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

Authors: Ervin Cotrik, Janete Hernandes, Viviane Castro e Edilson Zancanella 

Abstract

Purpose

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

Methods

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.

Results

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.

Conclusion

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.

Available at:https://link.springer.com/article/10.1007/s11325-026-03631-0#MOESM1