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Observational Study
. 2016 Feb;56 Suppl 1(Suppl 1):S54-66.
doi: 10.1093/geront/gnv668.

Sleep Disturbance, Diabetes, and Cardiovascular Disease in Postmenopausal Veteran Women

Michelle B Rissling  1 , Kristen E Gray  2 , Christi S Ulmer  3 , Jennifer L Martin  4 , Oleg Zaslavsky  5 , Shelly L Gray  6 , Lauren Hale  7 , Jamie M Zeitzer  8 , Michelle Naughton  9 , Nancy F Woods  10 , Andrea LaCroix  11 , Patrick S Calhoun  12 , Marcia Stefanick  13 , Julie C Weitlauf  14
Affiliations
Observational Study

Sleep Disturbance, Diabetes, and Cardiovascular Disease in Postmenopausal Veteran Women

Michelle B Rissling et al. Gerontologist. 2016 Feb.

Abstract

Purpose of the study: To compare the prevalence and cardiometabolic health impact of sleep disturbance among postmenopausal Veteran and non-Veteran participants in the Women's Health Initiative (WHI).

Design and methods: The prevalence of five categories of sleep disturbance--medication/alcohol use for sleep; risk for insomnia; risk for sleep disordered breathing [SDB]; risk for comorbid insomnia and SDB (insomnia + SDB); and aberrant sleep duration [SLD]--was compared in 3,707 Veterans and 141,354 non-Veterans using logistic or multinomial regression. Cox proportional hazards models were used to evaluate the association of sleep disturbance and incident cardiovascular disease (CVD) and Type 2 diabetes in Veterans and non-Veterans.

Results: Women Veterans were more likely to have high risk for insomnia + SDB relative to non-Veteran participants. However, prevalence of other forms of sleep disturbance was similar across groups. Baseline sleep disturbance was not differentially associated with cardiometabolic health outcomes in Veteran versus non-Veteran women. Risks for SDB and insomnia + SDB were both linked to heightened risk of CVD and diabetes; SLD was consistently linked with greater risk of CVD and diabetes in non-Veterans but less strongly and consistently in Veterans.

Implications: Efforts to identify and treat sleep disturbances in postmenopausal women are needed and may positively contribute to the attenuation of cardiometabolic morbidity risk. Increased awareness of women Veterans' vulnerability to postmenopausal insomnia + SDB may be particularly important for health care providers who treat this population.

Keywords: Postmenopausal Health; Sleep; Veterans; Women.

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Figures

Figure 1.
Figure 1.
Conceptual framework adapted from biopsychosocial model of healthy aging ( Seeman & Crimmins, 2001 ). We propose three pathways from military service to cardiometabolic morbidity via sleep disturbance in postmenopausal women veterans: ( A ) traumatic exposure/hyperarousal and associated sleep-disordered breathing (SDB); ( B ) health risk behaviors; and ( C ) circadian sleep–wake rhythm disruption and associated insomnia complaint or aberrant sleep duration. The dashed line represents the hypothesized association of comorbid insomnia and SDB on cardiometabolic morbidity.
Figure 2.
Figure 2.
Flow diagram for study inclusion and exclusion. A total of 141,354 non-Veterans and 3,707 Veterans had baseline data on sleep disturbance, which reflects the study population described in Table 1 . Additional exclusions were made for each study question.
See this image and copyright information in PMC

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