共病失眠与睡眠呼吸暂停（COMISA）与心血管事件风险：HypnoLaus队列的前瞻性分析
Comorbid insomnia and sleep apnea (COMISA) and incident cardiovascular risk: a prospective analysis from the HypnoLaus cohort.
文献信息
| PMID | 42857102 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Geoffroy Solelhac |
| 作者单位 | Center for Investigation and Research in Sleep, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. |
| 期刊 | EClinicalMedicine |
| SCI 分区 | Q1 |
| IF | 11.8 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
背景： 共病失眠与阻塞性睡眠呼吸暂停（COMISA）是一种普遍且具有临床相关性的表型。虽然失眠和OSA分别与心血管风险增加相关，但很少有纵向研究评估它们对普通人群新发心血管事件的联合影响。
方法： 共纳入1860名来自CoLaus|PsyCoLaus队列的参与者，该队列最初于2003年至2008年间招募，并在2009年至2013年间接受HypnoLaus研究评估，所有参与者均接受了整夜多导睡眠监测并完成了匹兹堡睡眠质量指数（PSQI）。OSA定义为呼吸暂停低通气指数（AHI）≥15次/小时。失眠症状定义为在过去一个月中每周至少3次入睡困难或睡眠维持困难。参与者被分为四组：参照组（无失眠、无OSA）、单纯失眠组、单纯OSA组和COMISA组。新发心血管事件（冠心病、心肌梗死、卒中或心血管死亡）由专家委员会在中位随访7.92年[IQR：6.30-8.77]期间进行裁定。Cox回归模型调整了人口学、行为和临床协变量。
结果： 与参照组相比，COMISA与新发心血管事件风险增加独立相关（HR 1.78，95% CI：1.09-2.92，p = 0.021），而单纯失眠（HR 0.59，95% CI：0.31-1.11，p = 0.10）或单纯OSA（HR 1.33，95% CI：0.84-2.10，p = 0.22）未观察到显著关联。观察到OSA与失眠之间存在显著交互作用（p = 0.035）。在无既往心血管事件的参与者中以及采用替代COMISA定义时，结果一致。
解释： COMISA，而非单纯OSA或失眠，与新发心血管事件增加相关。这些发现强调需要在心血管预防策略中将COMISA识别并治疗为一种独特的高风险表型。
资助： 洛桑大学生物与医学学院、洛桑大学医院、瑞士国家科学基金会、Leenaards基金会、葛兰素史克、沃州肺联盟。
英文摘要
BACKGROUND: Comorbid insomnia and obstructive sleep apnea (COMISA) is a prevalent and clinically relevant phenotype. While both insomnia and OSA have been individually associated with increased cardiovascular risk, few longitudinal studies have evaluated their combined impact on incident cardiovascular events in the general population.
METHODS: A total of 1860 participants from the CoLaus|PsyCoLaus cohort, originally recruited between 2003 and 2008 and assessed in the HypnoLaus study between 2009 and 2013, were included, all of whom underwent full-night polysomnography and completed the Pittsburgh Sleep Quality Index (PSQI). OSA was defined as an apnea-hypopnea index (AHI) ≥15 events/h. Insomnia symptoms were defined as difficulty initiating or maintaining sleep ≥3 times/week over the past month. Participants were classified into four groups: reference (no insomnia, no OSA), insomnia alone, OSA alone, and COMISA. Incident cardiovascular events (coronary heart disease, myocardial infarction, stroke, or cardiovascular death) were adjudicated by an expert committee over a median follow-up period of 7.92 years [IQR: 6.30-8.77]. Cox regression models were adjusted for demographic, behavioral, and clinical covariates.
FINDINGS: Compared to the reference group, COMISA was independently associated with an increased risk of incident cardiovascular events (HR 1.78, 95% CI: 1.09-2.92, p = 0.021), while no significant association was observed for insomnia (HR 0.59, 95% CI: 0.31-1.11, p = 0.10) or OSA alone (HR 1.33, 95% CI: 0.84-2.10, p = 0.22). A significant interaction between OSA and insomnia was observed (p = 0.035). Results were consistent in participants without prior cardiovascular events and across alternative definitions of COMISA.
INTERPRETATION: COMISA, but not OSA or insomnia alone, was associated with increased incident cardiovascular events. These findings highlight the need to identify and treat COMISA as a distinct and high-risk phenotype in cardiovascular prevention strategies.
FUNDING: Faculty of Biology and Medicine of Lausanne, Lausanne University Hospital, Swiss National Science Foundation, Leenaards Foundation, GlaxoSmithKline, Ligue Pulmonaire Vaudoise.