Evidence mapPaperPMID 41677976Full record

ArticleJournal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine2026

Obstructive sleep apnea comorbid with insomnia symptoms and objective short sleep duration is associated with incident hypertension.

Nikolaos Athanasiou, Slobodanka Pejovic, Alexandros N Vgontzas, Julio Fernandez-Mendoza, Yun Li, Maria Karataraki, Edward O Bixler

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Article in Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

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4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Nikolaos AthanasiouSleep Research and Treatment Center, Department of Psychiatry and Behavioral Health, Penn State University College of Medicine, 500 University Drive, Hershey, PA, 17033, USA.
Slobodanka PejovicSleep Research and Treatment Center, Department of Psychiatry and Behavioral Health, Penn State University College of Medicine, 500 University Drive, Hershey, PA, 17033, USA.
Alexandros N VgontzasSleep Research and Treatment Center, Department of Psychiatry and Behavioral Health, Penn State University College of Medicine, 500 University Drive, Hershey, PA, 17033, USA. avgontzas@pennstatehealth.psu.edu.ORCID 0000-0002-8323-7526
Julio Fernandez-MendozaSleep Research and Treatment Center, Department of Psychiatry and Behavioral Health, Penn State University College of Medicine, 500 University Drive, Hershey, PA, 17033, USA.
Yun LiDepartment of Sleep Medicine, Shantou University Mental Health Center, Shantou University Medical College, Shantou, Guangdong, China.
Maria KaratarakiDepartment of Psychiatry and Behavioral Sciences, University of Crete, Heraklion, Crete, Greece.
Edward O BixlerSleep Research and Treatment Center, Department of Psychiatry and Behavioral Health, Penn State University College of Medicine, 500 University Drive, Hershey, PA, 17033, USA.

Funding

SLEEP APNEA--AGE EFFECTS ON PREVALENCE &NATURAL HISTORYR01HL040916 · NHLBI · PENNSYLVANIA STATE UNIV HERSHEY MED CTR · PI BIXLER, EDWARD O. · 1990 to 1994
NHLBI NIH HHS Grants ROl HL40916NHLBI NIH HHS HLS193NHLBI NIH HHS R01 HL040916
6 · The paper itself

Abstract

purposeCo-morbid insomnia and obstructive sleep apnea (COMISA) poses greater cardiovascular risks than either condition alone. We investigated whether COMISA associated with insomnia with short sleep duration (ISSD) phenotype is associated with an increased risk of incident hypertension in a large random general population sample.

methodsFrom the 1741 participants of the Penn State Adult Cohort, 1395 were followed-up after 7.5 years and 786 did not have hypertension at baseline. Hypertension was determined by a self-report of receiving treatment for high blood pressure. Insomnia symptoms were defined as either a complaint of chronic insomnia lasting ≥ 1 year or a complaint of difficulty falling asleep, staying asleep, nonrestorative sleep, or early morning awakening. All subjects underwent 8-h in-laboratory polysomnography. Obstructive sleep apnea was defined as an obstructive apnea/hypopnea index ≥ 5 event/h. Objective short sleep duration was defined as < 6 h sleep.

resultsThe mean age of the study population was 47.5 ± 12.7 years and 51.3% were women. Compared to good sleepers, the highest risk of incident hypertension was in the COMISA with ISSD phenotype (OR = 4.25, 95%CI = 1.52-11.90), followed by OSA-alone (OR = 3.31, 95%CI = 1.85-5.92) and ISSD (OR = 2.27, 95%CI = 1.29-4). The insomnia with normal sleep duration phenotype alone or with OSA (COMISA) was not significantly associated with incident hypertension.

conclusionsThe additive effect of COMISA on hypertension risk is associated with the ISSD phenotype, the most severe biological phenotype of insomnia. Obtaining objective sleep duration in addition to apnea/hypopnea and/or oxygen saturation indices may lead to a more accurate diagnosis and treatment of COMISA.

Indexed as

HypertensionSleep Apnea, ObstructiveSleep Initiation and Maintenance DisordersAdultCohort StudiesComorbidityFemaleHumansIncidenceMaleMiddle AgedPennsylvaniaPolysomnographyRisk FactorsSleep DurationBlood pressureCOMISA phenotypesObjective sleep duration

Identifiers

PMID41677976
PMCPMC12789127

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.