Comorbid insomnia and obstructive sleep apnea increase risks of cardiovascular and cerebrovascular diseases

Comorbid insomnia and obstructive sleep apnea (COMISA) are increasingly recognized as a distinct sleep disorder with cardiocerebrovascular implications. This study compared long-term risks of cardiovascular and cerebrovascular diseases (CCVDs) between patients with COMISA and those with obstructive sleep apnea (OSA) alone.

Using the TriNetX U.S. Collaborative Network, we identified adults diagnosed with OSA from 2010 to 2023. COMISA was defined as OSA plus an insomnia diagnosis within 90 days of the index date; patients without insomnia codes were classified as OSA-only. After exclusions, cohorts were constructed and 1:1 propensity score-matched on demographic, socioeconomic, comorbidity, and laboratory covariates. 10-year risks and hazard ratios (HRs) for incident CCVDs were estimated overall and in subgroups defined by sex, continuous positive airway pressure (CPAP) use, and benzodiazepine/Z-drug use.

The matched cohort included 165 522 patients with COMISA and 165 522 with OSA alone. COMISA was associated with higher 10-year risks of cerebrovascular disease (HR 1.17, 95% CI 1.14-1.20), arrhythmias, inflammatory and ischemic heart disease, and thrombotic disorders. Atrial fibrillation/flutter and heart failure were slightly less frequent in COMISA, and the association with time-to-first major adverse cardiovascular event was modest (HR 1.03, 95% CI 1.01-1.05). These patterns were generally consistent across subgroups.

COMISA was associated with higher long-term risks of several CCVD subtypes, particularly cerebrovascular and thrombotic events, further characterizing COMISA as a high-risk clinical phenotype.