Abstract
Study Objectives 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 co-morbid 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 a month and daytime impairment. OSA was defined as an apnoea-hypopnoea index ≥15 events/h sleep. COMISA was defined if both conditions were present. Multivariable adjusted Cox proportional hazard 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 (control), 170 (3%) had insomnia-alone, 2221 (42%) had OSA-alone, and 137 (3%) had COMISA. COMISA participants had a higher prevalence of hypertension (ORs [95%CI]; 2.00 [1.39, 2.90]) and cardiovascular disease compared to controls (1.70 [1.11, 2.61]). Insomnia-alone and OSA-alone were associated with higher risk of hypertension but not cardiovascular disease compared to controls. Compared to controls, COMISA was associated with a 47% (HR, 95% CI; 1.47 (1.06, 2.07)) increased risk of mortality. The association between COMISA and mortality was consistent across multiple definitions of OSA and insomnia.
Conclusions Co-morbid insomnia and sleep apnoea was associated with higher rates of hypertension and cardiovascular disease at baseline, and an increased risk of all-cause mortality compared to no insomnia/OSA.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. Lechat has nothing to disclose.
Conflict of interest: Dr. Appleton has nothing to disclose.
Conflict of interest: Dr. Melaku has nothing to disclose.
Conflict of interest: Dr. Hansen reports grants from Australian Research Council, during the conduct of the study.
Conflict of interest: Dr. McEvoy reports grants from National Health and Medical Research Council, during the conduct of the study.
Conflict of interest: Dr. Adams reports grants from The Hospital Research Foundation, grants from National Health and Medical Research Council, grants from ResMed Foundation, grants from Phillips Foundation, grants from Sleep Health Foundation, during the conduct of the study.
Conflict of interest: Dr. Catcheside reports grants from National Health and Medical Research Council, grants from Defence Science and Technology, grants from Flinders Foundation, outside the submitted work.
Conflict of interest: Dr. Lack reports grants from Re-time Pty. Ltd., personal fees from Re-time Pty. Ltd. , non-financial support from Re-time Pty. Ltd., outside the submitted work.
Conflict of interest: Dr. Eckert reports grants from National Health and Medical Research Council of Australia, during the conduct of the study; grants and personal fees from Apnimed, grants and personal fees from Bayer, grants from Collaborative Research Centre (CRC-P) Grant , outside the submitted work; In addition, Dr. Eckert has a patent Dutta, Ritaban; Eckert, Danny J. Title: Methods for estimating key phenotypic traits for obstructive sleep apnea and simplified clinical tools to direct targeted therapy, PCT Patent Application. pending.
Conflict of interest: Dr. Sweetman has nothing to disclose.
This is a PDF-only article. Please click on the PDF link above to read it.
- Received July 13, 2021.
- Accepted November 16, 2021.
- Copyright ©The authors 2021. For reproduction rights and permissions contact permissions{at}ersnet.org
