Association between COMISA and cardiovascular disease: Evidence from the TURKAPNE registry
Yüksel Peker1,2,3,4,5, Aylin Pihtili6, Esen Kiyan6
1Department of Pulmonary Medicine, Koc University School of Medicine, Istanbul, Türkiye.
Plos One
|July 31, 2026
Summary
Comorbid insomnia and obstructive sleep apnea (COMISA) is more common in patients with cardiovascular disease (CVD). This distinct sleep phenotype may indicate an increased cardiometabolic risk, influenced by various factors.
Area of Science:
- Sleep Medicine
- Cardiology
- Public Health
Background:
- Comorbid insomnia and obstructive sleep apnea (COMISA) is recognized as a distinct clinical entity.
- The relationship between COMISA and cardiovascular disease (CVD) requires further investigation.
Purpose of the Study:
- To investigate the association between COMISA and CVD in a large clinical sleep cohort.
- To determine if COMISA represents a distinct phenotype with increased cardiometabolic burden.
Main Methods:
- Analysis of 12,715 adults from the TURKAPNE registry.
- Classification into four sleep phenotypes: neither OSA nor insomnia, insomnia only, OSA only, and COMISA.
- Multivariable logistic regression to assess associations between COMISA and CVD, adjusting for covariates.
Main Results:
- COMISA was more prevalent in individuals with CVD (31.6%) compared to those without (22.7%).
- CVD was independently associated with COMISA (OR 1.108, p=0.038), though the association was modest.
- Female sex, diabetes, airway disease, psychiatric disease, lower education, and smoking were also associated with COMISA.
Conclusions:
- COMISA is more prevalent in individuals with CVD, supporting its role as a distinct phenotype with increased cardiometabolic burden.
- The modest effect size suggests that COMISA's association with CVD is influenced by a complex interplay of behavioral and metabolic factors.
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