# Physiopathological correlations of comorbid insomnia and sleep apnoea (comisa) – a systematic review and meta-analysis

## TL;DR

This study reviews how insomnia and sleep apnoea together affect health, finding they worsen each other's symptoms and require personalized treatment.

## Contribution

The study provides new insights into the combined physiopathological mechanisms of comorbid insomnia and sleep apnoea.

## Key findings

- COMISA is associated with higher AHI and lower oxygen saturation.
- COMISA patients show disrupted sleep architecture and increased wake time after sleep onset.
- The condition involves complex interactions of arousal and neurobiological changes.

## Abstract

To ascertain the physiopathological correlations of insomnia and obstructive sleep apnoea (Comorbid Insomnia and Sleep Apnoea (COMISA).

Systematic review and meta-analysis, with searches in PubMed, Embase, Web of Science, Scopus, Cochrane, and grey literature, including physiopathological characteristics and prevalence of COMISA in observational studies. The meta-analysis employed the I² and Cochran’s Q tests, as well as the random effects method, and the results were presented in forest plots. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal tools.

Sixteen studies were selected, with a prevalence of 30% for COMISA, 39% among ages 18–40, 42% in European countries, and an average Body Mass Index (BMI) of 28.55 (± 1.12). Patients with COMISA have higher Apnoea-Hypopnea Index (AHI), lower minimum oxygen saturation, higher micro-arousal index, longer wake time after sleep onset Wake Time After Sleep Onset (WASO), lower sleep efficiency, longer sleep latency, and possibly shorter Rapid Eye Movement (REM) sleep duration.

The physiopathology of COMISA involves compromised sleep architecture and a complex interaction of mechanisms related to central arousal, sleep fragmentation, neurobiological changes, and a more severe profile of clinical and psychiatric comorbidities, with additive or synergistic consequences of the isolated disorders, requiring a comprehensive and personalized diagnostic and therapeutic approach.

PROSPERO Registry number: CRD420251038279.

The online version contains supplementary material available at 10.1007/s11325-026-03631-0.