30-Second Takeaway
- COMISA in post‑9/11 veterans confers very high incident hypertension and CVD risk versus insomnia or OSA alone.
- The concise, objective B‑APNEIC score outperforms STOP‑BANG for predicting severe OSA in a sleep‑clinic cohort.
- Orexin‑2 agonist therapy in narcolepsy type 1 improves attention, memory, and executive function over eight weeks.
- High preoperative OSA risk strongly predicts postoperative respiratory and cardiac events, while benefits of current perioperative interventions remain uncertain.
- OSA nearly doubles diabetic kidney disease risk and lowers eGFR, supporting tighter bidirectional surveillance.
Week ending December 13, 2025
Sleep disorders, cardiometabolic risk, and emerging tools: updates for the sleep clinic
COMISA in post‑9/11 veterans sharply elevates incident hypertension and CVD risk
Among 937,598 post‑9/11 US veterans, comorbid insomnia and OSA (COMISA) conferred the highest risk of incident hypertension and CVD. COMISA was associated with an adjusted hazard ratio for hypertension of 2.43, exceeding risk from insomnia alone or OSA alone. For CVD, COMISA carried an adjusted hazard ratio of 3.81, similar in men and women and greater than either disorder alone. Associations persisted after adjustment for demographic, behavioral, and clinical factors and were robust in multiple sensitivity analyses.
B‑APNEIC outperforms STOP‑BANG for severe OSA prediction in a sleep‑clinic cohort
In 274 Australian sleep‑clinic patients, a B‑APNEIC score ≥3 predicted severe OSA with 84% sensitivity and 60% specificity. The negative predictive value was 86%, supporting use to help rule out severe OSA in lower‑risk perioperative candidates. Compared with STOP‑BANG ≥5, B‑APNEIC showed higher sensitivity, better positive and negative predictive values, and higher AUC (0.72 vs 0.66). Specificity was similar between tools despite B‑APNEIC using only four, largely objective items focused on obesity, blood pressure, neck, and witnessed apneas.
Orexin‑2 agonist oveporexton improves cognition in narcolepsy type 1
In a phase 2 double‑blind randomized trial, 112 adults with narcolepsy type 1 received placebo or various doses of oral oveporexton for eight weeks. Oveporexton reduced Psychomotor Vigilance Task lapses versus placebo across all dose groups, indicating improved sustained attention. Errors on Continuous Paired Associate Learning decreased compared with placebo, suggesting better visual associative memory. Executive function improved on One Back and digit symbol tests, indicating broader cognitive benefits beyond sleepiness and cataplexy control.
High preoperative OSA risk predicts complications; benefit of perioperative interventions uncertain
This meta‑analysis of 54 studies including 324,935 surgical patients found high‑risk OSA significantly increased postoperative respiratory and cardiac complications. High‑risk OSA patients had 3.59‑fold higher odds of respiratory and 2.82‑fold higher odds of cardiac events versus low‑risk patients. Length of stay was longer by 0.79 days, while delirium, ICU admission, and 30‑day readmission were not significantly increased overall. Among high‑risk patients, interventions such as CPAP, auto‑PAP, protocols, or education did not clearly reduce adverse outcomes versus no intervention, with heterogeneous evidence.
References
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Additional Reads
Optional additional studies from this edition.