Cardiovascular Comorbidity in Obstructive Sleep Apnea: The “Excessive Daytime Sleepiness” Phenotype Versus Comorbid Insomnia and Sleep Apnea (COMISA)

Background/Objectives: Excessive daytime sleepiness (EDS) and comorbid insomnia and sleep apnea (COMISA) are common clinical phenotypes of obstructive sleep apnea (OSA). We compared their cardiovascular and metabolic comorbidity. Methods: Cross-sectional, single-center retrospective analysis of adults with polygraphy-confirmed OSA (apnea–hypopnea index ≥ 5 events/h). The EDS phenotype was defined as an Epworth Sleepiness Scale score ≥ 10 without insomnia (n = 54), and COMISA as OSA with clinically reported insomnia (n = 45). Multivariable logistic regression identified factors independently associated with phenotype. Results: OSA severity and the prevalence of any cardiovascular disease (90.7% vs. 86.7%) were similar. In the adjusted model, higher BMI (aOR 0.92 per kg/m2) and cardiac arrhythmias (aOR 0.20) were associated with lower odds of COMISA, and dyslipidemia with higher odds (aOR 2.51). Conclusions: Both phenotypes carry a high cardiovascular burden, but they seem to differ in metabolic profile: severe obesity and an arrhythmic tendency in sleepy OSA, and dyslipidemia in COMISA.