{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T00:40:58Z","timestamp":1793752858897,"version":"4.6.1"},"reference-count":57,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100032748","name":"St. Martin De Porres hospital","doi-asserted-by":"crossref","award":["P2304"],"award-info":[{"award-number":["P2304"]}],"id":[{"id":"10.13039\/100032748","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100008641","name":"Chung-Shan Medical University","doi-asserted-by":"crossref","award":["NCHU-CSMU 11312"],"award-info":[{"award-number":["NCHU-CSMU 11312"]}],"id":[{"id":"10.13039\/501100008641","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Study Objectives<\/jats:title>\n                    <jats:p>Comorbid insomnia and obstructive sleep apnea (COMISA) are increasingly recognized as a distinct sleep disorder with cardiocerebrovascular implications. This study compared long-term risks of cardiovascular and cerebrovascular diseases (CCVDs) between patients with COMISA and those with obstructive sleep apnea (OSA) alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using the TriNetX U.S. Collaborative Network, we identified adults diagnosed with OSA from 2010 to 2023. COMISA was defined as OSA plus an insomnia diagnosis within 90\u00a0days of the index date; patients without insomnia codes were classified as OSA-only. After exclusions, cohorts were constructed and 1:1 propensity score\u2013matched on demographic, socioeconomic, comorbidity, and laboratory covariates. 10-year risks and hazard ratios (HRs) for incident CCVDs were estimated overall and in subgroups defined by sex, continuous positive airway pressure (CPAP) use, and benzodiazepine\/Z-drug use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The matched cohort included 165\u2009522 patients with COMISA and 165\u2009522 with OSA alone. COMISA was associated with higher 10-year risks of cerebrovascular disease (HR 1.17, 95% CI 1.14\u20131.20), arrhythmias, inflammatory and ischemic heart disease, and thrombotic disorders. Atrial fibrillation\/flutter and heart failure were slightly less frequent in COMISA, and the association with time-to-first major adverse cardiovascular event was modest (HR 1.03, 95% CI 1.01\u20131.05). These patterns were generally consistent across subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>COMISA was associated with higher long-term risks of several CCVD subtypes, particularly cerebrovascular and thrombotic events, further characterizing COMISA as a high-risk clinical phenotype.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/sleep\/zsag048","type":"journal-article","created":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T12:32:15Z","timestamp":1771677135000},"source":"Crossref","is-referenced-by-count":2,"title":["Comorbid insomnia and obstructive sleep apnea increase risks of cardiovascular and cerebrovascular diseases"],"prefix":"10.1093","volume":"49","author":[{"given":"Yen-Ting","family":"Lu","sequence":"first","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, St. Martin De Porres Hospital , Chiayi ,","place":["Taiwan"]},{"name":"Department of Otolaryngology-Head and Neck Surgery, Chung Shan Medical University Hospital , Taichung ,","place":["Taiwan"]},{"name":"School of Medicine, Chung Shan Medical University , Taichung ,","place":["Taiwan"]},{"name":"Institute of Medicine, Chung Shan Medical University , Taichung ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsueh-Yu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital , Linkou ,","place":["Taiwan"]},{"name":"College of Medicine, Chang Gung University , Taoyuan ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1711-8715","authenticated-orcid":false,"given":"Yu-Ru","family":"Lin","sequence":"additional","affiliation":[{"name":"School of Medicine, Chung Shan Medical University , Taichung ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chung-Han","family":"Hsin","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Chung Shan Medical University Hospital , Taichung ,","place":["Taiwan"]},{"name":"School of Medicine, Chung Shan Medical University , Taichung ,","place":["Taiwan"]},{"name":"Institute of Medicine, Chung Shan Medical University , Taichung ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shang-Feng","family":"Tsai","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan"},{"name":"Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University , Taichung ,","place":["Taiwan"]},{"name":"Department of Life Science, Tunghai University , Taichung ,","place":["Taiwan"]},{"name":"Clinical Informatics Division, Department of Digital Medicine, Taichung Veterans General Hospital, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shun-Fa","family":"Yang","sequence":"additional","affiliation":[{"name":"Institute of Medicine, Chung Shan Medical University , Taichung ,","place":["Taiwan"]},{"name":"Department of Medical Research, Chung Shan Medical University Hospital , Taichung ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0794-9388","authenticated-orcid":false,"given":"Jing-Yang","family":"Huang","sequence":"additional","affiliation":[{"name":"Institute of Medicine, Chung Shan Medical University , Taichung ,","place":["Taiwan"]},{"name":"Department of Medical Research, Chung Shan Medical University Hospital , Taichung ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2313-0890","authenticated-orcid":false,"given":"Yao-Te","family":"Tsai","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University , Taoyuan ,","place":["Taiwan"]},{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital , Chiayi ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,2,24]]},"reference":[{"key":"2026061506422078100_ref1","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1016\/j.smrv.2016.07.002","article-title":"Prevalence of obstructive sleep apnea in the general population: a systematic review","volume":"34","author":"Senaratna","year":"2017","journal-title":"Sleep Med 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