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We investigated whether COMISA associated with insomnia with short sleep duration (ISSD) phenotype is associated with an increased risk of incident hypertension in a large random general population sample.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>From the 1741 participants of the Penn State Adult Cohort, 1395 were followed-up after 7.5\u00a0years and 786 did not have hypertension at baseline. Hypertension was determined by a self-report of receiving treatment for high blood pressure. Insomnia symptoms were defined as either a complaint of chronic insomnia lasting\u2009\u2265\u20091\u00a0year or a complaint of difficulty falling asleep, staying asleep, nonrestorative sleep, or early morning awakening. All subjects underwent 8-h in-laboratory polysomnography. Obstructive sleep apnea was defined as an obstructive apnea\/hypopnea index\u2009\u2265\u20095 event\/h. Objective short sleep duration was defined as\u2009&lt;\u20096\u00a0h sleep.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean age of the study population was 47.5\u2009\u00b1\u200912.7\u00a0years and 51.3% were women. Compared to good sleepers, the highest risk of incident hypertension was in the COMISA with ISSD phenotype (OR\u2009=\u20094.25, 95%CI\u2009=\u20091.52\u201311.90), followed by OSA-alone (OR\u2009=\u20093.31, 95%CI\u2009=\u20091.85\u20135.92) and ISSD (OR\u2009=\u20092.27, 95%CI\u2009=\u20091.29\u20134). The insomnia with normal sleep duration phenotype alone or with OSA (COMISA) was not significantly associated with incident hypertension.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The additive effect of COMISA on hypertension risk is associated with the ISSD phenotype, the most severe biological phenotype of insomnia. Obtaining objective sleep duration in addition to apnea\/hypopnea and\/or oxygen saturation indices may lead to a more accurate diagnosis and treatment of COMISA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s44470-025-00027-x","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T16:37:55Z","timestamp":1767976675000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Obstructive sleep apnea comorbid with insomnia symptoms and objective short sleep duration is associated with incident hypertension"],"prefix":"10.1007","volume":"22","author":[{"given":"Nikolaos","family":"Athanasiou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Slobodanka","family":"Pejovic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8323-7526","authenticated-orcid":false,"given":"Alexandros N.","family":"Vgontzas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julio","family":"Fernandez-Mendoza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Karataraki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward O.","family":"Bixler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,9]]},"reference":[{"key":"27_CR1","doi-asserted-by":"publisher","unstructured":"Fryar CD, Kit B, Carroll MD, Afful J. 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