Insomnia Alongside Sleep Apnea Tracked With Sharply Higher Heart Risk

CATEGORY: SLEEP & RECOVERY

Veterans who carried both insomnia and obstructive sleep apnea had close to four times the risk of developing cardiovascular disease as veterans with neither. That comparison rests on 937,598 US veterans, none of whom had either sleep condition when they entered care.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 carried elevated risk on its own. Together they carried substantially more.

Records From 2001 to 2021, Watched a Median 7.2 Years

The records belonged to post-9/11 veterans who enrolled in Veterans Affairs care between 2001 and 2021. Everyone counted here was free of insomnia, sleep apnea, high blood pressure and cardiovascular disease at entry. A sleep diagnosis registered only when it showed up at two or more outpatient visits, and a veteran counted as unaffected until that point and as affected after it. Follow-up ran a median of 7.2 years, with some records stretching to 22, adding up to more than 7 million person-years. New diagnoses of high blood pressure and cardiovascular disease came out of those same records.

About a Third Developed High Blood Pressure

High blood pressure was the study’s main outcome, and the link was clear. Veterans with both sleep conditions ran about two and a half times the risk, once other health and demographic factors were accounted for. About a third of the whole group developed it during follow-up. Sex did not meaningfully change the combined-condition association overall, although insomnia alone tracked more strongly with high blood pressure in women.¹

3.8 Times the Cardiovascular Risk

Cardiovascular disease showed the larger effect. That category covers heart failure, heart attack, ischemic stroke, atrial fibrillation and peripheral vascular disease. Having both conditions was associated with 3.8 times the risk. Insomnia alone went with roughly 36% higher risk. Sleep apnea alone went with somewhere between about two and a half and three times the risk. The pattern held in men and in women, women showing 3.4 times the risk. In all, 3.2% of the veterans developed cardiovascular disease during follow-up.¹ The two conditions are usually thought of, and treated, as separate problems, and a person can carry both with neither recognized, since the daytime tiredness one produces looks much like the other.

Median Age 41, and 88% Men

This is observational research built on medical records, so it shows association rather than causation. Diagnoses enter a record only when someone seeks care, which means veterans who use health services more may simply have more of these conditions detected. The researchers tested for that. They repeated 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 to older or civilian groups. Other work on the same pairing runs parallel. 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, blood pressure that stayed high despite treatment appeared in 10.2% of those with both conditions and 4.4% of those with neither.³

Key Takeaways

• Among 937,598 veterans followed a median of 7.2 years, carrying both insomnia and sleep apnea went with 3.8 times the risk of cardiovascular disease and about 2.5 times the risk of high blood pressure.
• Either condition alone carried raised risk. The pair carried more, and the two are commonly handled as separate problems.
• The study is observational and record-based. It shows a strong association, not proof that treating one or both conditions lowers heart risk.

References

1. 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
2. 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.
3. 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.