Limitations
Limitations in this study include possible reporting errors due to improper or insufficient medical coding as well as data entry errors at the clinic that may exist within medical billing databases. Therefore, the results of this analysis may be over- or underrepresented. The increase in incidence and prevalence may not necessarily reflect an increasing number of people who have the disease. The increase could be a result of better SDB detection practices or incentives to be diagnosed with SDB (VA disability claims upon retirement). The assumption is made that procedures corresponding with SDB diagnoses are directly related to SDB, and any costs incurred from those procedures are due to SDB.
It is important to note variability between services and institutions within the DoD in the diagnosis and treatment of SDB. Specifically, some institutions use ambulatory polysomnograms, or studies done at home, and autotitration of continuous positive airway pressure, whereas others require more costly hospital-based studies and laboratory titration. Another confounder in the cost data is the number of diagnoses and treatment deferred to the network as a result of the relatively small number of sleep-trained physicians within the military.
Conclusion
As the field of sleep medicine continues to develop its literature, it is becoming clearer that the detrimental sequelae of SDB are varied and pose significant short- and long-term risks. Active-duty service members represent a subset of the population with consequences that are potentially graver than those of civilians, especially when they are expected to operate complicated machinery or to make rapid and critical decisions in battle.
The prevalence and incidence of SDB increased each year during a 5-year review and currently affects 1 in 20 service members. Furthermore, the cost of civilian care for this disease process was nearly $100 million in FY 2012 to FY 2013, suggesting a growing financial burden for taxpayers. Further research is warranted to fully appreciate the impact of SDB on both service members and the U.S. military.
Acknowledgments
The authors thank the U.S. Navy and specifically the support within the Department of Otolaryngology at the Naval Medical Center Portsmouth for the time and effort allotted for completion of this study. This research was supported in part by an appointment to the Postgraduate Research Participation Program at the Navy and Marine Corps Public Health Center (NMCPHC) administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the U.S. Department of Energy and NMCPHC.