Research involving nearly 1 million US veterans identifies the combination of insomnia and obstructive sleep apnea as a distinct risk state for hypertension and cardiovascular disease.
Key takeaways:
- Researchers analyzed data from nearly 1 million post-9/11 US veterans to assess cardiovascular risks associated with sleep disorders.
- The study found that comorbid insomnia and sleep apnea (COMISA) presents a higher risk for hypertension and cardiovascular disease than either condition alone.
- Investigators emphasize that sleep disorders are modifiable risk factors that should be addressed early in the cardiovascular risk trajectory.
- The findings suggest sleep health should be assessed as routinely as other cardiovascular risk factors.
New research from Yale School of Medicine highlights the significant impact of comorbid insomnia and sleep apnea (COMISA) on heart health, identifying the combination as a distinct and harmful risk state for cardiovascular disease.
In a study published in the Journal of the American Heart Association, researchers analyzed data from nearly 1 million post-9/11 US veterans. The findings reveal that adults diagnosed with both insomnia and obstructive sleep apnea face substantially higher risks of hypertension and cardiovascular disease compared to those with either condition in isolation.
“We spend an enormous amount of time managing cardiovascular disease downstream, but far less time addressing more upstream modifiable risk factors,” says Allison Gaffey, PhD, assistant professor of medicine (cardiovascular medicine) at Yale School of Medicine and first author of the paper, in a release. “Sleep disturbances, which are common in the veteran population, are often treated as secondary problems.”
While insomnia and obstructive sleep apnea are typically diagnosed and treated as separate entities, they frequently overlap in clinical practice. Insomnia is characterized by difficulty falling or staying asleep, whereas sleep apnea involves repeated pauses in breathing. According to the researchers, the interaction between these two conditions worsens health outcomes.
“These conditions don’t just coexist politely,” Gaffey says in a release. “Treating one while ignoring the other is a bit like bailing water out of a boat without fixing the leak.”
The study underscores the foundational role sleep plays in regulating cardiovascular function overnight. When sleep is repeatedly disrupted through awakenings, shortened duration, or breathing cessations, the cardiovascular system is denied necessary recovery time.
“Sleep touches every single part of our existence,” says Andrey Zinchuk, MD, MHS, associate professor of medicine (pulmonary, critical care, and sleep medicine) at Yale School of Medicine and senior author of the paper, in a release. “Oftentimes, it is neglected even though it has such an important impact on our lives.”
Zinchuk notes that these disruptions prevent the heart and blood vessels from having the opportunity to recover, adapt, and reset.
A primary goal of the study was to determine if sleep disorders influence future cardiovascular risk during a window when prevention can still alter long-term outcomes. Gaffey emphasizes that trouble sleeping places a measurable strain on the cardiovascular system over time.
“We wanted to know whether COMISA mattered early in the cardiovascular risk trajectory,” Gaffey says in a release, “rather than decades later when disease is already established.”
The researchers conclude that prevention, rather than late-stage management, must guide future care in sleep medicine. They advocate for assessing sleep as routinely as other cardiovascular risk factors and considering insomnia and sleep apnea together. By paying attention to these treatable risk factors sooner, clinicians may be able to change the trajectory of cardiovascular disease.
