Integrated Sleep Assessment as a Standard for Cardiovascular Risk Stratification

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Summary of  Journal of the American Heart Association https://doi.org/10.1161/JAHA.125.045382 
Dr. Allison E. Gaffey  et al.

Points

Researchers identified that veterans suffering from both insomnia and obstructive sleep apnea face significantly higher risks of developing hypertension and cardiovascular disease than those with only one sleep disorder.
The study examined nearly one million post nine eleven veterans to determine how comorbid sleep disturbances act as upstream modifiable risk factors before heart disease becomes permanently established in the body.
Sleep apnea and insomnia frequently interact to prevent the cardiovascular system from resetting overnight which places measurable strain on the heart and blood vessels during the critical recovery window of sleep.
Allison Gaffey and her team found that the combination of these conditions creates a distinct risk state that must be addressed through integrated rather than separate clinical diagnostic and treatment pathways.
The findings advocate for sleep to be routinely assessed during cardiovascular screenings to allow for early interventions that could potentially alter the long term health trajectory for millions of patients.

Summary

This research evaluated the association between comorbid insomnia and obstructive sleep apnea (COMISA) and the incidence of hypertension and cardiovascular disease (CVD) in a cohort of nearly 1 million post-9/11 U.S. veterans. While insomnia and sleep apnea are traditionally managed as independent pathologies, this study identifies COMISA as a distinct clinical state that significantly accelerates the cardiovascular risk trajectory. The investigation aimed to determine if sleep disturbances serve as primary upstream modifiable risk factors for CVD, particularly in a high-risk veteran population prone to early-onset neuro-hormonal and vascular dysfunction.

The analysis demonstrated that the synergistic interaction of repeated nocturnal awakenings and periodic cessations of breathing prevents the cardiovascular system from achieving essential overnight recovery. This chronic physiological strain resulted in substantially higher risks for both incident hypertension and CVD compared to veterans presenting with either insomnia or obstructive sleep apnea alone. By focusing on a younger, post-9/11 cohort, the researchers highlighted that the deleterious effects of COMISA are measurable early in life, rather than appearing only after decades of established disease.

The findings suggest that sleep should be integrated into routine cardiovascular risk assessments alongside traditional metrics like blood pressure and lipid profiles. The study emphasizes that treating a single sleep disorder while ignoring a comorbid condition may fail to mitigate long-term cardiovascular outcomes effectively. These results underscore the necessity for integrated sleep medicine interventions to shift the management paradigm from late-stage CVD treatment to early-stage prevention, potentially altering the health trajectory of millions of veterans and adults in the general population.

Link to the article: https://www.ahajournals.org/doi/10.1161/JAHA.125.045382

References

Gaffey, A. E., Burg, M. M., Yaggi, H. K., Wang, K., Brandt, C. A., Haskell, S. G., Bastian, L. A., Chang, T. E., Levine, A., Skanderson, M., & Zinchuk, A. (2025). Insomnia, sleep apnea, and incidence of hypertension and cardiovascular disease among men and women us veterans. Journal of the American Heart Association, 14(24), e045382. https://doi.org/10.1161/JAHA.125.045382