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

STUDY OBJECTIVES: Comorbid insomnia and obstructive sleep apnea (COMISA) is 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. METHODS: Using the TriNetX U.S. Collaborative Network, we identified adults diagnosed with OSA from 2010 -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. Ten-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. RESULTS: 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. CONCLUSIONS: 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.