Abstract
Background Increased mortality has been reported in people with insomnia and in those with obstructive sleep apnoea (OSA). However, these conditions commonly co-occur and the combined effect of comorbid insomnia and sleep apnoea (COMISA) on mortality risk is unknown. This study used Sleep Heart Health Study (SHHS) data to assess associations between COMISA and all-cause mortality risk.
Methods Insomnia was defined as difficulties falling asleep, maintaining sleep and/or early morning awakenings from sleep ≥16 times per month, and daytime impairments. OSA was defined as an apnoea–hypopnoea index ≥15 events·h−1. COMISA was defined if both conditions were present. Multivariable adjusted Cox proportional hazards models were used to determine the association between COMISA and all-cause mortality (n=1210) over 15 years of follow-up.
Results 5236 participants were included. 2708 (52%) did not have insomnia/OSA (reference group), 170 (3%) had insomnia-alone, 2221 (42%) had OSA-alone and 137 (3%) had COMISA. COMISA participants had a higher prevalence of hypertension (OR 2.00, 95% CI 1.39–2.90) and cardiovascular disease (CVD) (OR 1.70, 95% CI 1.11–2.61) compared with the reference group. Insomnia-alone and OSA-alone were associated with higher risk of hypertension but not CVD compared with the reference group. Compared with the reference group, COMISA was associated with a 47% (hazard ratio 1.47, 95% CI 1.06–2.07) increased risk of mortality. The association between COMISA and mortality was consistent across multiple definitions of OSA and insomnia.
Conclusions COMISA was associated with higher rates of hypertension and CVD at baseline, and an increased risk of all-cause mortality compared with no insomnia/OSA.
Abstract
Comorbid insomnia and sleep apnoea is associated with a 47% increase in mortality risk compared with participants with no insomnia or obstructive sleep apnoea over 15 years of follow-up https://bit.ly/3kXylQH
Footnotes
Conflict of interest: B. Lechat has nothing to disclose.
Conflict of interest: S. Appleton has nothing to disclose.
Conflict of interest: Y.A. Melaku has nothing to disclose.
Conflict of interest: K. Hansen reports grants from the Australian Research Council, during the conduct of the study.
Conflict of interest: R.D. McEvoy reports grants from the National Health and Medical Research Council, during the conduct of the study.
Conflict of interest: R. Adams reports grants from The Hospital Research Foundation, National Health and Medical Research Council, ResMed Foundation, Phillips Foundation and Sleep Health Foundation, during the conduct of the study.
Conflict of interest: P. Catcheside reports grants from the National Health and Medical Research Council, Defence Science and Technology, and the Flinders Foundation, outside the submitted work.
Conflict of interest: L. Lack reports grants, personal fees and nonfinancial support from Re-time Pty Ltd, outside the submitted work.
Conflict of interest: D.J. Eckert reports grants from the National Health and Medical Research Council of Australia, during the conduct of the study; grants and personal fees from Apnimed, and Bayer, grants from the Collaborative Research Centre (CRC-P), outside the submitted work; and has a patent “Methods for estimating key phenotypic traits for obstructive sleep apnoea and simplified clinical tools to direct targeted therapy”, PCT patent application pending.
Conflict of interest: A. Sweetman has nothing to disclose.
Support statement: Open-data resources made available through the National Sleep Research Resources were funded by the National Heart, Lung, and Blood Institute (NSRR R24 HL114473: NHLBI National Sleep Research Resource). The Sleep Heart Health Study was supported by multiple grants from the National Institutes of Health (U01 HL53916, U0 1HL53931, U01 HL53934, U01 HL53937, U01 HL53938, U01 HL53940, U01 HL53941 and U01 HL64360).
- Received July 13, 2021.
- Accepted November 16, 2021.
- Copyright ©The authors 2022. For reproduction rights and permissions contact permissions{at}ersnet.org
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