{"doi":"10.1161/jaha.125.045382","title":"Insomnia, Sleep Apnea, and Incidence of Hypertension and Cardiovascular Disease Among Men and Women US Veterans","abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background</jats:title>\n                    <jats:p xml:lang=\"en\">Comorbid insomnia and obstructive sleep apnea (COMISA) is associated with cardiovascular disease (CVD) in older adults. The associations of COMISA with cardiovascular risk among military veterans, who show a greater risk for hypertension and CVD than non‐Veterans, and whether associations differ by sex are unknown. Thus, we examined associations of COMISA with incident hypertension and CVD risk in post‐9/11 Veterans.</jats:p>\n                  </jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods</jats:title>\n                    <jats:p xml:lang=\"en\">This retrospective cohort included patients who enrolled in Veterans Health Administration care from 2001 to 2021. Insomnia and obstructive sleep apnea were defined by ≥2 outpatient diagnoses. Hypertension was defined by ≥2 outpatient‐coded diagnoses or ≥1 antihypertensive medication fill; CVD by ≥1 inpatient or ≥2 outpatient diagnoses. Time‐varying Cox proportional hazard models adjusted for demographics, behavioral, and clinical factors were conducted overall and by sex. Sensitivity analyses accounted for health care use, a 180‐day washout, sleep study–confirmed diagnoses, outpatient blood pressure data, and inclusion of patients deceased during follow‐up.</jats:p>\n                  </jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results</jats:title>\n                    <jats:p xml:lang=\"en\">Among 937 598 veterans (12% women; median age, 41 years), COMISA was associated with increased hypertension risk overall (adjusted hazard ratio [aHR], 2.43 [95% CI, 2.36–2.50]), in men (aHR, 2.09 [95% CI, 2.02–2.16]) and in women (aHR, 2.20 [95% CI, 2.00–2.42]). Insomnia alone (aHR, 1.27–1.44) and obstructive sleep apnea only (aHR, 2.00–2.26) were also associated with elevated risk. COMISA was similarly associated with CVD 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 (aHR, 1.36–1.37) and obstructive sleep apnea (aHR, 3.32–2.62). Sensitivity analyses were consistent.</jats:p>\n                  </jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions</jats:title>\n                    <jats:p xml:lang=\"en\">COMISA conferred the greatest risk of hypertension and CVD among post‐9/11 Veterans. Identifying disordered sleep among men and women may be an important CVD prevention priority.</jats:p>\n                  </jats:sec>","journal":"Journal of the American Heart Association","year":2025,"id":671798,"datarank":0.24141568686511508,"base_score":1.6094379124341003,"endowment":1.6094379124341003,"self_citation_contribution":0.24141568686511508,"citation_network_contribution":0.0,"self_endowment_contribution":0.24141568686511508,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":4,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":374650,"name":"Matthew M. Burg","orcid":"0000-0002-1263-2385","position":1,"is_corresponding":false},{"id":465646,"name":"H. Klar Yaggi","orcid":"0000-0002-9888-2480","position":2,"is_corresponding":false},{"id":896996,"name":"Kaicheng Wang","orcid":"0000-0003-2519-2670","position":3,"is_corresponding":false},{"id":263472,"name":"Cynthia Brandt","orcid":"0000-0001-8179-1796","position":4,"is_corresponding":false},{"id":374649,"name":"Sally G. Haskell","orcid":"0000-0002-2888-2637","position":5,"is_corresponding":false},{"id":360883,"name":"Lori A. Bastian","orcid":"0000-0003-2874-6405","position":6,"is_corresponding":false},{"id":230980,"name":"Tiffany Chang","orcid":"0000-0003-4700-2823","position":7,"is_corresponding":false},{"id":1440734,"name":"Allison Levine","orcid":"0000-0003-4316-784X","position":8,"is_corresponding":false},{"id":496154,"name":"Melissa Skanderson","orcid":"0000-0002-5539-8680","position":9,"is_corresponding":false},{"id":851215,"name":"Andrey Zinchuk","orcid":"0000-0003-0488-9778","position":10,"is_corresponding":false},{"id":674109,"name":"Allison E. Gaffey","orcid":"0000-0002-2960-2772","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Insomnia, Sleep Apnea, and Incidence of Hypertension and Cardiovascular Disease Among Men and Women US Veterans","abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background</jats:title>\n                    <jats:p xml:lang=\"en\">Comorbid insomnia and obstructive sleep apnea (COMISA) is associated with cardiovascular disease (CVD) in older adults. The associations of COMISA with cardiovascular risk among military veterans, who show a greater risk for hypertension and CVD than non‐Veterans, and whether associations differ by sex are unknown. Thus, we examined associations of COMISA with incident hypertension and CVD risk in post‐9/11 Veterans.</jats:p>\n                  </jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods</jats:title>\n                    <jats:p xml:lang=\"en\">This retrospective cohort included patients who enrolled in Veterans Health Administration care from 2001 to 2021. Insomnia and obstructive sleep apnea were defined by ≥2 outpatient diagnoses. Hypertension was defined by ≥2 outpatient‐coded diagnoses or ≥1 antihypertensive medication fill; CVD by ≥1 inpatient or ≥2 outpatient diagnoses. Time‐varying Cox proportional hazard models adjusted for demographics, behavioral, and clinical factors were conducted overall and by sex. Sensitivity analyses accounted for health care use, a 180‐day washout, sleep study–confirmed diagnoses, outpatient blood pressure data, and inclusion of patients deceased during follow‐up.</jats:p>\n                  </jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results</jats:title>\n                    <jats:p xml:lang=\"en\">Among 937 598 veterans (12% women; median age, 41 years), COMISA was associated with increased hypertension risk overall (adjusted hazard ratio [aHR], 2.43 [95% CI, 2.36–2.50]), in men (aHR, 2.09 [95% CI, 2.02–2.16]) and in women (aHR, 2.20 [95% CI, 2.00–2.42]). Insomnia alone (aHR, 1.27–1.44) and obstructive sleep apnea only (aHR, 2.00–2.26) were also associated with elevated risk. COMISA was similarly associated with CVD 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 (aHR, 1.36–1.37) and obstructive sleep apnea (aHR, 3.32–2.62). Sensitivity analyses were consistent.</jats:p>\n                  </jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions</jats:title>\n                    <jats:p xml:lang=\"en\">COMISA conferred the greatest risk of hypertension and CVD among post‐9/11 Veterans. Identifying disordered sleep among men and women may be an important CVD prevention priority.</jats:p>\n                  </jats:sec>","is_dataset_classified":null,"base_score":1.6094379124341003,"endowment":1.6094379124341003,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"41378507","pmcid":"PMC12826891","openalex_id":"https://openalex.org/W4417230337","authors":[],"funders":[{"funder_name":"NHLBI NIH HHS","grant_id":"K23 HL168233","title":null}],"total_grants":1,"fwci":4.3746,"citation_percentile":0.94841128,"influential_citations":0,"citation_trend":[{"year":2026,"count":4}],"oa_status":"gold","license":"cc-by-nc","oa_locations":[{"url":"https://doi.org/10.1161/jaha.125.045382","host_type":"journal"},{"url":"https://doi.org/10.1161/jaha.125.045382","host_type":"publisher"},{"url":"https://www.ahajournals.org/doi/full/10.1161/JAHA.125.045382","host_type":"publisher"},{"url":"https://pubmed.ncbi.nlm.nih.gov/41378507","host_type":"repository"},{"url":"https://doaj.org/article/5f9403160c954517b143bf4d4aa8391c","host_type":"repository"},{"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12826891/","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC12826891","host_type":"Europe_PMC"},{"url":"https://europepmc.org/articles/PMC12826891?pdf=render","host_type":"Europe_PMC"}],"fields_of_study":["Sleep and related disorders","Obstructive Sleep Apnea Research","Blood Pressure and Hypertension Studies","Humans","Female","Male","Hypertension","Sleep Initiation and Maintenance Disorders","United States","Incidence","Retrospective Studies","Middle Aged","Veterans","Adult","Cardiovascular Diseases","Sleep Apnea Syndromes","Risk Factors","Risk Assessment","Sleep Apnea, Obstructive","Comorbidity","Sex Factors","Aged","Veterans Health"],"mesh_terms":["Adult","Aged","Cardiovascular Diseases","Female","Humans","Hypertension","Sleep Initiation and Maintenance Disorders","Male","Middle Aged","Retrospective Studies","Risk Factors","Sex Factors","Sleep Apnea Syndromes","United States","Veterans","Comorbidity","Incidence","Risk Assessment","Sleep Apnea, Obstructive","Veterans Health"],"keywords":["Incidence (geometry)","Disease","Sleep (system call)","Epidemiology","Blood pressure","Sleep apnea","Risk factor","Hypertension","Prevention","Cardiovascular disease","Insomnia","Sex differences","obstructive sleep apnea"],"sdg_mappings":[],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[{"name":"doi"}],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-16T04:36:49.928961Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}