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Publications

Journal Article Epublish

PubMed: 42857102 DOI: 10.1016/j.eclinm.2026.104227

Comorbid insomnia and sleep apnea (COMISA) and incident cardiovascular risk: a prospective analysis from the HypnoLaus cohort.

EClinicalMedicine 100:104227

Authors: Geoffroy Solelhac, Théo Imler, Nicola-Andrea Marchi, Sébastien Baillieul, Sandra Van Den Broecke, Gabriela Caetano, Grégory Heiniger, Adrien Waeber, Isabel Ericson, Virginie Bayon, Anne-Sophie Lombardi, José Haba-Rubio, Peter Vollenweider, Pedro Marques-Vidal, Raphaël Heinzer

Affiliations

  • Center for Investigation and Research in Sleep, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
  • Grenoble Alpes University, HP2 Laboratory, INSERM U1300 and Grenoble Alpes University Hospital, Grenoble, France.
  • Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

Abstract

BACKGROUND

Comorbid insomnia and obstructive sleep apnea (COMISA) is a prevalent and clinically relevant phenotype. While both insomnia and OSA have been individually associated with increased cardiovascular risk, few longitudinal studies have evaluated their combined impact on incident cardiovascular events in the general population.

METHODS

A total of 1860 participants from the CoLaus|PsyCoLaus cohort, originally recruited between 2003 and 2008 and assessed in the HypnoLaus study between 2009 and 2013, were included, all of whom underwent full-night polysomnography and completed the Pittsburgh Sleep Quality Index (PSQI). OSA was defined as an apnea-hypopnea index (AHI) ≥15 events/h. Insomnia symptoms were defined as difficulty initiating or maintaining sleep ≥3 times/week over the past month. Participants were classified into four groups: reference (no insomnia, no OSA), insomnia alone, OSA alone, and COMISA. Incident cardiovascular events (coronary heart disease, myocardial infarction, stroke, or cardiovascular death) were adjudicated by an expert committee over a median follow-up period of 7.92 years [IQR: 6.30-8.77]. Cox regression models were adjusted for demographic, behavioral, and clinical covariates.

FINDINGS

Compared to the reference group, COMISA was independently associated with an increased risk of incident cardiovascular events (HR 1.78, 95% CI: 1.09-2.92, p = 0.021), while no significant association was observed for insomnia (HR 0.59, 95% CI: 0.31-1.11, p = 0.10) or OSA alone (HR 1.33, 95% CI: 0.84-2.10, p = 0.22). A significant interaction between OSA and insomnia was observed (p = 0.035). Results were consistent in participants without prior cardiovascular events and across alternative definitions of COMISA.

INTERPRETATION

COMISA, but not OSA or insomnia alone, was associated with increased incident cardiovascular events. These findings highlight the need to identify and treat COMISA as a distinct and high-risk phenotype in cardiovascular prevention strategies.

FUNDING

Faculty of Biology and Medicine of Lausanne, Lausanne University Hospital, Swiss National Science Foundation, Leenaards Foundation, GlaxoSmithKline, Ligue Pulmonaire Vaudoise.

MeSH

Sleep, Apnea, Phenotype, Sleep Apnea Syndromes, Sleep Initiation And Maintenance Disorders