TOPLINE:

Comorbid insomnia and obstructive sleep apnea (OSA) were associated with higher 10-year risk for cerebrovascular disease, arrhythmia, and thrombotic disorders than OSA alone, a new cohort study showed.

METHODOLOGY:

• A retrospective matched-cohort study included 2010-2023 data from the TriNetX US Collaborative Network for more than 3.5 million individuals who had at least two diagnostic encounters for OSA.
• More than 165,500 patients with both OSA and insomnia (median follow-up, 3.9 years) and an equal number of those with OSA alone (median follow-up, 4.2 years; mean age, 52 years for both groups) were included after propensity score matching on demographic, socioeconomic, comorbidity, and laboratory factors.
• Primary outcomes were cardiovascular and cerebrovascular disease (CCVD) endpoints, assessed from day 90 after the first-recorded diagnosis of OSA until the earliest of the first qualifying event, death, or end of data availability for up to 10 years.

TAKEAWAY:

• Insomnia with OSA was associated with a higher 10-year risk for a composite of cerebrovascular disorders compared to OSA alone (9% vs 8%, respectively; hazard ratio [HR], 1.17), with increased risks for ischemic stroke (HR, 1.17), hemorrhagic stroke (HR, 1.12), and transient ischemic attack (HR, 1.22).
• An arrhythmia composite was more frequent in the comorbid group than in the OSA-only group (20% vs 19%; HR, 1.10), with increased tachycardia, bradycardia, and ventricular and other arrhythmias. However, atrial fibrillation/flutter was slightly less frequent in this group (HR, 0.95).
• Comorbid insomnia and OSA were also linked to higher risk for inflammatory heart disease (HR, 1.14), ischemic heart disease (HR, 1.06), and thrombotic disorders (HR, 1.08), particularly superficial vein thrombosis (HR, 1.26).
• The association with time-to-first major adverse cardiovascular event was modest in both groups (15% vs 15%; HR, 1.03), and heart failure occurred slightly less often in the combination group than the OSA alone group (8.5% vs 9.1%; HR, 0.97).

IN PRACTICE:

The study supports asking about comorbid insomnia and OSA in routine risk assessments for CCVD and highlight that this combination is “an important clinical phenotype in OSA populations,” the investigators wrote.

“Further studies are needed to clarify the mechanisms…and to determine whether targeted interventions can effectively reduce this excess risk,” they added. 

SOURCE:

The study was led by Yen-Ting Lu, MD, St Martin De Porres Hospital, Chiayi, Taiwan. It was published online on February 24 in Sleep.

LIMITATIONS:

Outcome ascertainment relied on diagnostic and procedural codes across multiple institutions and on the accuracy of routine clinical documentation. The database lacked standardized information on treatment adherence, OSA severity metrics, and sleep architecture, which may have influenced the risk for CCVD and contributed to residual confounding. 

DISCLOSURES:

This study was funded in part by St Martin De Porres Hospital and Chung Shan Medical University. The investigators reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.