10-Year Risk for Cardiovascular Disease Associated with COMISA (Co-Morbid Insomnia and Sleep Apnea) in Hypertensive Subjects

Abstract

Due to the few studies available, this study aimed to investigate the 10-year risk for cardiovascular disease (CVD) associated with COMISA (co-morbid insomnia and sleep apnea) in hypertensive subjects. Clinical data of 1009 hypertensive subjects extracted from the Sleep Laboratory database were analyzed. Framingham Risk Score ≥ 10% was used as a cut-off to identify hypertensive subjects with high 10-year risk for CVD. The association between 10-year risk for CVD and COMISA was investigated using logistic regression analyses. 65.3% of hypertensive subjects from our sample presented a high 10-year risk for CVD. After controlling for major confounding factors, multivariate logistic regression analyses demonstrated that unlike its components present separately, COMISA was significantly associated with high 10-year risk for CVD in hypertensive subjects (OR 1.88, 95% CI 1.01–3.51). In this study, we have demonstrated that the negative synergy between obstructive sleep apnea syndrome and insomnia disorder seems to play a central role in the 10-year risk for CVD in hypertensive subjects, which seems to indicate that the establishment of a systematic research and an adapted treatment of COMISA could open new perspectives to promote a better cardiovascular outcome in this specific subgroup of patients.

Cardiovascular Outcome in Patients with Major Depression: Role of Obstructive Sleep Apnea Syndrome, Insomnia Disorder, and COMISA

“…Consistent with the data currently available in the literature, we confirmed that ID (67.0%) and OSAS (42.0%) are frequent comorbidities for MDD patients [44,45]. Furthermore, in this study, we demonstrated that 58.4% of MDD patients with OSAS presented a comorbid ID, which seems to indicate a more frequent occurrence of insomnia complaints in cases of OSAS for MDD patients than for the other subpopulations currently studied for COMISA [12,13,18]. Furthermore, similar to other available studies [12,13,18], we demonstrated that high 10-year cardiovascular risk was significantly associated with COMISA but was not significantly associated with ID or OSAS alone.…”

“…Furthermore, in this study, we demonstrated that 58.4% of MDD patients with OSAS presented a comorbid ID, which seems to indicate a more frequent occurrence of insomnia complaints in cases of OSAS for MDD patients than for the other subpopulations currently studied for COMISA [12,13,18]. Furthermore, similar to other available studies [12,13,18], we demonstrated that high 10-year cardiovascular risk was significantly associated with COMISA but was not significantly associated with ID or OSAS alone. However, pathophysiologically, this high prevalence of COMISA and its potential role in unfavorable cardiovascular prognosis for MDD patients may be explained by different elements.…”

“…A summary of the comparison of the main results of this study with the literature is available in Table 5. [12,13,18].…”

“…Our main objective for this study was to explore the 10-year cardiovascular risk associated with OSAS, ID, and COMISA for MDD patients. Given previous studies available in the literature for other subgroups of patients [12,13,18,19], the hypothesis of this study was that, unlike OSAS or ID alone, only COMISA is associated with an increased 10-year cardiovascular risk for MDD patients. Obtaining reliable data on the 10-year cardiovascular risk associated with comorbid sleep disorders (OSAS, ID, and COMISA) for MDD patients was the aim of this approach to enable better management by health professionals of this specific population subgroup characterized by higher cardiovascular morbidity and mortality.…”

“…Obstructive sleep apnea syndrome (OSAS) and insomnia disorder (ID) are cardiovascular risk factors demonstrated for the general population [10,11]. Furthermore, following the existence of data supporting a potential negative synergistic action of these two sleep disorders, comorbid insomnia and sleep apnea (COMISA) appear to be associated with a more severe cardiovascular risk than OSAS or ID alone [12,13]. However, although the rate of OSAS and ID is significant for MDD patients [14,15], only a limited number of studies have currently investigated the risk of cardiovascular diseases associated with these sleep disorders for this specific population subgroup [16,17].…”