The Hidden Burden of COMISA in Hypertensive Obstructive Sleep Apnea Patients.

Publisher: KARE publishing Country of Publication: Turkey NLM ID: 101652981 Publication Model: Print Cited Medium: Internet ISSN: 2149-2271 (Electronic) Linking ISSN: 21492263 NLM ISO Abbreviation: Anatol J Cardiol Subsets: MEDLINE

Publication: 2023- : İstanbul, Turkey : KARE publishing
Original Publication: İstanbul, Turkey : Aves, [2015]-

Sleep Apnea, Obstructive*/complications ; Sleep Apnea, Obstructive*/epidemiology ; Hypertension*/complications ; Hypertension*/epidemiology ; Sleep Initiation and Maintenance Disorders*/complications ; Sleep Initiation and Maintenance Disorders*/epidemiology; Humans ; Male ; Female ; Retrospective Studies ; Middle Aged ; Cross-Sectional Studies ; Polysomnography ; Comorbidity ; Risk Factors ; Adult ; Severity of Illness Index ; Logistic Models

Objective: Comorbid insomnia and sleep apnea (COMISA) is a frequent but underrec-ognized condition in patients with obstructive sleep apnea (OSA). While OSA is strongly linked to hypertension, the independent contribution of COMISA to resistant hyper-tension (RH) remains unclear. This study aimed to investigate the association between COMISA and RH in hypertensive OSA patients and to identify independent predictors of RH.
Methods: This retrospective cross-sectional study included 131 patients diagnosed with both OSA and hypertension who underwent full-night polysomnography (PSG) at a ter- tiary sleep center. The Insomnia Severity Index (ISI) was used to define COMISA (ISI ≥15). Resistant hypertension (RH) was defined as uncontrolled blood pressure despite the use of at least 3 antihypertensive agents of different classes, including a diuretic. Demographic, clinical, and polysomnographic data were analyzed using multiple logistic regression to determine independent predictors of RH.
Results: Of 131 hypertensive OSA patients, 39 (29.8%) met criteria for COMISA. The preva-lence of RH was 43.5%. COMISA was significantly more frequent in the RH group (66.7% vs. 33.3%, P = .006). In the multiple logistic regression analysis, COMISA (OR = 5.26, P < .001, 95% CI: 2.04-13.57) and male sex (OR = 3.24, P = .010, 95% CI: 1.36-7.72) were identi-fied as independent predictors of RH, while age, apnea-hypopnea index (AHI), and body mass index (BMI) were not significantly associated.
Conclusion: Comorbid insomnia and sleep apnea (COMISA) markedly increases the risk of RH in hypertensive OSA patients, independent of apnea severity and obesity. These find-ings highlight COMISA as a distinct cardiovascular phenotype within the OSA spectrum. Routine screening and targeted treatment of insomnia in OSA may represent a critical approach to improving blood pressure control and cardiovascular outcomes.

Date Created: 20260223 Date Completed: 20260410 Latest Revision: 20260410

20260410

PMC12979065

10.14744/AnatolJCardiol.2026.6025

41725465