Abstract
INTRODUCTION: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.