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Association of obstructive airway disease with COMISA: findings from the Turkish sleep apnea database (TURKAPNE)
Aylin Pihtili1, Esen Kiyan1, Mehmet Sezai Tasbakan2
1Department of Pulmonary Medicine, Istanbul University School of Medicine, Istanbul, Türkiye.
Background:
Comorbid insomnia and sleep apnea (COMISA) is a highly burdensome phenotype with additive effects on symptoms, quality of life, and health outcomes. Although obstructive airway diseases (OAD)-including asthma and chronic obstructive pulmonary disease-commonly coexist with sleep complaints, the association between OAD and COMISA in large sleep-clinic cohorts remains unclear. We investigated whether OAD is independently associated with COMISA in a nationwide cohort undergoing full-night polysomnography (PSG).
Methods:
We analyzed 12,715 adults in the Turkish Sleep Apnea Database (TURKAPNE), a prospective, multicenter registry. Demographics, comorbidities, insomnia symptoms, and PSG parameters were compared between individuals with and without OAD, defined as self-reported, physician-diagnosed asthma or COPD. COMISA was defined as the coexistence of obstructive sleep apnea (apnea-hypopnea index ≥ 5 events/h) and insomnia symptoms occurring "often" or "very often." Multivariable logistic regression was used to determine the independent association between OAD and COMISA.
Results:
OAD was present in 12.2% of participants (n = 1,546). COMISA prevalence was higher in those with OAD than in those without OAD (16.1% vs 10.8%, p < 0.001). After adjustment for age, sex, body mass index, education, smoking status, and comorbidities, OAD remained independently associated with COMISA (adjusted odds ratio 1.19; 95% CI 1.06-1.35; p = 0.004). Among participants with COMISA, individuals with OAD were older, more frequently female, more obese, and demonstrated shorter total sleep time, longer wake after sleep onset, higher periodic limb movement index, and poorer nocturnal oxygenation.
Conclusions:
In this nationwide sleep-clinic cohort, OAD was independently associated with COMISA. COMISA patients with OAD exhibited more adverse clinical and polysomnographic features. These findings highlight the multidimensional sleep burden in OAD and support integrated, personalized management strategies.
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