The Hidden Burden of COMISA in Hypertensive Obstructive Sleep Apnea Patients

Comorbid insomnia and sleep apnea (COMISA) is a frequent but underrec-ognized condition in patients with obstructive sleep apnea (OSA). While OSA is strongly linked to hypertension, the independent contribution of COMISA to resistant hyper-tension (RH) remains unclear. This study aimed to investigate the association between COMISA and RH in hypertensive OSA patients and to identify independent predictors of RH.

This retrospective cross-sectional study included 131 patients diagnosed with both OSA and hypertension who underwent full-night polysomnography (PSG) at a ter- tiary sleep center. The Insomnia Severity Index (ISI) was used to define COMISA (ISI ≥15). Resistant hypertension (RH) was defined as uncontrolled blood pressure despite the use of at least 3 antihypertensive agents of different classes, including a diuretic. Demographic, clinical, and polysomnographic data were analyzed using multiple logistic regression to determine independent predictors of RH.

Of 131 hypertensive OSA patients, 39 (29.8%) met criteria for COMISA. The preva-lence of RH was 43.5%. COMISA was significantly more frequent in the RH group (66.7% vs. 33.3%, P = .006). In the multiple logistic regression analysis, COMISA (OR = 5.26, P < .001, 95% CI: 2.04-13.57) and male sex (OR = 3.24, P = .010, 95% CI: 1.36-7.72) were identi-fied as independent predictors of RH, while age, apnea-hypopnea index (AHI), and body mass index (BMI) were not significantly associated.

Comorbid insomnia and sleep apnea (COMISA) markedly increases the risk of RH in hypertensive OSA patients, independent of apnea severity and obesity. These find-ings highlight COMISA as a distinct cardiovascular phenotype within the OSA spectrum. Routine screening and targeted treatment of insomnia in OSA may represent a critical approach to improving blood pressure control and cardiovascular outcomes.