The prevalence of chronotype and associations with patient-reported outcomes among military veterans with obstructive sleep apnea, insomnia, and COMISA

Oct 16, 2025Sleep medicine

Common sleep timing patterns and their links to health reports in military veterans with sleep apnea, insomnia, or both

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Circadian Biology on OpenScience ↗PubMed ↗DOI ↗

Abstract

Among 387 veterans, 67% were identified with comorbid insomnia and sleep apnea (COMISA).

Insomnia alone and COMISA were linked to worse outcomes in anxiety, depression, fatigue, sleep disturbance, social disruption, physical function, and pain interference compared to obstructive sleep apnea (OSA) alone.
The prevalence of chronotypes among the cohort was 33% morning, 50% intermediate, and 16% evening.
Evening chronotype was more common in veterans with insomnia alone (19%) and COMISA (17%) compared to those with OSA alone (8%).
Evening chronotype was associated with higher depressive symptoms in all diagnostic groups.
Veterans with COMISA and insomnia alone demonstrated greater functional impairment than those with OSA alone.

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OBJECTIVE: Among military veterans, it is unclear whether insomnia, obstructive sleep apnea (OSA), and comorbid insomnia and sleep apnea (COMISA) carry disproportionate burden to patient-reported outcomes (PROs). Furthermore, differences in chronotype preference among these diagnostic groups and their contribution to PROs have not been explored.

METHODS: Veterans at risk for OSA were evaluated at the Miami VAHS Sleep Center across a year-long period. Home polysomnography (PSG) and questionnaires (demographics, insomnia severity index [ISI], patient-reported outcomes measurement information system [PROMIS-29]) were used to establish well-characterized diagnostic clinical groups. Chronotype preference was self-reported as morning, intermediate or evening type according to the Morningness-Eveningness Questionnaire.

RESULTS: The cohort consisted of 387 veterans (85 % male, M = 52 ± 15 yrs), identified with OSA alone (N = 60, 16 %), insomnia alone (N = 68, 18 %) or COMISA (N = 259, 67 %). The chronotype prevalence of morning, intermediate, and evening were 33 %, 50 %, 16 %, respectively. Evening chronotype frequency was more prevalent in those with insomnia alone (19 %) and COMISA (17 %) than in those with OSA alone (8 %). Insomnia alone and COMISA were associated with worse anxiety, depression, fatigue, sleep disturbance, social disruption, physical function, and pain interference than OSA alone. Evening chronotype was associated with greater depressive symptoms across all sleep disorder groups. age

CONCLUSIONS: Veterans with COMISA and insomnia alone preferred evening chronotype and were more functionally impaired than those with OSA alone. Regardless of sleep disorder, evening chronotype was associated with active depressive symptoms. Incorporating chronotype assessment in military veterans with sleep disorders may have clinical implications for treatment planning.

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The prevalence of chronotype and associations with patient-reported outcomes among military veterans with obstructive sleep apnea, insomnia, and COMISA

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