0369 Mortality in Veterans with Insomnia, Sleep Apnea and Comorbid Insomnia and Sleep Apnea (COMISA): A Cohort Study

Abstract Introduction Insomnia and Sleep Apnea (SA), the two most prevalent sleep disorders, can occur separately or concurrently as comorbid insomnia and sleep apnea (COMISA). This study utilized a large national Veterans Health Administration (VA) database to compare all-cause mortality among them. Methods We constructed a cohort of veterans who used any sleep services in the VA from 10/1999 to 10/2023. Using ICD 9/10 codes and a VA-validated algorithm, we identified veterans with confirmed diagnoses of insomnia and/or SA. For insomnia, we required the presence of relevant medications or CBT-I. We extracted mortality data for three groups: insomnia-only, SA-only, and COMISA. We estimated the association of these conditions using multivariable logistic regression, adjusting for age, sex, race, ethnicity, Charlson Comorbidity Index (CCI), and exposure time (time from the initial insomnia or SA diagnosis). Results Out of 4,722,693 veterans who used VA sleep services, we identified 2,159,412 participants with a confirmed diagnosis of either SA or insomnia, who had ≥2 specialty visits in the past three years. We observed 518,574 (24%) with insomnia-only (mean age 58.5, 77.2% male, 71.4% white, 22.6% with CCI > 2), 1,343,035 (63%) with SA-only (mean age 57.6, 93.5% male, 70.1% white, 25% with CCI > 2), and 297,803 (13.8%) with COMISA (mean age 52.5, 89.2% male, 68.3% white, 18.5% with CCI > 2). All-cause mortality rates were 33.2%, 23.3%, and 16.2% for insomnia-only, SA-only, and COMISA, respectively. Compared to the SA-only group as a reference, the insomnia-only group was associated with a 73% increased risk (adjusted Odds Ratio [aOR] 1.73; 95% Confidence Interval [CI]: 1.72, 1.75) and the COMISA group with a 12% decreased risk of mortality (aOR 0.88; 95%CI: 0.87, 0.89). Conclusion In a cohort referred to VA sleep centers, SA, insomnia, and COMISA were prevalent. Mortality was highest in the insomnia-only group, compared to the SA-only and COMISA groups. Further studies are needed to explore the causes of this increased mortality. Support (if any) Supported by NIH-NHLBI-K25 funding (#1K25HL152006-01 [J.R.]); seed funding by AHBPCE (#FY2024-002 [J.R.]); and Center for Innovations in Quality, Effectiveness, and Safety (CIN 13-413), Michael E. DeBakey VA Medical Center, Houston, TX.