Gaffey Allison E, Burg Matthew M, Yaggi Henry K, Wang Kaicheng, Brandt Cynthia A, Haskell Sally G, Bastian Lori A, Chang Tiffany E, Levine Allison, Skanderson Melissa, Zinchuk Andrey
VA Connecticut Healthcare System, West Haven, CT.
Department of Internal Medicine (Cardiovascular Medicine), Yale School of Medicine.
medRxiv. 2025 Jun 3:2025.06.02.25328832. doi: 10.1101/2025.06.02.25328832.
Comorbid insomnia and obstructive sleep apnea (OSA, i.e., COMISA) are associated with cardiovascular disease (CVD) among older adults. It is unknown how the comorbidity is related to cardiovascular risk among younger military Veterans, who show a greater risk for hypertension and CVD than non-Veterans, and if associations differ by sex. Thus, we examined whether COMISA is associated with incident hypertension and CVD risk in younger men and women Veterans.
The cohort included post-9/11 Veterans who enrolled in Veterans Health Administration care from 2001 to 2021. Administrative and electronic health record data were merged. Insomnia and OSA were defined by 2 outpatient International Classification of Diseases, 9 or 10 diagnoses. Hypertension was defined by ≥2 outpatient-coded diagnoses or ≥1 antihypertensive medication fill. CVD was defined by 1≥ inpatient or ≥2 outpatient diagnoses. Time-varying Cox proportional hazard models were adjusted for demographics, behavioral, and clinical factors and conducted overall and by sex.
Analyses included 937,598 Veterans (12% women; median age: 41 years). Greater hypertension risk was observed overall (adjusted hazard ratio [aHR]:2.43: 95%CI:2.36-2.50), for men (aHR:2.09, 95%CI:2.02-2.16) and women with COMISA (aHR:2.20, 95%CI:2.00-2.42), insomnia only (aHRs:1.27-1.44), and OSA only (aHRs:2.00-2.26) versus no sleep disorder. For incident CVD, COMISA was again associated with risk overall (aHR:3.81, 95%CI:3.64-3.99), in men (aHR:3.81, 95%CI:3.63-4.00), and women (aHR:3.44, 95%CI:2.98-3.98), as were insomnia (aHRs:1.36-1.37) and OSA (aHRs:3.32-2.62).
For post-9/11 Veterans, COMISA was associated with the greatest risk of hypertension and CVD. Identifying disordered sleep among men and women should be a cardiovascular prevention priority.
共病性失眠与阻塞性睡眠呼吸暂停（OSA，即COMISA）在老年人中与心血管疾病（CVD）相关。目前尚不清楚这种共病在年轻退伍军人中与心血管风险的关系，这些年轻退伍军人患高血压和心血管疾病的风险高于非退伍军人，以及这种关联是否因性别而异。因此，我们研究了COMISA是否与年轻男性和女性退伍军人的高血压发病及心血管疾病风险相关。
该队列包括2001年至2021年参加退伍军人健康管理局医疗服务的9·11事件后退伍军人。将行政和电子健康记录数据合并。失眠和OSA由2次门诊国际疾病分类第9版或第10版诊断定义。高血压由≥2次门诊编码诊断或≥1次抗高血压药物配药定义。心血管疾病由≥1次住院诊断或≥2次门诊诊断定义。时变Cox比例风险模型针对人口统计学、行为和临床因素进行了调整，并按总体和性别进行了分析。
分析纳入了937,598名退伍军人（12%为女性；中位年龄：41岁）。总体上观察到COMISA患者患高血压的风险更高（调整后风险比[aHR]：2.43；95%置信区间[CI]：2.36 - 2.50），男性（aHR：2.09，95%CI：2.02 - 2.16）和女性（aHR：2.20，95%CI：2.00 - 2.42），仅患失眠症者（aHRs：1.27 - 1.44）和仅患OSA者（aHRs：2.00 - 2.26）与无睡眠障碍者相比。对于心血管疾病发病，COMISA总体上再次与风险相关（aHR：3.81，95%CI：3.64 - 3.99），男性（aHR：3.81，95%CI：3.63 - 4.00）和女性（aHR：3.44，95%CI：2.98 - 3.98），失眠症（aHRs：1.36 - 1.37）和OSA（aHRs：3.32 - 2.62）也是如此。
对于9·11事件后退伍军人，COMISA与高血压和心血管疾病的最大风险相关。识别男性和女性的睡眠障碍应成为心血管疾病预防的重点。
