{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T07:21:29Z","timestamp":1788420089748,"version":"build-2803163510"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":["www.atsjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Rationale: Comorbid insomnia and sleep apnea (COMISA) has been linked to poorer health outcomes and increased allcause mortality compared with either insomnia or obstructive sleep apnea (OSA) alone.<\/jats:p>\n                  <jats:p>Objective: We investigated the relationship between COMISA and uncontrolled hypertension in SCAPIS (Swedish CardioPulmonary BioImage Study).<\/jats:p>\n                  <jats:p>Methods: A cross-sectional analysis including participants from the SCAPIS Gothenburg cohort (n = 3,832; 46% males; aged 57.564.3 yr; body mass index, 26.664.3 kg\/m2) was performed. Subjects underwent a comprehensive examination, including functional tests and a home polygraph sleep recording. COMISA was defined as an apnea\u2013hypopnea index (AHI) &amp;gt;10 events\/h and an Insomnia Severity Index score \u2a7e15. Blood pressure (BP) status was characterized as uncontrolled hypertension (office systolic BP \u2a7e140\u2009mm Hg or diastolic BP \u2a7e90\u2009mm Hg), controlled hypertension (antihypertensive medication\u2013treated hypertension with systolic\/diastolic BP &amp;lt;140\/90 mm Hg) or normotension with systolic\/diastolic BP &amp;lt;140\/90 mm Hg.<\/jats:p>\n                  <jats:p>Results: The prevalence of COMISA was 3.1% in the population and 14.5% among patients with OSA (AHI, &amp;gt;10 events\/h). AHI was comparable between patients with OSA only and patients with COMISA (18\u2009\u00b1\u20099 vs. 19\u2009\u00b1\u20099 events\/h; P\u2009=\u20090.86). Uncontrolled hypertension was found in 4.4%, 4.5%, 7.9%, and 10.2% of the control group, insomnia-only, OSA-only, and COMISA groups, respectively (P\u2009&amp;lt;\u20090.001). Compared with the control group, the risk of uncontrolled hypertension was significantly increased in the OSA-only group (odds ratio [95% confidence interval], 1.31 [1.05\u20131.64]; P\u2009=\u20090.02) and the COMISA group (1.88 [1.23\u20132.89]; P\u2009=\u20090.004) after controlling for anthropometrics, lifestyle, comorbidities, Epworth Sleepiness Scale score, and nocturnal hypoxic exposure (T90 [percentage recording time with oxygen saturation \u2a7d90%]). T90 was found to be a significant mediator of uncontrolled hypertension in the relationship between both OSA and COMISA.<\/jats:p>\n                  <jats:p>Conclusions: This study is the first to demonstrate an independent association between COMISA and uncontrolled hypertension in the general population. These findings provide novel insights for identifying subgroups of patients with OSA at risk of adverse cardiovascular consequences. Furthermore, our results underscore the importance of recognizing sleep health as a multidimensional construct and advocate for personalized treatment strategies to effectively combat the burden of this common sleep disorder. (See the data supplement for graphical abstract and summary of key findings).<\/jats:p>","DOI":"10.1513\/annalsats.202501-080oc","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T19:53:46Z","timestamp":1757361226000},"page":"125-131","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":7,"title":["Comorbid Insomnia and Sleep Apnea Is Associated with Uncontrolled Hypertension in a Middle-aged Population"],"prefix":"10.1093","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9809-111X","authenticated-orcid":false,"given":"Mio","family":"Kobayashi Frisk","sequence":"first","affiliation":[{"name":"Center for Sleep and Vigilance Disorders, Department of Internal Medicine and Clinical Nutrition , and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel","family":"Bergqvist","sequence":"additional","affiliation":[{"name":"Center for Sleep and Vigilance Disorders, 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Sweden; and"},{"name":"Department of Clinical Physiology, Sahlgrenska University Hospital , Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2057-8558","authenticated-orcid":false,"given":"Ding","family":"Zou","sequence":"additional","affiliation":[{"name":"Center for Sleep and Vigilance Disorders, Department of Internal Medicine and Clinical Nutrition , and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,9,8]]},"reference":[{"key":"2026031006273726000_bib1","doi-asserted-by":"crossref","first-page":"2982","DOI":"10.1016\/j.jacc.2020.11.010","article-title":"Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: update from the GBD 2019 Study","volume":"76","author":"Roth","year":"2020","journal-title":"J Am Coll 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