Concordance Between Self-Report and Electronic Medical Record Diagnoses of Insomnia and Sleep Apnea

Lessons From the Airborne Hazards and Open Burn Pit Registry

Bibliographic Data

ID9102483
AuthorsMelissa B Jones (0000-0002-3774-3356, Michael E. DeBakey VA Medical Center, Houston, TX, corresponding author), Saba Sharafkhaneh (William Carey University of Osteopathic Medicine, Hattiesburg, MS), D R Glick (0000-0003-3808-7570, University of Maryland, Baltimore), Amin Ramezani (0000-0001-7901-7945, Michael E. DeBakey VA Medical Center, Houston, TX, corresponding author), Max Hirshkowitz (Baylor College of Medicine), Amir Sharafkhaneh (0000-0002-7893-2946, Michael E. DeBakey VA Medical Center, Houston, TX, corresponding author), Drew A Helmer (0000-0003-0385-432X, Michael E. DeBakey VA Medical Center, Houston, TX, corresponding author), Javad Razjouyan (0000-0003-1157-159X, Michael E. DeBakey VA Medical Center, Houston, TX, corresponding author)
Year2026
Volume64
Issue2S
PagesS155-S160
Publication date2026-01-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000002240
PMID41385261
OpenAlexW4417304871
LanguageEN
Citations received1
References cited24

BACKGROUND: Veteran participants in the Airborne Hazards and Open Burn Pit Registry (AHOBPR) report respiratory and sleep-related symptoms, including sleep-disordered breathing and difficulty sleeping. The AHOBPR Questionnaire elicits sleep-related disturbances and other health outcomes potentially associated with burn pit exposures. Responses to this questionnaire may influence resource allocation and future longitudinal studies of toxic sequelae. The level of agreement between sleep apnea and insomnia responses to the AHOPBPR questionnaire and clinical diagnoses of sleep apnea and insomnia in the electronic medical record (EMR) is unclear. OBJECTIVE: In this study, we compare concordance between reports of symptoms associated with sleep apnea and insomnia to corresponding clinical diagnoses documented in EMRs among Veterans in the AHOBPR. METHODS: We included 469,179 Veterans with AHOBPR survey responses and available EMR data in the Veteran Health Administration. Concordances between reports of sleep-related symptoms on the AHOBPR questionnaire and relevant EMR diagnoses were analyzed for 469,179 Veterans. Concordance was assessed with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa coefficients. We further considered sex differences in concordance measures. RESULTS: Reports of symptoms associated with sleep apnea were common (52% overall, 54.5% in men, 28.5% in women) as were EMR diagnoses (31.6% overall, 32.8% in men, 19.8% in women). The overall concordance between self-reported and EMR diagnoses for sleep apnea was fair (kappa=0.38). Reports of symptoms associated with insomnia were highly prevalent (81% overall, 80.8% in men, 82.6% in women) but poorly aligned with EMR diagnoses (17.8% overall, kappa=0.08). Agreement between reports of symptoms associated with sleep apnea and EMR-diagnosed sleep apnea was higher for females (kappa=0.46) than for males (kappa=0.37). CONCLUSION: This study highlights significant discrepancies between self-reported symptoms and EMR diagnoses of sleep apnea and insomnia among Veterans who completed the AHOBPR survey. While fair agreement for sleep apnea suggests some alignment with clinical diagnosis, poor concordance for insomnia highlights the limitations of self-reported case identification methods

Apnea · Concordance · Electronic medical record · Insomnia · Medical diagnosis · Medical record · Obstructive sleep apnea · Sleep (system call) · Sleep apnea · Chronic Obstructive Pulmonary Disease (COPD) Research · Obstructive Sleep Apnea Research · Sleep and related disorders