Scientists say the combination of insomnia and sleep apnea could quietly increase the risk of heart disease.
New research from Yale School of Medicine (YSM) points to a powerful and adjustable factor that could help reduce the risk of cardiovascular disease.
In a study published in the Journal of the American Heart Association, researchers analyzed data from nearly 1 million post-9/11 U.S. veterans. The team found that adults who experience both insomnia and obstructive sleep apnea face a much greater risk of hypertension and cardiovascular disease than people with only one of these conditions. The overlapping condition, called comorbid insomnia and sleep apnea (COMISA), stood out as a particularly harmful risk profile.
“We spend an enormous amount of time managing cardiovascular disease downstream, but far less time addressing more upstream modifiable risk factors,” says Allison Gaffey, PhD, assistant professor of medicine (cardiovascular medicine) at YSM and first author of the paper. “Sleep disturbances, which are common in the veteran population, are often treated as secondary problems.”
When Insomnia and Sleep Apnea Occur Together
Insomnia and obstructive sleep apnea are usually diagnosed and managed as separate disorders. Insomnia refers to persistent difficulty falling asleep or staying asleep. Sleep apnea involves repeated pauses in breathing that interrupt sleep throughout the night. However, many people experience both conditions at the same time, and their combined effects can worsen health outcomes.
“These conditions don’t just coexist politely,” Gaffey says. “Treating one while ignoring the other is a bit like bailing water out of a boat without fixing the leak.”
Why Sleep Disruption Strains the Heart
The connection matters because sleep plays a crucial role in regulating the cardiovascular system overnight.
“Sleep touches every single part of our existence,” says Andrey Zinchuk, MD, MHS, associate professor of medicine (pulmonary, critical care, and sleep medicine) at YSM and senior author of the paper. “Oftentimes, it is neglected even though it has such an important impact on our lives.”
Zinchuk explains that when sleep is repeatedly interrupted—whether from frequent awakenings, shortened sleep time, or pauses in breathing—the heart and blood vessels miss an important opportunity to recover and rebalance.
Early Sleep Problems Could Shape Future Heart Risk
One aim of the research was to determine whether sleep disorders influence cardiovascular risk early enough for prevention to make a difference. “We wanted to know whether COMISA mattered early in the cardiovascular risk trajectory,” Gaffey says, “rather than decades later when disease is already established.”
Gaffey stresses that ongoing sleep problems should not be dismissed as a minor inconvenience. “Over time, it places a measurable strain on your cardiovascular system,” she says.
Zinchuk also emphasizes the importance of prevention. He says future approaches to sleep health should focus on reducing risk earlier rather than treating disease after it develops.
According to the researchers, sleep should be evaluated as routinely as other major cardiovascular risk factors. They recommend considering insomnia and sleep apnea together rather than separately. Because sleep disturbances are common, measurable, and treatable, addressing them earlier could significantly alter the course of cardiovascular disease.
Reference: “Insomnia, Sleep Apnea, and Incidence of Hypertension and Cardiovascular Disease Among Men and Women US Veterans” by Allison E. Gaffey, Matthew M. Burg, Henry K. Yaggi, Kaicheng Wang, Cynthia A. Brandt, Sally G. Haskell, Lori A. Bastian, Tiffany E. Chang, Allison Levine, Melissa Skanderson and Andrey Zinchuk, 11 December 2025, Journal of the American Heart Association.
DOI: 10.1161/JAHA.125.045382
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5 Comments
“Another fine example of healthcare professionals not being educated about undiagnosed sub-acute (nearly subclinical) non-IgE-mediated food (minimally, just about anything) allergy reactions aggravated (or not) with toxic FDA approved food additives (e.g., soy, MSG, minimally?) and/or excessive related/resultant medical errors. “Experience-based,” the still very, very mild allergy reactions can occur on something of a “bell curve,” a notable temporary increase/irregularity in pulse within an hour of two of eating and again about six to twelve hours later, interrupting and/or making sleep less restful; one underlying cause for both (minimally, other) conditions. Statistically, now 82, I’ve had mostly untreated (bad side effects) high blood pressure since 1992, Presently, insomnia, fatigue and muscle weakness are frequent and I’m abnormally non-productive; something more common now, I wonder, perhaps the cooking oil preservative TBHQ?”
Mr. Shaver, please try low-carb to knock out your hypertension. Give it a month or two to work. It has worked for me and many, many others. You have nothing to lose.
Thanks, Fred, but my hypertension has never been as problematic to me (just to my drug pushing doctors) as my multiple protein allergy reactions aggravated with added MSG. Despite a diet heavy in carbs I didn’t have hypertension prior to the FDA approval of the expanded use of added MSG in 1980. It’s also possible to be allergic to carbs, just about anything; highly individual. However, TBHQ is a ‘scary’ whole other matter.
Tbhq?what is it ?
Hello, Edith. Possibly a matter of individual allergic sensitivity, I find this is a reasonable place to begin to research TBHQ online: https://www.healthline.com/health/food-nutrition/potential-tbhq-dangers