{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T17:38:28Z","timestamp":1792690708670,"version":"4.5.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Study Objectives<\/jats:title>\n                    <jats:p>Comorbid insomnia and sleep apnea (COMISA) results in worse health outcomes than either condition alone. While the bidirectional link between obstructive sleep apnea (OSA) and insomnia is established, the causal trajectory from OSA to incident insomnia\u2014and potential disparities by sex, race, and ethnicity\u2014remains understudied. We investigated the association between OSA and incident insomnia within a large, diverse clinical cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of 313\u2009953 adults (aged 40\u201385\u00a0years) within the Electronic Medical Records (EMR) of the University of Michigan Health System (2012\u20132023). Participants were required to be insomnia-free for one year following cohort entry. Arab ethnicity was identified using a validated surname-based algorithm, while Black and White designations were based on EMR self-report.<\/jats:p>\n                    <jats:p>To estimate the risk of incident insomnia following an OSA diagnosis, we employed multivariable Cox proportional hazards models adjusted for age, sex, race, and ethnicity, body mass index, and area deprivation index, a measure of socioeconomic disadvantage. Interaction terms were included to evaluate whether the association between OSA and insomnia differed significantly across sex, racial, and ethnic subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>OSA diagnosis was associated with a significantly increased risk of subsequent insomnia. Although these associations did not vary by sex, significant interactions were observed according to race and ethnicity (interaction term p\u2009&amp;lt;\u20090.04). Arab (HR\u2009=\u20091.57; 95% CI [1.34-1.84]) and Black patients (HR\u2009=\u20091.57; 95% CI [1.45-1.70]) exhibited a higher hazard of incident insomnia than White patients (HR\u2009=\u20091.39; 95% CI [1.35-1.43]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings demonstrate that Arab and Black patients face a disproportionately higher risk of developing COMISA following OSA diagnosis.<\/jats:p>\n                    <jats:p>Statement of Significance Although the link between obstructive sleep apnea (OSA) and insomnia has been established, this study quantified how racial and ethnic disparities influence the development of comorbid insomnia. Utilizing a large clinical cohort and a validated algorithm to identify Arab ethnicity, we demonstrated that Black and Arab patients face a significantly higher hazard (1.57) of incident insomnia following an OSA diagnosis than White patients (1.39). These findings suggest that the progression from a single sleep disorder to a comorbid state is not uniform across populations and challenge the \u201cone-size-fits-all\u201d approach to complex, comorbid sleep phenotypes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/sleep\/zsag257","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T11:58:54Z","timestamp":1790164734000},"source":"Crossref","is-referenced-by-count":0,"title":["Sleep apnea and risk of comorbid insomnia in Arab, Black, and White women and men: a longitudinal study"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7240-4923","authenticated-orcid":false,"given":"Galit L","family":"Dunietz","sequence":"first","affiliation":[{"name":"Department of Neurology, Michigan Medicine, University of Michigan , Ann Arbor, MI ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5202-5562","authenticated-orcid":false,"given":"Benjamin","family":"Osafo Agyare","sequence":"additional","affiliation":[{"name":"Department of Statistics, College of Literature, Science, and the Arts, University of Michigan , Ann Arbor, MI ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Punithavathy","family":"Vijayakumar","sequence":"additional","affiliation":[{"name":"Department of Neurology, Michigan Medicine, University of Michigan , Ann Arbor, MI ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2090-693X","authenticated-orcid":false,"given":"Ronald","family":"Gavidia","sequence":"additional","affiliation":[{"name":"Department of Neurology, Michigan Medicine, University of Michigan , Ann Arbor, MI ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3962-5257","authenticated-orcid":false,"given":"Xiru","family":"Lyu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Michigan Medicine, University of Michigan , Ann Arbor, MI ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2400-3375","authenticated-orcid":false,"given":"Abdulghani","family":"Sankari","sequence":"additional","affiliation":[{"name":"Pulmonary & Critical Care and Sleep Medicine, School of Medicine, Wayne State University , Detroit, MI ,","place":["United States"]},{"name":"John D. Dingell Department of Veteran Affairs Medical Center, Pulmonary& Critical Care Section , Detroit, MI ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hrayr","family":"Attarian","sequence":"additional","affiliation":[{"name":"Department of Neurology, Division of Sleep Medicine, Feinberg School of Medicine, Northwestern University , Chicago, IL ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Kaleba","sequence":"additional","affiliation":[{"name":"Medical School Office of Research , , Ann Arbor, MI ,","place":["United States"]},{"name":"Data Office for Clinical and Translational Research, University of Michigan , , Ann Arbor, MI ,","place":["United 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