An urgent operational need: Addressing the hidden health crisis of sleep apnea in military and civilian populations

By Alison S. Kole, MD, MPH; Sally Ibrahim, MD; and Kunwar P. Vohra, MD, MBA

A recent study published in CHEST has uncovered the staggering impact of obstructive sleep apnea (OSA) among active-duty military personnel, revealing health consequences that demand more immediate attention — and highlighting a critical access-to-care crisis that affects both military service members and civilians nationwide.

The Scale of the Problem

The largest study of its kind examined more than 118,000 active-duty service members from 2016 to 2021, comparing 59,203 newly diagnosed OSA patients with matched controls without sleep disorders. The findings reveal a hidden health crisis with alarming consequences.

Military personnel with OSA experienced dramatically elevated risks for:

• Posttraumatic stress disorder (PTSD): 4.4× increased risk
• Traumatic brain injury: 3.3× increased risk
• Anxiety disorders: 3.4× increased risk
• Depression: 2.95× increased risk
• Musculoskeletal injuries: 1.66× increased risk

The health care utilization burden is equally staggering: OSA was associated with an additional 170,511 outpatient visits, 66 inpatient stays, and 1,852 emergency department encounters annually.

A Unique Military Phenotype

As noted in the accompanying editorial, OSA in military personnel presents a distinct clinical picture that differs markedly from civilian populations. Military service members with OSA are typically younger, leaner, and more physically active than their civilian counterparts, creating a paradox: Despite being a generally healthier population, military personnel face heightened risks from sleep disorders due to their high-performance, operationally critical work environment.

Even mild OSA may carry greater significance for military personnel than civilian guidelines would suggest. Daytime sleepiness impairs vigilance, reaction time, and situational awareness, thereby increasing the likelihood of workplace accidents and battlefield injuries. This is compounded by the substantial background burden of inadequate sleep already endemic in military culture, with at least 42% of active-duty service members sleeping five hours or less per night.

Novel Findings with Clinical Implications

The study reveals several associations that warrant immediate attention across both military and civilian health care settings. The connection between newly diagnosed OSA and subsequent traumatic brain injury represents a previously unreported finding with significant implications. While the mechanism may involve OSA-induced daytime sleepiness increasing accident risks, further investigation is needed.

Similarly, the fourfold increased risk of developing PTSD within 12 months of OSA diagnosis suggests potential pathophysiologic relationships that could inform treatment approaches. Military personnel often present with a low arousal threshold phenotype characterized by less severe oxygen desaturation but greater sleep fragmentation, which may require personalized treatment strategies beyond traditional positive airway pressure therapy.

The Health Care Economics Imperative

From a health economics perspective, the findings carry enormous implications for health care budgeting and resource allocation across both military and civilian systems. The additional health care encounters attributable to OSA represent substantial costs that could potentially be mitigated through improved screening, diagnosis, and treatment programs.

The research specifically calls for expanded clinical programs, including OSA telehealth initiatives, to address the access-to-care crisis. This recommendation aligns with broader health care policy needs, as permanent telehealth coverage could ensure continued access to OSA diagnosis and management for patients nationwide.

From Military Crisis to National Health Care Challenge

While the military findings are striking, they illuminate a far broader health care access crisis affecting the entire nation. The Military Health System’s well-documented shortage of trained sleep specialists mirrors a nationwide gap in OSA care capacity. According to the American Academy of Sleep Medicine, only 7,500 board-certified sleep specialists serve an estimated 325 million Americans — a massive demand-supply imbalance that has been increasingly addressed through telemedicine.

The critical role of telehealth in bridging this gap is evident in both military and civilian health care. A recent review of nearly 3 million telehealth visits for more than 1 million active component members of the U.S. Armed Forces from 2020 to 2024 reported OSA as the fourth leading cause for telehealth encounters. The American Academy of Sleep Medicine has stated unequivocally that “telehealth is an essential tool for the provision of high-quality, patient-centered care for patients with sleep disorders.”

The Policy Crisis: A Capability Gap with Serious Consequences

Despite telehealth’s proven value, access to this essential care delivery model continues to be under threat. Medicare telehealth coverage expansions that began in March 2020 to provide uninterrupted access to quality health care recently endured disruptive lapses during late 2025 and early 2026 government shutdowns. Although the Consolidated Appropriations Act of 2026 temporarily restored these critical flexibilities through Dec. 31, 2027, the continued absence of permanent telehealth legislation leaves the long-term future of remote care uncertain.

This represents what military terminology defines as an “urgent operational need” — a capability gap that, if unfulfilled, could result in serious psychological and physical health consequences. The high prevalence, health care resource burden, and associated risk of death from OSA complications globally highlight this critical gap in access to care.

Since Medicare coverage decisions often serve as a bellwether for the broader U.S. commercial health care market, Congressional inaction on permanent telehealth legislation threatens to cascade across the entire health care system.

A Call to Action for Stakeholders

This research represents more than an academic exercise; it’s a clarion call for immediate action on multiple fronts. Health care professionals, policymakers, patient advocates, and industry stakeholders must work together to:

• Support permanent telehealth legislation to ensure continued access to sleep medicine care.
• Expand screening and diagnostic programs for OSA in both military and civilian populations.
• Develop and implement evidence-based treatment protocols tailored to diverse sleep apnea phenotypes.
• Invest in research to determine whether timely diagnosis and effective treatment can improve outcomes and reduce health care costs.
• Address the workforce shortage in sleep medicine through training initiatives and innovative care delivery models.

The convergence of military health data, clinical commentary, and health care policy challenges creates a compelling case for prioritizing sleep health across all health care systems. The hidden burden of sleep apnea among military personnel illuminates a capability gap that affects the entire nation — an urgent operational need that demands immediate and sustained attention.

Ensuring access to comprehensive OSA care through permanent telehealth coverage will benefit the health of patients — both military and civilian — across the nation. The time for action is now.

For links to references, visit the online version of this article.

Dr. Alison Kole is the vice chair of the AASM Advocacy Committee and the creator and host of the Sleep Is My Waking Passion™ podcast, a physician-led series advancing evidence-based dialogue on sleep medicine, patient care, and health policy.

Dr. Sally Ibrahim is an adult and pediatric sleep medicine physician and system director of pediatric sleep medicine at University Hospitals. She is an associate professor at Case Western Reserve University and chairs the AASM Advocacy Committee.

Dr. Kunwar Praveen Vohra is medical director of the Ascension St. Vincent Sleep Center at the Heart Center in Indiana. He has been closely involved in advocacy for permanent standard time and sleep telehealth. He currently serves on the AASM Advocacy Committee.

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This article appeared in volume 11, issue 2 of Montage magazine.