military personnel: a high rate of comorbid insomnia and obstructive sleep apnea. Chest 2013 Aug;144(2):549-57. DOI: https:// doi.org/10.1378/chest.13-0088
  • 29 Brownlow JA, Klingaman EA, Boland EM, Brewster GS, Gehrman PR. Psychiatric disorders moderate the relationship between insomnia and cognitive problems in military soldiers. J Affect Disord. 2017 Oct;221:25-30. DOI: https://doi.org/10.1016/j.jad.2017.06.023
  • 30 Wang HE, Campbell-Sills L, Kessler RC, Sun X, Heeringa SG, Nock MK, et al. Pre-deployment insomnia is associated with post-deployment posttraumatic stress disorder and suicidal ideation in US Army soldiers. Sleep. 2019 Feb;42(2):zsy229. DOI: https://doi.org/10.1093/sleep/zsy229
  • 31 Hansen LP, Kinskey C, Koffel E, Polusny M, Ferguson J, Schmer- Galunder S, et al. Sleep patterns and problems among Army National Guard soldiers. Mil Med. 2018 May;183(11-12):e396-e401. DOI: https:// doi.org/10.1093/milmed/usy107
  • 32 Van Liempt S. Sleep disturbances and PTSD: a perpetual circle? Eur J Psychotraumatol. 2012 Oct;3(1):19142. DOI: https://doi.org/10.3402/ ejpt.v3i0.19142
  • 33 Van Liempt S, Van Zuiden M, Westenberg H, Super A, Vermetten E. Impact of impaired sleep on the development of PTSD symptoms in combat veterans: a prospective longitudinal cohort study. Depress Anxiety. 2013 Feb;30(5):469-74. DOI: https://doi.org/10.1002/da.22054
  • 34 Steele M, Germain A, Campbell JS. Mediation and moderation of the relationship between combat experiences and post-traumatic stress symptoms in active duty military personnel. Mil Med. 2017 May;182(5-6):e1632-e9. DOI: https://doi.org/10.7205/MILMED-D-16-00169
  • 35 Macera CA, Aralis HJ, Rauh MJ, MacGregor AJ. Do sleep problems mediate the relationship between traumatic brain injury and development of mental health symptoms after deployment? Sleep. 2013 Jan;36(1):83-90. DOI: https://doi.org/10.5665/sleep.2306
  • 36 Osgood JM, Finan PH, Hinman SJ, So CJ, Quartana PJ. Combat exposure, post-traumatic stress symptoms, and health-related behaviors: the role of sleep continuity and duration. Sleep. 2019 Mar;42(3):zsy257. DOI: https://doi.org/10.1093/sleep/zsy257
  • 37 Lewis V, Creamer M, Failla S. Is poor sleep in veterans a function of post-traumatic stress disorder? Mil Med. 2009 Sep;174(9):948-51. DOI: https://doi.org/10.7205/milmed-d-04-0208
  • 38 Hughes JM, Ulmer CS, Hastings SN, Gierisch JM, Howard MO. Sleep, resilience, and psychological distress in United States military Veterans. Mil Psychol. 2018 Aug;30(5):404-14. DOI: https://doi.org/10.1080/08995605.2018.1478551
  • 39 Hunt E, Greenberg N, Jones N. Poor sleep after military deployment: associations with mental health difficulties. Occup Med. 2016 Nov;66(8):669-75. DOI: https://doi.org/10.1093/occmed/kqw116
  • 40 Kim TK, Lee HC, Lee SG, Han KT, Park EC. The combined effect of sleep duration and quality on mental health among Republic of Korea Armed Forces. Mil Med. 2016 Nov;181(11-12):e1581. DOI: https://doi. org/10.7205/MILMED-D-15-00538
  • 41 Hougsn's S, Bøe HJ, Dahl AA, Reichelt JG. Norwegian male military veterans show low levels of mental health problems four years after deployment in Afghanistan. Nord J Psychiatry. 2017;71(1):26. DOI: https://doi.org/10.1080/08039488.2016.1201529
  • 42 Soreca I, Tighe CA, Bramoweth AD. The intersection of sleep apnea and severe mental illness in veterans. Psychosomatics. 2019 Sep/ Oct;60(5):481-7. DOI: https://doi.org/10.1016/j.psym.2019.01.007
  • 43 Ulmer CS, Van Voorhees E, Germain AE, Voils CI, Beckham JC, VA Mid- Atlantic Mental Illness Research Education and Clinical Center Registry Workgroup. A comparison of sleep difficulties among Iraq/Afghanistan theater veterans with and without mental health diagnoses. J Clin Sleep Med. 2015 Sep;11(9):995-1005. DOI: https://doi.org/10.5664/ jcsm.5012
  • 44 Wang Z, Chen B, Li W, Xie F, Loke AY, Shu Q. Sleep quality and its impacts on quality of life among military personnel in remote frontier areas and extreme cold environments. Health Qual Life Outcomes. 2020 Jul;18(1):227. DOI: https://doi.org/10.1186/s12955-020-01460-7
  • 45 Chou HW, Tzeng WC, Chou YC, Yeh HW, Chang HA, Kao YC, et al. Stress, sleep and depressive symptoms in active duty military personnel. Am J Med Sci. 2016 Aug;352(2):146-53. DOI: https://doi.org/10.1016/j. amjms.2016.05.013
  • 46 Tonon AC, Carissimi A, Schimitt RL, Lima LS, Pereira FS, Hidalgo MP. How do stress, sleep quality, and chronotype associate with clinically significant depressive symptoms? A study of young male military recruits in compulsory service. Braz J Psychiatry. 2020 Jan/Feb;42(1):54-62. DOI: https://doi.org/10.1590/1516-4446-2018-0286
  • 47 Hom MA, Lim IC, Stanley IH, Chiurliza B, Podlogar MC, Michaels MS, et al. Insomnia brings soldiers into mental health treatment, predicts treatment engagement, and outperforms other suicide-related symptoms as a predictor of major depressive episodes. J Psychiatr Res. 2016 Aug;79:108-15. DOI: https://doi.org/10.1016/j.jpsychires.2016.05.008