COMISA (Comorbid Insomnia and Sleep Apnea): a Practical Approach

Purpose of Review: Comorbid insomnia and sleep apnea (COMISA) is prevalent and carries significant morbidity but lacks a standardized diagnostic and therapeutic approach. Through a critical evaluation of the literature, we propose a novel approach to COMISA that incorporates the underlying etiology and existence of different phenotypes in this disorder. Recent Findings: A low arousal threshold and/or hyperarousability may underlie the development of COMISA. Pretreatment symptoms may serve as baseline predictors of response to positive airway pressure therapy in COMISA and differentiate insomnia secondary to OSA from independent insomnia. A variety of therapeutic strategies for COMISA have been put forward with evidence supporting the use of monotherapy or combined therapy in the appropriate clinical setting. Summary: Patients with either OSA or insomnia must be effectively screened for both disorders based on presenting symptoms and response to therapy. Recognition of the underlying etiology of COMISA and the different COMISA phenotypes can guide therapy.