Military veterans with comorbid insomnia and sleep apnea (COMISA) face a significantly greater chance of developing diabetes than those with only one condition.
RT’s Three Key Takeaways
- COMISA Risk Multiplier: Veterans diagnosed with both insomnia and obstructive sleep apnea face a 6.2 times higher risk of developing type 2 diabetes compared to those without sleep disorders.
- Gender-Specific Findings: While sleep apnea alone increases diabetes risk more significantly in men, insomnia alone is associated with a 48% increased risk in women compared to 39% in men.
- Preventative Screening Value: Researchers identified sleep disorders as an independent and underrecognized risk factor for cardiometabolic disease, suggesting that early screening could serve as a vital tool for diabetes prevention.
US military veterans with comorbid insomnia and obstructive sleep apnea face a markedly elevated risk of developing type 2 diabetes, according to a study to be presented at Sleep 2026. The risk associated with the comorbid condition substantially exceeds the risk of either sleep disorder alone.
The research, which analyzed data from more than 1 million veterans, found that insomnia alone was associated with a 41% increased risk of incident type 2 diabetes. In contrast, sleep apnea alone conferred a risk more than five times higher in men and nearly four times higher in women. Veterans with both conditions, a phenotype often called comorbid insomnia and sleep apnea (COMISA), had an overall hazard ratio 6.2 times higher than those with neither disorder.
“Among younger veterans, having both insomnia and obstructive sleep apnea was associated with a much higher risk of new-onset type 2 diabetes, well beyond the risk of either disorder alone,” said Karam Al Jumaily, clinical sleep medicine fellow at Yale University, in a news release.
The associations remained significant even after the research team accounted for various risk factors, including demographics, body mass index, smoking, hypertension, hyperlipidemia, psychiatric conditions, and substance use.
“What was particularly striking was that these associations remained significant even after accounting for a broad range of demographic, metabolic, psychiatric, and behavioral risk factors,” said Al Jumaily, clinical sleep medicine fellow at Yale University, in a news release. “This suggests that sleep disorders may represent an independent and underrecognized risk factor for future cardiometabolic disease.”
The study involved secondary data analyses of a cohort of 1,074,113 US veterans with a mean age of 33 years who did not have baseline sleep disorders or type 2 diabetes at enrollment. Participants were followed through their encounters in the Department of Veterans Affairs (VA) healthcare system.
Insomnia and obstructive sleep apnea are among the most common sleep disorders in the US. The American Academy of Sleep Medicine (AASM) notes that both conditions are linked to adverse health outcomes, including metabolic dysfunction. The AASM recommends that adults experiencing symptoms of either condition seek evaluation from a sleep medicine clinician.
“COMISA represents an important sleep phenotype that clinicians and public health practitioners should be aware of, especially in veteran populations where sleep disorders and metabolic disease frequently overlap,” said Al Jumaily, clinical sleep medicine fellow at Yale University, in a news release. “These findings underscore the potential value of early sleep disorder screening and intervention as part of diabetes prevention efforts.”
