CATEGORY: SLEEP & RECOVERY
Among 937,598 US veterans who had neither condition when they entered care, those later diagnosed with both insomnia and obstructive sleep apnea had close to four times the risk of developing cardiovascular disease compared with those diagnosed with neither.1 Insomnia means persistent trouble falling or staying asleep; obstructive sleep apnea is a condition in which the airway repeatedly collapses during sleep, interrupting breathing dozens of times an hour. Each one alone carried elevated risk, but the combination carried substantially more.
Veterans Enrolled Between 2001 and 2021, Median 7.2 Years
Researchers examined the health records of post-9/11 veterans who enrolled in Veterans Affairs care between 2001 and 2021. Everyone included was free of insomnia, sleep apnea, high blood pressure and cardiovascular disease at the point they entered. Sleep diagnoses counted only when they appeared at two or more outpatient visits, and a veteran counted as unaffected until the diagnosis appeared and as affected afterward. The group was followed for a median of 7.2 years, some records running as long as 22, adding up to more than 7 million person-years. New diagnoses of high blood pressure and cardiovascular disease came from those same records.
A Third of the Group Developed High Blood Pressure
High blood pressure was the study’s main outcome, and it was clearly linked: veterans with both sleep conditions had about two and a half times the risk, after accounting for other health and demographic factors. About a third of the whole group developed high blood pressure during follow-up. Sex did not significantly change the combined-condition association overall, though insomnia alone was linked more strongly to high blood pressure in women.1
Cardiovascular disease—a category covering heart failure, heart attack, ischemic stroke, atrial fibrillation and peripheral vascular disease—showed the larger effect. Having both conditions was associated with 3.8 times the risk. Insomnia alone was linked to roughly 36% higher risk, and sleep apnea alone to somewhere between about two and a half and three times the risk. The pattern held for men and for women, with women showing 3.4 times the risk. Overall, 3.2% of the veterans developed cardiovascular disease during follow-up.1
Daytime Tiredness Masks One Condition as the Other
Insomnia and sleep apnea are usually thought of, and treated, as separate problems, and a person can carry both without either being recognized—the daytime tiredness one produces looks much like the other. This study is one of the largest to examine what happens when they occur together, and the risk attached to that pairing was greater than to either condition on its own.
A Veteran Group With Median Age 41, 88% Men
This is observational research based on medical records, so it shows association, not causation. Because diagnoses only appear in records when someone seeks care, veterans who use health services more may be more likely to have any of these conditions detected; the researchers tested for that, repeating the analysis using only sleep-study-confirmed diagnoses and measured blood pressure readings, and the results held. The participants were post-9/11 veterans—median age 41 and 88% men—so the findings may not carry over to older or civilian populations.
Both Conditions Tied to 47% Higher Death Risk
Other research on the same pairing points the same way. Among 5,236 middle-aged and older US adults in a community sleep study, having both conditions was associated with a 47% higher risk of dying during follow-up than having neither.2 In a Swedish study of 3,832 middle-aged adults, uncontrolled high blood pressure—pressure still high despite treatment—appeared in 10.2% of those with both conditions versus 4.4% of those with neither.3
Key Takeaways
- In 937,598 veterans followed a median of 7.2 years, having both insomnia and sleep apnea was associated with 3.8 times the risk of cardiovascular disease and about 2.5 times the risk of high blood pressure.
- Either condition alone carried elevated risk, but the two together carried more—and they are commonly treated as separate problems.
- The study is observational and based on health records; it shows a strong association, not proof that treating one or both conditions lowers heart risk.
References
- Gaffey AE, Burg MM, Yaggi HK, et al. Insomnia, Sleep Apnea, and Incidence of Hypertension and Cardiovascular Disease Among Men and Women US Veterans. Journal of the American Heart Association. 2025;14(24):e045382. link
- Lechat B, Appleton S, Melaku YA, et al. Comorbid insomnia and sleep apnoea is associated with all-cause mortality. European Respiratory Journal. 2022;60(1):2101958. link.
- Kobayashi Frisk M, Bergqvist J, Svedmyr S, et al. Comorbid insomnia and sleep apnea is associated with uncontrolled hypertension in a middle-aged population. Annals of the American Thoracic Society. 2026;23(1):125–131. link.