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The meta-analysis employed the I\u00b2 and Cochran\u2019s Q tests, as well as the random effects method, and the results were presented in forest plots. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal tools.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sixteen studies were selected, with a prevalence of 30% for COMISA, 39% among ages 18\u201340, 42% in European countries, and an average Body Mass Index (BMI) of 28.55 (\u00b1\u20091.12). Patients with COMISA have higher Apnoea-Hypopnea Index (AHI), lower minimum oxygen saturation, higher micro-arousal index, longer wake time after sleep onset Wake Time After Sleep Onset (WASO), lower sleep efficiency, longer sleep latency, and possibly shorter Rapid Eye Movement (REM) sleep duration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The physiopathology of COMISA involves compromised sleep architecture and a complex interaction of mechanisms related to central arousal, sleep fragmentation, neurobiological changes, and a more severe profile of clinical and psychiatric comorbidities, with additive or synergistic consequences of the isolated disorders, requiring a comprehensive and personalized diagnostic and therapeutic approach.<\/jats:p>\n                    <jats:p>\n                      <jats:bold>PROSPERO Registry number<\/jats:bold>\n                      : CRD420251038279.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11325-026-03631-0","type":"journal-article","created":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T16:02:00Z","timestamp":1774108920000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Physiopathological correlations of comorbid insomnia and sleep apnoea (comisa) \u2013 a systematic review and meta-analysis"],"prefix":"10.1007","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7609-2528","authenticated-orcid":false,"given":"Ervin","family":"Cotrik","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janete","family":"Hernandes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viviane","family":"Castro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edilson","family":"Zancanella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,21]]},"reference":[{"key":"3631_CR1","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1007\/s40675-018-0127-2","volume":"4","author":"MS Brock","year":"2018","unstructured":"Brock MS, Foster SN, Motamedi V, Mysliwiec V (2018) COMISA (Comorbid insomnia and sleep apnoea): a practical approach. 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