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However, its association with diabetes mellitus (DM) remains insufficiently characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2013hypopnea index (AHI)\u2009\u2265\u20095 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). 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\u20131.31;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006). 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) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials gov (NCT02784977).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s44470-026-00109-4","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T16:53:02Z","timestamp":1783011182000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Diabetes mellitus is associated with increased prevalence and severity of COMISA: evidence from the nationwide TURKAPNE cohort"],"prefix":"10.1007","volume":"22","author":[{"given":"Canan 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