Comorbid insomnia in patients undergoing surgery for obstructive sleep apnea: Clinical profile and postoperative outcomes in a nationwide cohort.

INTRODUCTION Comorbid insomnia and obstructive sleep apnea (COMISA) remains undercharacterized in surgical populations. We compared baseline profiles and postoperative outcomes in patients with COMISA versus OSA alone undergoing upper airway surgery.

Methods

Retrospective cohort study using the Apollo electronic health record and claims dataset (2015-2024). Adults with OSA undergoing upper airway surgery were classified as COMISA if insomnia was documented beforehand. Both groups were indexed at the surgical date. Outcomes were restricted to incident events by excluding patients with the outcome at baseline. Five prespecified models were evaluated after propensity-score matching over 3 years (1 year for healthcare utilization). Odds ratios were estimated with exact conditional methods.

Results

Of 3292 adults, 863 (26.2%) had documented insomnia. Compared with 2429 patients with OSA alone, they had double the prevalence of depression or anxiety (61.5% vs 30.6%), antidepressant use (51.4% vs 27.6%) and chronic pain (25.1% vs 12.4%), and were older with higher comorbidity. After matching, patients with COMISA had higher odds of initiating antidepressant therapy within three years (26.9% vs 6.0%; OR 5.71, 95% CI 1.73-24.7; unadjusted OR 2.38, 1.31-4.33). No differences were observed for substance use disorders, constitutional symptoms, sleep-related movement disorders or healthcare utilization (office visits IRR 0.99, 0.86-1.15).

Conclusions

COMISA identifies a distinct preoperative phenotype with greater psychiatric and somatic morbidity. This burden did not translate into worse postoperative outcomes or increased utilization, apart from antidepressant initiation, an estimate of uncertain magnitude. This observational analysis cannot assess surgical efficacy, and residual confounding is possible.