Comorbid Insomnia and Sleep Apnea (COMISA) – a real problem for psychiatrists, pulmonologists, and primary care physicians

Introduction: Insomnia and obstructive sleep apnea are among the most common sleep-wake disorders. A relatively new category of disorders, studied more thoroughly for only a few years, is the occurrence of symptoms of both obstructive sleep apnea and insomnia in one patient and treating it as a different disease entity. This phenomenon is increasingly referred to as COMISA (Co-morbid insomnia and sleep apnea). The aim of this paper is to: 1) draw attention to this interesting issue, 2) show treatment differences of COMISA from isolated insomnia or obstructive sleep apnea and to help choose better therapy by general practitioners, pulmonologists, and psychiatrists for these patients. Materials and methods: The literature review was based on a search of articles in Medline, PubMed, and Google Scholar from 2012 to 2023 using the keywords: obstructive sleep apnea; insomnia; cognitive behavioral therapy for insomnia; continuous positive airway pressure; COMISA. The analysis included original studies, meta-analyses, and review articles. Discussion: The prevalence of both diseases in patients is importantly higher than in the general population. Many patients with COMISA or OSA alone remain undiagnosed. The most common examination of OSA requires a hospital stay to perform polysomnography or polygraphy (2). A lot of people are not willing to go through with the diagnostic process. Conclusions: It is important that during the standard medical history, doctors take into account the possibility of co-occurrence of these diseases, due to the high risk of not diagnosing them on time. Keywords: Obstructive sleep apnea, Insomnia, Cognitive behavioral therapy for insomnia, Continuous positive airway pressure, COMISA