Journal Article Multicenter Study Epublish 3 citations
PubMed: 42390661 DOI: 10.1007/s44470-026-00109-4
Diabetes mellitus is associated with increased prevalence and severity of COMISA: evidence from the nationwide TURKAPNE cohort.
J Clin Sleep Med 22(1)
Authors: Canan Gündüz Gürkan, Aylin Pihtili, Esen Kiyan, Mehmet Sezai Tasbakan, Özen K Basoglu, Semih Arbatli, Senay Aydin, Aykut Cilli, Neşe Dursunoglu, Burcu Baran, Yüksel Peker
Affiliations
- Department of Pulmonary Medicine, Süreyyapasa Chest Diseases Research and Training Hospital, Istanbul, Türkiye.
- Department of Pulmonary Medicine, Istanbul University School of Medicine, Istanbul, Türkiye.
- Department of Pulmonary Medicine, Ege University School of Medicine, Izmir, Türkiye.
- Koc University Research Center for Translational Medicine (KUTTAM), Koc University School of Medicine, Davutpasa Cad No 4, Zeytinburnu, Istanbul, TR, 34010, Türkiye.
- Department of Neurology, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Türkiye.
- Department of Pulmonary Medicine, Akdeniz University School of Medicine, Antalya, Türkiye.
- Department of Pulmonary Medicine, Pamukkale University School of Medicine, Denizli, Türkiye.
- Department of Pulmonary Medicine, Erciyes University School of Medicine, Kayseri, Türkiye.
- Koc University Research Center for Translational Medicine (KUTTAM), Koc University School of Medicine, Davutpasa Cad No 4, Zeytinburnu, Istanbul, TR, 34010, Türkiye. Department of Pulmonary Medicine, Koc University School of Medicine, Istanbul, Türkiye. Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden. Department of Clinical Sciences, Respiratory Medicine and Allergology, Lund University School of Medicine, Lund, Sweden. Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Abstract
BACKGROUND
Comorbid insomnia and obstructive sleep apnea (COMISA) is increasingly recognized as a clinically important sleep disorder phenotype with potential cardiometabolic consequences. However, its association with diabetes mellitus (DM) remains insufficiently characterized.
METHODS
This cross-sectional analysis included 12,715 adults with suspected obstructive sleep apnea (OSA) from the nationwide multicenter TURKAPNE cohort who underwent full-night polysomnography. Insomnia symptoms were assessed using standardized questionnaire items, and OSA was defined as apnea-hypopnea index (AHI) ≥ 5 events/hour. COMISA was defined as the coexistence of insomnia symptoms and OSA. DM was identified based on self-reported physician diagnosis or use of antidiabetic medications. Multivariable logistic regression was performed to evaluate independent variables associated with COMISA.
RESULTS
COMISA was present in 3,275 patients (25.7%). DM was significantly more prevalent among patients with COMISA compared with those without COMISA (22.8% vs. 15.4%, p < 0.001). Overall, COMISA was observed in 33.9% of diabetic individuals and 24.1% of non-diabetic individuals. In multivariable analysis adjusted for age, sex, body-mass-index, smoking status, education level, and comorbidities, DM remained independently associated with COMISA (adjusted OR 1.17; 95% CI 1.05-1.31; p = 0.006). Among COMISA patients, those with DM exhibited greater sleep fragmentation and more severe sleep-disordered breathing, including higher AHI (30.0 vs. 24.0 events/h) and oxygen desaturation index (26.0 vs. 20.0 events/h) (p < 0.001).
CONCLUSIONS
DM is independently associated with COMISA and with more severe sleep and respiratory disturbances within this phenotype. These findings highlight the need for integrated screening of sleep disorders in individuals with DM.
TRIAL REGISTRATION
ClinicalTrials gov (NCT02784977).
MeSH
Diabetes Mellitus, Sleep Apnea, Obstructive, Sleep, Apnea, Phenotype, Signs And Symptoms, Prevalence, Sleep Apnea Syndromes, Sleep Initiation And Maintenance Disorders