A Yale School of Medicine-led study of nearly 1 million post-9/11 U.S. veterans found that people diagnosed with both insomnia and obstructive sleep apnea had substantially higher rates of new-onset hypertension and cardiovascular disease than those with only one of the conditions.
A Yale School of Medicine-led study is drawing attention to a potentially underrecognized sleep-related risk factor for cardiovascular disease: the combination of insomnia and obstructive sleep apnea, known as comorbid insomnia and sleep apnea (COMISA).
The research, published in the Journal of the American Heart Association, analyzed health records from 937,598 post-9/11 U.S. veterans who received care through the U.S. Department of Veterans Affairs. The investigators reported that COMISA was associated with the highest risk of developing new hypertension and cardiovascular disease compared with insomnia alone or obstructive sleep apnea alone.
According to the study’s abstract and clinical summary, COMISA was independently associated with more than a twofold increase in incident hypertension and more than a threefold increase in incident cardiovascular disease after accounting for demographic, behavioral and clinical factors.
Allison E. Gaffey, PhD—an assistant professor of medicine at Yale School of Medicine and the paper’s first author—argued that sleep problems deserve more attention as modifiable risk factors. “We spend an enormous amount of time managing cardiovascular disease downstream, but far less time addressing more upstream modifiable risk factors,” she said.
The report describes insomnia as difficulty falling asleep or staying asleep, and obstructive sleep apnea as repeated pauses in breathing during sleep. While these disorders are often diagnosed and treated separately, the researchers said their overlap may intensify cardiovascular strain. “These conditions don’t just coexist politely,” Gaffey said. “Treating one while ignoring the other is a bit like bailing water out of a boat without fixing the leak.”
The study also sought to assess whether COMISA is relevant earlier in a person’s cardiovascular risk trajectory, rather than only later in life after disease is established. “We wanted to know whether COMISA mattered early in the cardiovascular risk trajectory, rather than decades later when disease is already established,” Gaffey said.
Andrey Zinchuk, MD, MHS—an associate professor of medicine at Yale School of Medicine and the senior author—emphasized sleep’s broad role in health. “Sleep touches every single part of our existence,” he said. “Oftentimes, it is neglected even though it has such an important impact on our lives.”
The researchers recommended that clinicians evaluate sleep routinely alongside other cardiovascular risk factors, and consider assessing and managing insomnia and sleep apnea together rather than in isolation.
