A new study published in the Journal of the American Heart Association reveals a significant link between sleep disorders – specifically the combination of insomnia and obstructive sleep apnea – and an increased risk of hypertension and cardiovascular disease among U.S. Military veterans. The research, which analyzed data from nearly one million post-9/11 veterans, highlights the critical need for identifying and addressing sleep disturbances as a key component of cardiovascular prevention.
The study underscores a growing understanding of the interconnectedness between sleep health and overall cardiovascular well-being. Veterans, who already demonstrate a higher predisposition to hypertension and cardiovascular disease compared to the general population, face an even greater risk when grappling with both insomnia and sleep apnea simultaneously. This combination, termed COMISA (Comorbid Insomnia and Obstructive Sleep Apnea), appears to be particularly detrimental.
COMISA and Cardiovascular Risk: Key Findings
Researchers found that veterans with COMISA exhibited a substantially elevated risk of developing hypertension. According to the study, the adjusted hazard ratio for hypertension was 2.43 (95% CI: 2.36-2.50) for those with COMISA, indicating a more than twofold increase in risk compared to veterans without any sleep disorder [1]. This risk was observed across both men and women, though the specific hazard ratios differed slightly by sex.
“Compared with veterans who had no sleep disorder, those with COMISA showed the highest risk of developing hypertension,” stated Allison Gaffey, PhD, lead author of the study and researcher at the VA Connecticut Healthcare System and Yale School of Medicine [2]. The research team utilized administrative and electronic health record data to identify cases of insomnia and obstructive sleep apnea, defined by diagnostic codes and medication fills.
Understanding the Impact of Sleep Apnea and Insomnia
Obstructive sleep apnea (OSA) is a condition where breathing repeatedly stops and starts during sleep, leading to oxygen deprivation and disrupted sleep patterns. Insomnia, is characterized by difficulty falling asleep, staying asleep, or experiencing non-restorative sleep. When these two conditions coexist, the negative effects on cardiovascular health appear to be amplified. The study suggests that the combined stress on the body – from oxygen fluctuations in OSA and the chronic hyperarousal associated with insomnia – contributes to the increased risk of hypertension and cardiovascular disease.
The study included 937,598 post-9/11 Veterans with a median age of 41 years, with 12% being women [5]. Researchers adjusted for a range of demographic, behavioral, and clinical factors to isolate the specific impact of COMISA on cardiovascular outcomes.
Implications for Veteran Healthcare and Beyond
The findings have significant implications for healthcare providers treating veterans, as well as for the broader medical community. The study emphasizes the importance of routinely screening for both insomnia and obstructive sleep apnea in patients at risk for cardiovascular disease. Early identification and intervention – including lifestyle modifications, cognitive behavioral therapy for insomnia, and continuous positive airway pressure (CPAP) therapy for sleep apnea – may assist mitigate the increased cardiovascular risk associated with COMISA.
“Identifying disordered sleep among men and women should be a cardiovascular prevention priority,” the study authors conclude [5]. The research too highlights the need for further investigation into the underlying mechanisms linking sleep disorders and cardiovascular disease, which could lead to the development of more targeted and effective prevention strategies.
The study, published December 11, 2025, builds on existing research demonstrating the link between sleep disturbances and cardiovascular health. A 2025 study published in J Am Heart Assoc further confirmed these associations in a veteran population [4]. The growing body of evidence underscores the importance of prioritizing sleep health as an integral part of overall cardiovascular care.
Looking ahead, researchers plan to explore the potential benefits of integrated sleep disorder treatment programs for veterans, as well as investigate the impact of COMISA on other health outcomes, such as cognitive function and mental health. Continued research and proactive clinical management are essential to address the significant health challenges posed by sleep disorders and their connection to cardiovascular disease.
Have you or a loved one experienced challenges with sleep and cardiovascular health? Share your thoughts in the comments below.
Disclaimer: This article provides informational content and should not be considered medical advice. Please consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.
