Project Summary

Title: Identification and Management of Sleep Disorders in Gulf War Veterans (13)
Synopsis: This program established a research center to evaluate, recognize and treat sleep disorders of Gulf War veterans.
Overall Project Objective: The most common complaints of Gulf War (GW) veterans are of fatigue and sleep disturbances. Approximately one quarter of veterans who participated in VA's Gulf War Health Examination Registry have complaints consistent with undetected sleep disorders. Preliminary studies suggest a high prevalence of sleep disorders in the GW veteran population. However, sleep disorders have not been recognized as a significant cause of Gulf War complaints, and no studies have been conducted to establish effective treatment programs. Given the high rate of sleep disorders in the general population and the high potential of the combat environment to induce sleep disorders, appropriate recognition and treatment of sleep disorders could have a profound impact on delivery of care to Gulf War veterans. To test this hypothesis, this study established a Gulf War Veterans Sleep Evaluation and Education Program (Gulf War SLEEP). Gulf War SLEEP utilized case managers to direct a multidisciplinary program designed to improve diagnosis of sleep disorders in Gulf War veterans, to provide optimal treatment regimens, and to improve patient satisfaction and retention. Successful treatment might reduce chronic symptoms, improve quality of life and improve patient satisfaction with VA care.
Status/Results to Date: Gulf War subjects diagnosed and treated for sleep disorders had a statistically significant improvement in quality of life scores compared to the nonintervention group. Of 2,020 GW veterans returning the initial sleep health questionnaire, 936 were from VISN 1, and 1,084 were from the comparison VISN. Despite small differences between the two groups, overall responses were similar. GW veterans continue to have high rates of symptoms suggestive of sleep disorders. Among the two groups, 66%, met eligibility criteria to qualify for a sleep disorder evaluation. Overall, 134 veterans participated in GW SLEEP during the 18-month study and 97% of those who completed the evaluation were diagnosed with an existing sleep disorder. We identified which veterans were current users of DVA services through the Outpatient Clinic Files (OPC). Fifty-one of those participating in the study were not current VA users. We demonstrated that a Sleep Evaluation Program similar to GW SLEEP could attract veterans not currently using VA facilities. In fact, of those participating in GW SLEEP, 51 percent were previous nonusers of DVA services (no visits in 3 years).
Agency:Department Of Veterans' Affairs
Location:VAMC Brockton
West Roxbury
P.I. Name:Lawrence J Epstein, M.D.
Research Type:Clinical
Research Focus:Treatment
Focus Category:Treatment
Study Start Date:July 01,1998
Estimated Completion Date:September 30,2000
Specific Aims: 1) To establish a multidisciplinary specialized treatment unit in order to evaluate the symptoms of 300 GW veterans and determine whether they have undiagnosed sleep disorders. 2) Treat those GW veterans with sleep disorders and assess the outcome of therapy. (3) Measure the satisfaction with care of GW veterans who participate in the treatment program and compare their level of satisfaction with that found in a control group.
Methodology: Patient Recruitment: GW veterans in the New England VISN were sent selected questions from the National Health Survey of Persian Gulf War Era Veterans questionnaire and existing validated sleep questionnaires. The services of Sleep Disorders Evaluation Center (SDEC) were offered to GW veterans with sleep related complaints on the initial questionnaire. Addresses of eligible GW veterans were obtained from existing GW databases. Local addresses were obtained from the GW Registries of the two participating sites, Brockton/West Roxbury VAMC and Boston VAMC. There are approximately 200 veterans registered at Brockton / West Roxbury VAMC and 300 at the Boston VAMC. Addresses for other veterans in the New England VISN were obtained from the VA Persian Gulf Registry, which lists about 2400 veterans in the New England region. Control Group: A demographically similar group of GW veterans not residing in VISN 1 and receiving care at facilities with similar characteristics to the Brockton/West Roxbury and Boston VAMCs were mailed the initial questionnaire and served as the control group. Addressees were obtained from the VA Persian Gulf Registry. As with the treatment group, the questionnaires were assessed and those with sleep-related complaints identified. Instead of being evaluated in the SDEC, these veterans were sent a letter stating that their symptoms may be due to and underlying sleep disorder and they should seek care at their local VAMC. A follow-up questionnaire was sent one year to later assess change in symptoms and customer satisfaction with standard care for GW related complaints.
Most Recent Publications:
None to date.