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Background <p>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.</p> Methods <p>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.</p> Results <p>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%, <i>p</i> &lt; 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; <i>p</i> = 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) (<i>p</i> &lt; 0.001).</p> Conclusions <p>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.</p> Trial registration <p>ClinicalTrials gov (NCT02784977).</p> Graphical abstract <p></p>

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

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  • 发表日期：

    2026年7月2日

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  • Canan Gündüz Gürkan,
  • Aylin Pihtili,
  • Esen Kiyan,
  • Mehmet Sezai Tasbakan,
  • Özen K. Basoglu,
  • Semih Arbatli,
  • Senay Aydin,
  • Aykut Cilli,
  • Neşe Dursunoglu,
  • Burcu Baran,
  • Yüksel Peker,
  • Ahmet Ursavaş,
  • Ali Nihat Annakkaya,
  • Alperen Aksakal,
  • Aydın Balcı,
  • Ayfer Utkusavaş,
  • Aylin Özsancak Ugurlu,
  • Ayşe Deniz Elmalı,
  • Baran Balcan,
  • Başak Gönen,
  • Bilkay Serez Kaya,
  • Burcu Oktay Arslan,
  • Caner Çınar,
  • Demet İlhan Algın,
  • Derya Karadeniz,
  • Dilara Mermi Dibek,
  • Dursun Dursunoglu,
  • Duygu Özol,
  • Ebru Çakır Edis,
  • Ebru Duygu,
  • Ege Güleç Balbay,
  • Ersin Günay,
  • Fuat Erel,
  • Funda Aksu,
  • Gökhan Kırbaş,
  • Gülçin Benbir Şenel,
  • Gülgün Çetintaş Afşar,
  • Gülin Sünter,
  • Hadice Selimoğlu Şen,
  • Hamza Ogun,
  • Hasan Akça,
  • Hikmet Firat,
  • Hilal Türkmen Kaya,
  • Işıl Yazıcı Gençdal,
  • İbrahim Öztura,
  • İlker Yılmam,
  • Kadriye Ağan,
  • Mehmet Ali Habeşoğlu,
  • Mehmet Karadağ,
  • Melike Banu Yüceege,
  • Metin Akgün,
  • Muhammed Emin Akkoyunlu,
  • Mustafa Saygın,
  • Nejat Altintas,
  • Nur Aleyna Yetkin,
  • Nurhan Sarıoğlu,
  • Oğuz Osman Erdinç,
  • Onur Bulut,
  • Oya İtil,
  • Oya Öztürk,
  • Önder Öztürk,
  • Özge Aydın Güçlü,
  • Özlem Erçen Diken,
  • Pınar Bekdik Şirinocak,
  • Pınar Yıldız Gülhan,
  • Sadık Ardıç,
  • Selma Fırat,
  • Sema Saraç,
  • Sevgi Ferik,
  • Sezgi Şahin Duyar,
  • Sinem Berik Safçi,
  • Sinem N. Sökücü,
  • Süreyya Yılmaz,
  • Tunahan Anber,
  • Uluğ Bey Hayri,
  • Ülkü Dübüş Hoş,
  • Ümmühan Okur,
  • Vasfiye Kabeloğlu,
  • Yeliz Celik,
  • Zahide Yılmaz,
  • Zeynep Zeren Uçar

摘要

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).

Graphical abstract