{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T05:32:56Z","timestamp":1792128776334,"version":"4.4.0"},"reference-count":56,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"24","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,12,16]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Comorbid insomnia and obstructive sleep apnea (COMISA) is associated with cardiovascular disease (CVD) in older adults. The associations of COMISA with cardiovascular risk among military veterans, who show a greater risk for\u00a0hypertension and CVD than non\u2010Veterans, and whether associations differ by sex are unknown. Thus, we examined associations of COMISA with incident hypertension and CVD risk in post\u20109\/11 Veterans.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">This retrospective cohort included patients who enrolled in Veterans Health Administration care from 2001 to 2021. Insomnia and obstructive sleep apnea were defined by \u22652 outpatient diagnoses. Hypertension was defined by \u22652 outpatient\u2010coded diagnoses or \u22651 antihypertensive medication fill; CVD by \u22651 inpatient or \u22652 outpatient diagnoses. Time\u2010varying Cox proportional hazard models adjusted for demographics, behavioral, and clinical factors were conducted overall and by sex. Sensitivity analyses accounted for health care use, a 180\u2010day washout, sleep study\u2013confirmed diagnoses, outpatient blood pressure data, and inclusion of patients deceased during follow\u2010up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">Among 937\u2009598 veterans (12% women; median age, 41\u2009years), COMISA was associated with increased hypertension risk overall (adjusted hazard ratio [aHR], 2.43 [95% CI, 2.36\u20132.50]), in men (aHR, 2.09 [95% CI, 2.02\u20132.16]) and in women (aHR, 2.20 [95% CI, 2.00\u20132.42]). Insomnia alone (aHR, 1.27\u20131.44) and obstructive sleep apnea only (aHR, 2.00\u20132.26) were also associated with elevated risk. COMISA was similarly associated with CVD risk overall (aHR, 3.81 [95% CI, 3.64\u20133.99]), in men (aHR, 3.81 [95% CI, 3.63\u20134.00]) and women (aHR, 3.44 [95% CI, 2.98\u20133.98]), as were insomnia (aHR, 1.36\u20131.37) and obstructive sleep apnea (aHR, 3.32\u20132.62). Sensitivity analyses were consistent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">COMISA conferred the greatest risk of hypertension and CVD among post\u20109\/11 Veterans. Identifying disordered sleep among men and women may be an important CVD prevention priority.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.045382","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T11:02:47Z","timestamp":1765450967000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Insomnia, Sleep Apnea, and Incidence of Hypertension and Cardiovascular Disease Among Men and Women US Veterans"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2960-2772","authenticated-orcid":false,"given":"Allison E.","family":"Gaffey","sequence":"first","affiliation":[{"name":"VA Connecticut Healthcare System","place":["West Haven"]},{"name":"Yale School of Medicine","place":["New Haven"]},{"name":"Yale School of Medicine","place":["New 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