{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T17:30:12Z","timestamp":1781717412942,"version":"3.54.5"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"9-10","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100021976","name":"Medical Technology Enterprise Consortium","doi-asserted-by":"publisher","award":["W81XWH1990006"],"award-info":[{"award-number":["W81XWH1990006"]}],"id":[{"id":"10.13039\/100021976","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100021976","name":"Medical Technology Enterprise Consortium","doi-asserted-by":"publisher","award":["W81XWH1990006"],"award-info":[{"award-number":["W81XWH1990006"]}],"id":[{"id":"10.13039\/100021976","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Comorbid insomnia and obstructive sleep apnea (COMISA) are prevalent conditions with significant physical and mental health comorbidities. Our study sought to estimate the effect of COMISA vs. obstructive sleep apnea (OSA) alone on subjective and objective sleep, daytime symptoms including cognition, and healthcare resource utilization (HCRU) among military service members (SMs).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>Military SMs (n\u2009=\u2009201) completed research questionnaires and then an intensive 10-day remote monitoring assessment, including wearing a commercial sleep tracker, completing daily sleep diaries, and completing twice-daily symptom surveys via a mobile application. Subjective cognition was measured using 3 self-report items assessing memory, concentration, and executive function. Between-groups (COMISA vs. OSA) differences in subjective and objective sleep, daytime symptoms, and HCRU were examined using a series of one-way ANOVAs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Compared to participants with OSA alone (n\u2009=\u200998; 48.8%), participants with COMISA (n\u2009=\u200981; 40.3%) demonstrated poorer subjective sleep and daytime symptoms as measured by traditional questionnaires (i.e., Epworth Sleepiness Scale and Insomnia Severity Index) and twice-daily symptom surveys, as well as increased HCRU. No between-groups differences were observed in objectively measured sleep.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Among military SMs and relative to OSA alone, COMISA was associated with worsened subjective but not objective sleep, worsened daytime symptoms including cognition, and greater HCRU.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usaf108","type":"journal-article","created":{"date-parts":[[2025,3,17]],"date-time":"2025-03-17T16:20:32Z","timestamp":1742228432000},"page":"e2072-e2078","source":"Crossref","is-referenced-by-count":1,"title":["Sleep, Daytime Symptoms, and Healthcare Resource Utilization in Military Personnel with Comorbid Insomnia and Obstructive Sleep Apnea"],"prefix":"10.1093","volume":"190","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7410-2435","authenticated-orcid":false,"given":"Connie L","family":"Thomas","sequence":"first","affiliation":[{"name":"Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research , Silver Spring, MD 20910,","place":["United States"]},{"name":"Department of Psychiatry, Uniformed Services University , Bethesda, MD 20814,","place":["United States"]},{"name":"Sleep Disorders Center, Walter Reed National Military Medical Center , Bethesda, MD 20889,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"II","given":"Vincent F","family":"Capaldi","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Uniformed Services University , Bethesda, MD 20814,","place":["United States"]},{"name":"Sleep Disorders Center, Walter Reed National Military Medical Center , Bethesda, MD 20889,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8064-6391","authenticated-orcid":false,"given":"Jacob","family":"Collen","sequence":"additional","affiliation":[{"name":"Department of Medicine, Uniformed Services University , Bethesda, MD 20814,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiwei","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Mathematics, University of Maryland , College Park, MD 20742,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott G","family":"Williams","sequence":"additional","affiliation":[{"name":"Sleep Disorders Center, Alexander T. Augusta Military Medical Center , Fort Belvoir, VA 22060,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samson Z","family":"Assefa","sequence":"additional","affiliation":[{"name":"Sleep Disorders Center, Alexander T. Augusta Military Medical Center , Fort Belvoir, VA 22060,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7990-4947","authenticated-orcid":false,"given":"Shuo","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Mathematics, University of Maryland , College Park, MD 20742,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer S","family":"Albrecht","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Public Health, University of Maryland School of Medicine , Baltimore, MD 21201,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emerson M","family":"Wickwire","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Medicine, Sleep Disorders Center, University of Maryland School of Medicine , Baltimore, MD 21201,","place":["United States"]},{"name":"Department of Psychiatry, University of Maryland School of Medicine , Baltimore, MD 21201,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,4,1]]},"reference":[{"issue":"2","key":"2025092416181523100_R1","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1016\/j.jsmc.2022.03.003","article-title":"Epidemiology of insomnia: prevalence, course, risk factors, and public health burden","volume":"17","author":"Morin","year":"2022","journal-title":"Sleep Med Clin"},{"key":"2025092416181523100_R2","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1093\/aje\/kws342","article-title":"Increased prevalence of sleep-disordered breathing in adults","volume":"177","author":"Peppard","year":"2013","journal-title":"Am J Epidemiol"},{"issue":"6","key":"2025092416181523100_R3","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1378\/chest.09-1485","article-title":"Insomnia and sleep-related breathing disorders","volume":"137","author":"Wickwire","year":"2010","journal-title":"Chest"},{"issue":"4102","key":"2025092416181523100_R4","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1126\/science.181.4102.856","article-title":"Insomnia with sleep apnea: a new syndrome","volume":"181","author":"Guilleminault","year":"1973","journal-title":"Science"},{"key":"2025092416181523100_R5","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.smrv.2016.04.004","article-title":"Developing a successful treatment for co-morbid insomnia and sleep apnoea","volume":"33","author":"Sweetman","year":"2017","journal-title":"Sleep Med Rev"},{"issue":"4","key":"2025092416181523100_R6","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1177\/1534650107309187","article-title":"Combined insomnia and poor CPAP compliance: a case study and discussion","volume":"7","author":"Wickwire","year":"2008","journal-title":"Clin Case Stud"},{"issue":"8","key":"2025092416181523100_R7","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1016\/j.sleep.2010.03.012","article-title":"Sleep maintenance insomnia complaints predict poor CPAP adherence: a clinical case series","volume":"11","author":"Wickwire","year":"2010","journal-title":"Sleep Med"},{"issue":"10","key":"2025092416181523100_R8","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1002\/jclp.21958","article-title":"The more the merrier? Working towards multidisciplinary management of obstructive sleep apnea and comorbid insomnia","volume":"69","author":"Ong","year":"2013","journal-title":"J Clin Psychol"},{"issue":"5","key":"2025092416181523100_R9","doi-asserted-by":"crossref","first-page":"2020","DOI":"10.1016\/j.chest.2020.12.002","article-title":"Sleep apnea and insomnia: emerging evidence for effective clinical management","volume":"159","author":"Ong","year":"2021","journal-title":"Chest"},{"issue":"12","key":"2025092416181523100_R10","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci9120371","article-title":"Co-morbid insomnia and sleep apnea (COMISA): prevalence, consequences, methodological considerations, and recent randomized controlled trials","volume":"9","author":"Sweetman","year":"2019","journal-title":"Brain Sci"},{"key":"2025092416181523100_R11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.sleepe.2022.100043","article-title":"Association of co-morbid insomnia and sleep apnoea symptoms with all-cause mortality: analysis of the NHANES 2005-2008 data","volume":"2","author":"Sweetman","year":"2022","journal-title":"Sleep Epidemiol"},{"issue":"3","key":"2025092416181523100_R12","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1016\/j.sleh.2024.03.001","article-title":"Association of comorbid obstructive sleep apnea and insomnia with risk of major adverse cardiovascular events in sleep medicine center patients","volume":"10","author":"Luyster","year":"2024","journal-title":"Sleep Health"},{"issue":"7","key":"2025092416181523100_R13","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsab024","article-title":"Incidence of insomnia and obstructive sleep apnea in active duty United States military service members","volume":"44","author":"Moore","year":"2021","journal-title":"Sleep"},{"issue":"2","key":"2025092416181523100_R14","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1378\/chest.13-0088","article-title":"Sleep disorders in US military personnel: a high rate of comorbid insomnia and obstructive sleep apnea","volume":"144","author":"Mysliwiec","year":"2013","journal-title":"Chest"},{"issue":"12","key":"2025092416181523100_R15","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsac203","article-title":"A comprehensive evaluation of insomnia, obstructive sleep apnea and comorbid insomnia and obstructive sleep apnea in US military personnel","volume":"45","author":"Mysliwiec","year":"2022","journal-title":"Sleep"},{"issue":"1","key":"2025092416181523100_R16","doi-asserted-by":"publisher","first-page":"17","DOI":"10.5664\/jcsm.10774","article-title":"Sex differences in US military personnel with insomnia, obstructive sleep apnea, or comorbid insomnia and obstructive sleep apnea","volume":"20","author":"Mysliwiec","year":"2024","journal-title":"J Clin Sleep Med"},{"key":"2025092416181523100_R17","volume-title":"Insomnia: Psychological Assessment and Management","author":"Morin","year":"1993"},{"issue":"7","key":"2025092416181523100_R18","doi-asserted-by":"publisher","first-page":"485","DOI":"10.7326\/0003-4819-131-7-199910050-00002","article-title":"Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome","volume":"131","author":"Netzer","year":"1999","journal-title":"Ann Intern Med"},{"key":"2025092416181523100_R19","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1016\/j.smrv.2017.04.001","article-title":"Validity of the Berlin questionnaire in detecting obstructive sleep apnea: A systematic review and meta-analysis","volume":"36","author":"Senaratna","year":"2017","journal-title":"Sleep Med Rev"},{"key":"2025092416181523100_R20","doi-asserted-by":"crossref","first-page":"59","DOI":"10.2147\/NSS.S391802","article-title":"Validation of Fitbit Inspire 2","volume":"15","author":"Lim","year":"2023","journal-title":"Nat Sci Sleep"},{"issue":"9","key":"2025092416181523100_R21","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: validity of a brief depression severity measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J Gen Intern Med"},{"key":"2025092416181523100_R22","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder the GAD-7","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch Intern Med"},{"issue":"6","key":"2025092416181523100_R23","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1093\/sleep\/14.6.540","article-title":"A new method for measuring daytime sleepiness: the Epworth sleepiness scale","volume":"14","author":"Johns","year":"1991","journal-title":"Sleep"},{"issue":"8","key":"2025092416181523100_R24","doi-asserted-by":"publisher","first-page":"1505","DOI":"10.1093\/pm\/pnw105","article-title":"Psychometric testing of the Defense and Veterans Pain Rating Scale (DVPRS): a new pain scale for military population","volume":"17","author":"Polomano","year":"2016","journal-title":"Pain Med"},{"key":"2025092416181523100_R25","doi-asserted-by":"crossref","DOI":"10.1038\/s44323-024-00008-y","article-title":"Prior-night sleep predicts next-day symptoms over ten days among military personnel with sleep problems","volume":"1","author":"Wickwire","year":"2024","journal-title":"npj Biol Timing Sleep"},{"issue":"2","key":"2025092416181523100_R26","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/S0895-4356(00)00261-4","article-title":"Self-reports of health care utilization compared to provider records","volume":"54","author":"Ritter","year":"2001","journal-title":"J Clin Epidemiol"},{"issue":"5","key":"2025092416181523100_R27","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1111\/jsr.12046","article-title":"The subjective-objective mismatch in sleep perception among those with insomnia and sleep apnea","volume":"22","author":"Bianchi","year":"2013","journal-title":"J Sleep Res"},{"issue":"11","key":"2025092416181523100_R28","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.5664\/jcsm.6280","article-title":"Sleep misperception in chronic insomnia patients with obstructive sleep apnea syndrome: implications for clinical assessment","volume":"12","author":"Choi","year":"2016","journal-title":"J Clin Sleep Med"},{"issue":"11","key":"2025092416181523100_R29","doi-asserted-by":"crossref","first-page":"2155","DOI":"10.5664\/jcsm.9348","article-title":"Profile of subjective-objective sleep discrepancy in patients with insomnia and sleep apnea","volume":"17","author":"Ma","year":"2021","journal-title":"J Clin Sleep Med"},{"issue":"1","key":"2025092416181523100_R30","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1093\/sleep\/23.1.1d","article-title":"Sleep latency and duration estimates among sleep disorder patients: variability as a function of sleep disorder diagnosis, sleep history, and psychological characteristics","volume":"23","author":"Vanable","year":"2000","journal-title":"Sleep"},{"issue":"2","key":"2025092416181523100_R31","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1037\/\/0882-7974.9.2.231","article-title":"Neuropsychological functioning in older insomniacs with or without obstructive sleep apnea","volume":"9","author":"Stone","year":"1994","journal-title":"Psychol Aging"},{"issue":"16","key":"2025092416181523100_R32","doi-asserted-by":"publisher","first-page":"1732","DOI":"10.1001\/archinte.166.16.1732","article-title":"Consequences of comorbid insomnia symptoms and sleep-related breathing disorder in elderly subjects","volume":"166","author":"Gooneratne","year":"2006","journal-title":"Arch Intern Med"},{"issue":"8","key":"2025092416181523100_R33","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsad128","article-title":"Neurocognitive functioning in comorbid insomnia and sleep apnea patients is better after positive airway pressure therapy, but worse after cognitive behavioral therapy for insomnia: exploratory analysis of cognitive outcomes from the Multidisciplinary Approach to the Treatment of Insomnia and Comorbid Sleep Apnea study","volume":"46","author":"Turner","year":"2023","journal-title":"Sleep"},{"issue":"4","key":"2025092416181523100_R34","doi-asserted-by":"publisher","DOI":"10.1111\/jsr.14099","article-title":"Healthcare resource utilisation and costs in patients with treated obstructive sleep apnea","volume":"33","author":"Sterling","year":"2024","journal-title":"J Sleep Res"},{"key":"2025092416181523100_R35","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1016\/j.smrv.2015.11.004","article-title":"Health economics of insomnia treatments: the return on investment for a good night\u2019s sleep","volume":"30","author":"Wickwire","year":"2016","journal-title":"Sleep Med Rev"},{"key":"2025092416181523100_R36","article-title":"Advance Policy Questions for Thomas Mccaffery Nominee for Assistant Secretary of Defense for Health Affairs","author":"U.S. Senate Committee on Armed Services","year":"2018"},{"issue":"8","key":"2025092416181523100_R37","doi-asserted-by":"publisher","DOI":"10.1007\/s11920-014-0459-7","article-title":"The impact of sleep on soldier performance","volume":"16","author":"Williams","year":"2014","journal-title":"Curr Psychiatry Rep"},{"key":"2025092416181523100_R38","article-title":"Comprehensive approach needed to address service member fatigue and manage related efforts","author":"United States Government Accountability Office","year":"2024"},{"issue":"3","key":"2025092416181523100_R39","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1016\/j.sleep.2006.10.006","article-title":"Daytime symptoms in primary insomnia: a prospective analysis using ecological momentary assessment","volume":"8","author":"Buysse","year":"2007","journal-title":"Sleep Med"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/190\/9-10\/e2072\/62844462\/usaf108.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/190\/9-10\/e2072\/62844462\/usaf108.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T20:18:26Z","timestamp":1758745106000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/190\/9-10\/e2072\/8104101"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,1]]},"references-count":39,"journal-issue":{"issue":"9-10","published-online":{"date-parts":[[2025,4,1]]},"published-print":{"date-parts":[[2025,9,1]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usaf108","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,9]]},"published":{"date-parts":[[2025,4,1]]}}}