Veterans with both insomnia and sleep apnea have elevated risk of developing type 2 diabetes: Study

A new study to be presented at the SLEEP 2026 annual meeting found that U.S. military veterans with both insomnia and obstructive sleep apnea face a markedly elevated risk of developing type 2 diabetes, substantially exceeding the risk associated with either sleep disorder alone.

Results show that insomnia alone was associated with a 41% increased risk of incident type 2 diabetes overall, with a greater elevation in the risk among women (48%) than men (39%). Sleep apnea alone conferred a risk of incident diabetes that was more than five times higher in men and nearly four times higher in women. Veterans with comorbid insomnia and sleep apnea, often referred to as COMISA, had the greatest risk of incident type 2 diabetes, with an overall hazard ratio that was 6.2 times higher (6.5 times higher in men and 4.7 times higher in women), compared with those with neither disorder.

“Among younger veterans, having both insomnia and obstructive sleep apnea was associated with a much higher risk of new-onset type 2 diabetes, well beyond the risk of either disorder alone,” said lead author Dr. Karam Al Jumaily, who is a clinical sleep medicine fellow at Yale University in New Haven, Connecticut. “What was particularly striking was that these associations remained significant even after accounting for a broad range of demographic, metabolic, psychiatric, and behavioral risk factors. This suggests that sleep disorders may represent an independent and underrecognized risk factor for future cardiometabolic disease.”

Insomnia and obstructive sleep apnea are among the most common sleep disorders in the United States. According to the American Academy of Sleep Medicine, both conditions are associated with a range of adverse health outcomes, including metabolic dysfunction. The AASM recommends that adults experiencing symptoms of insomnia or sleep apnea seek evaluation from a sleep medicine clinician.

The study conducted secondary data analyses of a cohort of 1,074,113 U.S. veterans (mean age 33 years; 12% women) without baseline sleep disorders or type 2 diabetes at enrollment. Participants were followed from their first encounter in the Department of Veterans Affairs healthcare system until their first type 2 diabetes diagnosis, death, last VA encounter, or administrative censoring. Insomnia, obstructive sleep apnea, and COMISA were defined using International Classification of Diseases codes and modeled as time-varying exposures. Incident type 2 diabetes was identified using laboratory values, clinical encounters, or antihyperglycemic medication use. Results were stratified by sex and adjusted for demographics and body mass index, smoking, hypertension, hyperlipidemia, psychiatric conditions, and substance use.

Al Jumaily noted that the findings underscore the potential value of early sleep disorder identification as part of diabetes prevention efforts in high-risk populations.

“COMISA represents an important sleep phenotype that clinicians and public health practitioners should be aware of, especially in veteran populations where sleep disorders and metabolic disease frequently overlap,” Al Jumaily said. “These findings underscore the potential value of early sleep disorder screening and intervention as part of diabetes prevention efforts.”

Reference: Karam Al Jumaily, Allison Gaffey, Andrey Zinchuk, Brian Wojeck, 1029 Insomnia, Sleep Apnea and Incident Diabetes Among U.S. Military Veterans, Sleep, Volume 49, Issue Supplement_1, May 2026, Page A458, https://doi.org/10.1093/sleep/zsag091.1028