Co-morbid insomnia and sleep apnea (COMISA): recent research and future directions

Alexander Sweetman, Amal Osman, Leon Lack, Megan Crawford, Douglas Wallace

Research output: Contribution to journalReview articlepeer-review


PURPOSE OF REVIEW: Insomnia and obstructive sleep apnea have previously been viewed as completely independent conditions. However, there is now increasing recognition that insomnia and sleep apnea frequently co-occur. Co-morbid insomnia and sleep apnea (COMISA) is a highly prevalent condition that is associated with impairment of sleep, daytime function, mental health and physical health outcomes, and mortality risk. This review aims to provide an update on COMISA prevalence, consequences, treatment approaches, and future research directions. 

RECENT FINDINGS: People with COMISA experience worse sleep, mental health, physical health, quality of life and longevity compared to people with neither condition, and often compared to those with insomnia alone and sleep apnea alone. Emerging evidence suggests that cognitive behavioral therapy for insomnia is an effective treatment in the presence of treated and untreated sleep apnea, that may also improve manifestations and subsequent management of sleep apnea. Future research is required to understand the etiology of COMISA, and to develop and implement tailored treatment approaches. 

SUMMARY: It is important for sleep and respiratory technicians, researchers and clinicians to be aware of the high co-morbidity rates, consequences, and treatment requirements of patients with co-morbid insomnia and sleep apnea.

Original languageEnglish
Pages (from-to)567-573
Number of pages7
JournalCurrent Opinion in Pulmonary Medicine
Issue number6
Publication statusPublished - Nov 2023


  • co-morbid insomnia and sleep apnea
  • continuous positive airway pressure
  • insomnia
  • sleep apnea
  • sleep disordered breathing
  • sleeplessness


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