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A2421 - Obstructive Sleep Apnea and Pain Intensity Among Veterans of Recent Wars
Author Block: M. Card1, A. Charokopos2, C. Steffens3, K. M. Akgun4, C. Gunderson1, J. Goulet5, E. Derycke6, C. Brandt1, L. Bastian5; 1Medicine, Yale/VA Connecticut, West Haven, CT, United States, 2Medicine, Mount Sinai, New York, NY, United States, 3VA Connecticut, West Haven, CT, United States, 4Yale/VA Connecticut, Madison, CT, United States, 5Yale/VA Connecticut, West Haven, CT, United States, 6Medicine, VA Connecticut, West Haven, CT, United States.
RATIONALE: Both obstructive sleep apnea (OSA) and pain are highly prevalent among Veterans. The specific link between OSA and pain is unknown but it has been hypothesized that OSA patients are hyperalgesic because of sleep fragmentation and/or hypoxia that enhances sensitivity to pain, promotes inflammation, and advances spontaneous pain. OSA is associated with the development and progression of many painful conditions such as headaches, temporomandibular disorders, and fibromyalgia. Most studies examining the association of OSA and pain have included older patients and there is a need to understand the relationship between OSA and pain among younger Veterans. This study examines whether Veterans of Operations Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND) who are diagnosed with OSA are more likely to report higher pain intensity compared to Veterans without OSA. METHODS: Cross-sectional analysis of a cohort study of OEF/OIF/OND Veterans who had at least one visit to a Veterans Health Administration primary care clinic between 2001 and 2014. OSA and other diagnoses were identified using ICD-9 codes from electronic medical records. Current pain intensity, based on the 0-10 numeric rating scale, was categorized as no pain/mild (0-3) and moderate/severe (4-10) and pain assessments occurred after sleep apnea diagnoses. Covariates included age, sex, race, mental health diagnoses (substance use, PTSD, depression, and anxiety), BMI, and smoking status. RESULTS: We identified 858,226 Veterans: mean age was 30 years; 94,296 (10.6%) had a diagnosis of OSA and 32% reported moderate/severe pain intensity. Compared to Veterans without an OSA diagnosis, Veterans who had a diagnosis of OSA were more likely to report moderate/severe pain intensity (OR=1.28; 95% Confidence Intervals 1.27-1.30), even after controlling for covariates including: age, gender, race, substance use disorder, major depression, Post-traumatic stress disorder, smoking status, and BMI. CONCLUSIONS: We found a clinically important association between OSA diagnosis and pain intensity. Veterans with OSA have greater odds of having moderate/severe pain. Due to the high burden of pain conditions in younger Veterans, the study highlights the need to understand the impact of OSA diagnosis and treatment on pain intensity and then develop interventions to promote screening and treatment for OSA among Veterans with pain.