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COMISA patients exhibit a more vulnerable body composition profile characterized by lower skeletal muscle mass and higher visceral fat area compared to OSA-only patients

In a cross-sectional study of 2915 patients with moderate-to-severe OSA, 29.7% were classified as COMISA. COMISA patients had lower skeletal muscle mass (SMM) and higher visceral fat area (VFA), with the SMM/VFA ratio inversely associated with insomnia severity (ฮฒ = -0.08, p = 0.001) and COMISA status (OR = 0.29, p = 0.004), particularly in males.

Last updated: Jul 23, 2026โ€ข0 RCTsโ€ข๐Ÿ“– Read as article โ†’

Evidence Score

Evidence Score34/100
Human RCTโ˜†โ˜†โ˜†โ˜†โ˜†
Meta-analysisโ˜†โ˜†โ˜†โ˜†โ˜†
Mechanismโ˜…โ˜…โ˜…โ˜…โ˜…
Safetyโ˜…โ˜…โ˜…โ˜…โ˜†
Confidencelow

Study Evidence

Study 1. Body composition profiles and metabolic vulnerability in comorbid insomnia and sleep apnea (COMISA): A large-scale BIA analysis.

observational

Kim JR, Park HR, Song P, Joo EY ยท Sleep medicine (2026)

Participants: N/A
Duration: cross-sectional
Intervention: Comparison of body composition profiles between COMISA (ISI โ‰ฅ 15) and OSA-only (ISI < 15) groups
Outcome: Skeletal muscle mass (SMM), visceral fat area (VFA), SMM/VFA ratio, Insomnia Severity Index (ISI) scores, COMISA status
Effect Size: ฮฒ = -0.08 for SMM/VFA ratio and ISI scores; OR = 0.29 for SMM/VFA ratio and COMISA status
Population: 2915 patients with moderate-to-severe OSA (AHI โ‰ฅ 15) who underwent polysomnography and body composition analysis

Result:

PubMed: 42442329DOI: 10.1016/j.sleep.2026.109134

Mechanism Graph

Insomnia and sleep apnea co-occur (COMISA)
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COMISA associated with lower skeletal muscle mass and higher visceral fat
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Reduced SMM/VFA ratio reflects metabolic vulnerability
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Lower muscle-to-fat ratio linked to greater insomnia severity and COMISA risk

Limitations

  • โš Cross-sectional design prevents causal inference
  • โš Body composition assessed via bioelectrical impedance analysis, not gold-standard methods like DXA or MRI
  • โš Insomnia severity defined solely by ISI score, not clinical interview

Frequently Asked Questions

What is COMISA?โ–ผ

COMISA stands for comorbid insomnia and sleep apnea, a condition where patients have both insomnia and obstructive sleep apnea.

How was body composition measured in this study?โ–ผ

Body composition was assessed using bioelectrical impedance analysis (BIA), measuring skeletal muscle mass (SMM), visceral fat area (VFA), and the SMM/VFA ratio.

Did the COMISA group have worse sleep than the OSA-only group?โ–ผ

Yes, COMISA patients had shorter total sleep time, prolonged sleep onset latency, increased wake after sleep onset, and lower sleep efficiency, despite similar BMI and apnea-hypopnea index.

Is the association between body composition and COMISA stronger in any subgroup?โ–ผ

Yes, the inverse association between SMM/VFA ratio and COMISA status was particularly strong in males.

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References

  1. 1.Kim JR, Park HR, Song P, Joo EY. "Body composition profiles and metabolic vulnerability in comorbid insomnia and sleep apnea (COMISA): A large-scale BIA analysis.." Sleep medicine, 2026. PMID: 42442329 DOI: 10.1016/j.sleep.2026.109134
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