0492 US Veterans with COMISA, Sleep Apnea, and Insomnia: Chronotype Prevalence and Patient-reported Outcomes

Abstract Introduction Among US veterans, it is unclear whether insomnia, obstructive sleep apnea (OSA), and comorbid insomnia in sleep apnea (COMISA) carry disproportionate burden to patient-reported functional outcomes (PROs). Furthermore, whether chronotypes vary among these sleep disorders groups and contribute independently to PROs has not been explored. Methods Veterans at risk for OSA evaluated at the Miami VA Sleep Center evaluated over one year. Veterans completed home polysomnography (PSG) and questionnaires (demographics, insomnia severity index ISI, patient-reported outcomes PROMIS-29). OSA diagnosis was per AHI ≥ 5 on PSG while insomnia was per ISI ≥ 15. Those with COMISA fulfilled both of these criteria. Chronotype was self-reported as “morning M”, “more morning than evening ME”, “more evening than morning EM” or “evening E” type. Sleep group characteristics were compared by ANOVA or Chi-square. Then, regression models were constructed to determine the association of COMISA and insomnia disorder reference to OSA alone on PROMIS domain T-scores. Finally, to explore whether chronotype was associated with PROs within each sleep group, regression models stratified by sleep disorder group were constructed. Results The cohort consisted of 387 veterans (85% male, mean age 52 ± 15 years ) where 60 participants (16%) had OSA alone, 68 (18%) had insomnia alone, and 259 (67%) met COMISA criteria. Participants in the insomnia group were significantly more likely to be female, have lower mean BMI and were younger than the OSA alone and COMISA groups. The chronotype prevalence of morning, ME, EM, and evening were 33%, 24%, 26%, 16%, respectively. These did not vary across sleep disorder groups (p=0.15). In regression analyses, participants with insomnia alone and COMISA had worse anxiety, depression, fatigue, sleep disturbance, social disruption, physical function, and pain interference than veterans with OSA alone. However, in analyses stratified by sleep disorder groups, chronotype was not associated with any of these PROs Conclusion Veterans with COMISA and insomnia alone were more functionally impaired than those with OSA alone. However, chronotype prevalence was similar across veterans with OSA, insomnia, and COMISA and chronotype itself was not associated with PROs. Larger studies with objective measures of chronotype are needed to replicate these findings. Support (if any) None