The trial from which these data were obtained was specifically designed to identify and recruit veterans at risk for CVD. Because the relationship between OSA and hypertension is a bidirectional and causal one, it is not surprising that we found high rates of sleep apnea in a sample of individuals wherein most were diagnosed with hypertension. What is surprising and arguably alarming is that, despite being engaged in routine clinical care (a study requirement) and diagnosed with conditions placing them at increased risk of CVD, under-treated sleep disorders were commonplace among veterans in this study. More than half of the sample screened positive for sleep apnea without prior diagnosis, more than 40% of those with sleep apnea reported under-treatment, and almost 40% endorsed current insomnia symptoms at levels consistent with an insomnia disorder diagnosis. Moreover, a notable discrepancy was found when comparing the prevalence of these sleep disorders in our sample identified through screening (82%) vs the medical record (23.3%). Of course not all participants screening positive for sleep apnea would ultimately be diagnosed with the condition after diagnostic testing. However, the positive predictive value of 50% for the Berlin Questionnaire suggests that an additional 109 participants (26% of the sample) screening positive for sleep apnea would likely meet criteria for sleep apnea based on a diagnostic sleep study, for a total of 46% of the sample ultimately diagnosed with sleep apnea. This value is more than double what was found by medical record review.
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