0993 Sleep Disorders as a Mediator of the Association Between PTSD/MDD and Cardiovascular Disease in Veterans Referred for CBT-I

Abstract Introduction Sleep disturbances are hallmark symptoms of psychiatric conditions, but also independent risk factors for adverse cardiovascular outcomes. Utilizing a clinically complex cohort of Veterans enriched with sleep disturbances, we sought to examine the association between psychiatric diagnoses (specifically major depressive disorder (MDD) and/or post-traumatic stress disorder (PTSD) and cardiometabolic disease and test the hypothesis that the presence of a comorbid sleep diagnosis (e.g., insomnia, obstructive sleep apnea (OSA) mediates this relationship. Methods Data were obtained from the Veterans Affairs (VA) Corporate Data Warehouse for all Veterans who had initiated at least one session of cognitive-behavioral therapy for insomnia as documented in their medical record, between 10/01/2015 and 06/15/2023. Medical and psychiatric comorbidities were assessed using diagnostic codes from ICD-9 and ICD-10. Results We used data from 83,494 veterans with complete diagnostic information. The mean age was 50.89±15.26 years, with a range of 18–89 years. The cohort was predominantly male (82.7%). The most prevalent conditions were OSA (55.1%) and heart disease (41.2%). PTSD and MDD were each associated with increased odds of cardiometabolic disease. Approximately 24% (95% CI 20–28%) of PTSD’s effect on cardiometabolic disease was mediated by sleep disorders. Similarly, MDD (ACME = 0.018, ADE = 0.058, total effect = 0.076) showed 24% (95% CI 19–28%) of the association mediated. Stratified analyses showed that mediation effects were stronger in Veterans under age 50. Network analysis confirmed clustering of cardiometabolic conditions (hypertension, diabetes, obesity, OSA, heart disease) and trauma–mood–sleep disorders (PTSD, depression, anxiety, insomnia), with OSA and obesity acting as bridges between psychiatric and medical domains. Conclusion This study demonstrates that sleep disorders partially mediate the relationship between PTSD, depression, and cardiometabolic disease in a large Veteran cohort. Both psychiatric conditions were associated with cardiometabolic outcomes, and approximately one-quarter of this effect was through sleep disorders. The findings suggest that sleep represents a meaningful pathway linking psychiatric illness to cardiometabolic risk, particularly in younger adults. Support (if any) VISN 4 MIRECC Pilot Funds