Diabetes mellitus is associated with increased prevalence and severity of COMISA: evidence from the nationwide TURKAPNE cohort

BACKGROUND: Comorbid insomnia and obstructive sleep apnea (COMISA) is increasingly recognized as a clinically important sleep disorder phenotype with potential cardiometabolic consequences. However, its association with diabetes mellitus (DM) remains insufficiently characterized. METHODS: This cross-sectional analysis included 12,715 adults with suspected obstructive sleep apnea (OSA) from the nationwide multicenter TURKAPNE cohort who underwent full-night polysomnography. Insomnia symptoms were assessed using standardized questionnaire items, and OSA was defined as apnea-hypopnea index (AHI) ≥ 5 events/hour. COMISA was defined as the coexistence of insomnia symptoms and OSA. DM was identified based on self-reported physician diagnosis or use of antidiabetic medications. Multivariable logistic regression was performed to evaluate independent variables associated with COMISA. RESULTS: COMISA was present in 3,275 patients (25.7%). DM was significantly more prevalent among patients with COMISA compared with those without COMISA (22.8% vs. 15.4%, p < 0.001). Overall, COMISA was observed in 33.9% of diabetic individuals and 24.1% of non-diabetic individuals. In multivariable analysis adjusted for age, sex, body-mass-index, smoking status, education level, and comorbidities, DM remained independently associated with COMISA (adjusted OR 1.17; 95% CI 1.05-1.31; p = 0.006). Among COMISA patients, those with DM exhibited greater sleep fragmentation and more severe sleep-disordered breathing, including higher AHI (30.0 vs. 24.0 events/h) and oxygen desaturation index (26.0 vs. 20.0 events/h) (p < 0.001). CONCLUSIONS: DM is independently associated with COMISA and with more severe sleep and respiratory disturbances within this phenotype. These findings highlight the need for integrated screening of sleep disorders in individuals with DM. TRIAL REGISTRATION: ClinicalTrials gov (NCT02784977).

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Journal
Journal of Clinical Sleep Medicine
Published
2026-07-02
DOI
https://doi.org/10.1007/s44470-026-00109-4
Primary Topic
Obstructive Sleep Apnea Research
Type
article
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0.00

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article

Diabetes mellitus is associated with increased prevalence and severity of COMISA: evidence from the nationwide TURKAPNE cohort

Pınar Bekdik Şirinocak, Alperen Aksakal, Ahmet Ursavaş, Ayfer Utkusavaş et al.
Journal of Clinical Sleep Medicine
Obstructive Sleep Apnea Research
article

Diabetes mellitus is associated with increased prevalence and severity of COMISA: evidence from the nationwide TURKAPNE cohort

Pınar Bekdik Şirinocak, Alperen Aksakal, Ahmet Ursavaş, Ayfer Utkusavaş, Hikmet Fırat, Bilkay Serez Kaya, Aylin Özsancak Uğurlu, Şenay Aydın, M Fatih Karadag, Pınar Yıldız Gülhan, Semih Arbatlı, Gökhan Kırbaş, Nejat Altıntaş, Işıl Yazıcı Gençdal, Özen K. Başoğlu, Dilara Mermi Dibek, Ayşe Deniz Elmalı, Mehmet Habeşoğlu, Ebru Çakır Edis, Ersin Günay, Sevgi Ferik, Uluğ Bey Hayri, Demet İlhan Algın, Oya Öztürk, Neşe Dursunoğlu, Zahide Yılmaz, Oğuz Osman Erdinç, Aydın Balcı, Mehmet Sezai Taşbakan, Burcu Baran Ketencioğlu, Fuat Erel, Sezgi Şahin Duyar, Nur Aleyna Yetkin, Zeynep Zeren Uçar, Esen Kıyan, Gülin Sunter, Özlem Erçen DİKEN, Ege Güleç Balbay, Hamza Ogün, İlker Yılmam, Aylin Pıhtılı, Aykut Çilli, Gülgün Çetintaş Afşar, Muhammed Emin Akkoyunlu, Yüksel Peker, Onur Bulut, Sinem Berik Safçı, Duygu Özol, Ali Nihat Annakkaya, F Aksu, Burcu Oktay Arslan, Süreyya Yılmaz, Dursun Dursunoğlu, B. Gonen, Ümmühan Okur, Hadice Selimoğlu Şen, Oya İtil, Hilal Türkmen Kaya, Derya Karadeniz, Kadriye Ağan, Sinem N. Sökücü, Ebru Duygu, Canan Gündüz Gürkan, Hasan Akça, Selma Fırat, Tunahan Anber, Ülkü Dübüş Hoş, Melike Banu Yüceege, Metin Akgün, Sema Saraç, İbrahim Öztura, Sadık Ardıç, Önder Öztürk, Yeliz Celik, Vasfiye Kabeloğlu, Turkapne Study Group, Baran Balcan, Gülçin Benbir Şenel, Özge Aydın Güçlü, Caner Çınar, Mustafa Saygın, Nurhan Sarıoğlu
article en

Abstract

BACKGROUND: Comorbid insomnia and obstructive sleep apnea (COMISA) is increasingly recognized as a clinically important sleep disorder phenotype with potential cardiometabolic consequences. However, its association with diabetes mellitus (DM) remains insufficiently characterized. METHODS: This cross-sectional analysis included 12,715 adults with suspected obstructive sleep apnea (OSA) from the nationwide multicenter TURKAPNE cohort who underwent full-night polysomnography. Insomnia symptoms were assessed using standardized questionnaire items, and OSA was defined as apnea-hypopnea index (AHI) ≥ 5 events/hour. COMISA was defined as the coexistence of insomnia symptoms and OSA. DM was identified based on self-reported physician diagnosis or use of antidiabetic medications. Multivariable logistic regression was performed to evaluate independent variables associated with COMISA. RESULTS: COMISA was present in 3,275 patients (25.7%). DM was significantly more prevalent among patients with COMISA compared with those without COMISA (22.8% vs. 15.4%, p < 0.001). Overall, COMISA was observed in 33.9% of diabetic individuals and 24.1% of non-diabetic individuals. In multivariable analysis adjusted for age, sex, body-mass-index, smoking status, education level, and comorbidities, DM remained independently associated with COMISA (adjusted OR 1.17; 95% CI 1.05-1.31; p = 0.006). Among COMISA patients, those with DM exhibited greater sleep fragmentation and more severe sleep-disordered breathing, including higher AHI (30.0 vs. 24.0 events/h) and oxygen desaturation index (26.0 vs. 20.0 events/h) (p < 0.001). CONCLUSIONS: DM is independently associated with COMISA and with more severe sleep and respiratory disturbances within this phenotype. These findings highlight the need for integrated screening of sleep disorders in individuals with DM. TRIAL REGISTRATION: ClinicalTrials gov (NCT02784977).

Journal of Clinical Sleep MedicineVol. 22(1)
Koç University (TR), University of Pittsburgh (US), Lund University (SE), Akdeniz University (TR), Ege University (TR), Chest Diseases Hospital (KW), Yedikule Teaching Hospital (TR), Pamukkale University (TR), Istanbul University (TR), Erciyes University (TR), University of Gothenburg (SE)
Göteborgs Universitet
Good health and well-being
Openalex Percentile: Top 8%
Obstructive Sleep Apnea Research
DOIOpen Access PDFOpenAlex
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