0931 COMISA-MARES: Comorbid Insomnia and Obstructive Sleep Apnea with and Without Nightmares in US Military Personnel

Abstract Introduction Comorbid insomnia and obstructive sleep apnea (OSA), also called COMISA, has deleterious effects on mental and physical health. Limited research has examined the occurrence of nightmares in patients with COMISA. In a sample of service members seen in a US military sleep disorders clinic, this study examined the impact of nightmares among participants with insomnia, OSA, and COMISA and how sleep and mental health symptoms differed by sleep disorder (i.e., insomnia only, OSA only, COMISA) among those with nightmares. Methods In this observational study, 372 participants completed video-polysomnography and received a primary sleep disorder diagnosis (i.e., insomnia, OSA, COMISA). Participants with nightmares 1 ≥ week that woke them up at least “sometimes” were counted as having nightmares. Participants also completed measures of insomnia, anxiety, depression, and posttraumatic stress disorder (PTSD). General linear and mixed effects models were used to test our research questions. Results Nightmares were endorsed by 30% (n = 111) and were significantly more likely to be reported by those in the insomnia (36%, n = 42) and COMISA (38%, n = 52) groups than in the OSA group (14%, n = 17; p <.0001). Among the sleep diagnostic groups (i.e., insomnia, OSA and COMISA), participants with nightmares had significantly increased insomnia, anxiety, depression and PTSD symptoms compared to those without nightmares. Participants with COMISA and nightmares (i.e., COMISA-MARES) had the worst overall symptoms. Conclusion We propose COMISA-MARES as the combination of three sleep disorders that manifests with the worst overall sleep and mental health symptoms in military personnel. Given the high diagnostic rate, military and veteran sleep clinics should incorporate insomnia and nightmare assessments in efforts to better characterize this disorder. COMISA is significantly more burdensome than OSA alone and insomnia alone, and nightmares pose an even greater additive element of burden. Research is needed to guide treatment. Support (if any) This work was supported by the Defense Health Agency, Defense Medical Research and Development Program, Clinical Research Intramural Initiative for Military Women’s Health (DM170708; Mysliwiec) and the US Air Force (USAF) Air Force Materiel Command (AFMC), Wright Patterson Air Force Base, Ohio (FA8650-18-2-6953; Peterson).