Mapping the comorbidome: A novel analysis of the associations between obstructive sleep apnea and its comorbidities in Colombia

Introduction: Obstructive sleep apnea (OSA) is linked to a complex network of comorbidities, including cardiovascular, metabolic, neurological, and oncological diseases. The comorbidome visually maps disease associations, highlighting the interconnected comorbidities of OSA, whose incidence and severity are strongly correlated. Methods: A retrospective cohort study was conducted between 2005 and 2020 to identify the comorbidities most frequently associated with OSA through a comprehensive comorbidity map. The prevalence of each comorbidity was calculated as a percentage, and a detailed analysis was performed to examine the relationship between these comorbidities and the severity of OSA. This graphic represents all comorbidities with significant associations to OSA, where the size of each bubble is proportional to the prevalence of the disease within the cohort, and the proximity to the center reflects the strength of the association. Results: A total of 3043 patients diagnosed with OSA were included, of whom 51.1% (1154/3043) had severe OSA, 29.2% (889/3043) had moderate OSA, and 19.7% (600/3043) had mild OSA. The average age was 57.6 years (SD ± 15.32), and 65.6% (1995/3043) were men. Among patients with mild OSA, hypertension was present in 48.0% (288/600), in moderate OSA in 53.0% (470/889), and in severe OSA in 58.5% (909/1554). Renal failure (OR: 9.39; 95% CI: 3.7–23.84), cardiovascular disease (OR: 7.73; 95% CI: 3.92–15.21), dementia (OR: 6.98; 95% CI: 2.85–17.11), hemiplegia/stroke sequelae (OR: 6.90; 95% CI: 2.02–23.51), smoking (OR: 5.54; 95% CI: 2.74–11.21), and diabetes (OR: 4.34; 95% CI: 2.02–9.35) were associated with mild OSA. Hemiplegia/stroke sequelae (OR: 10.11; 95% CI: 3.8–26.89), cardiovascular disease (OR: 9.77; 95% CI: 6.18–15.46), chronic pulmonary disease (OR: 7.48; 95% CI: 4.76–11.77), and dementia (OR: 6.80;95% CI: 3.37–13.71) were associated with moderate OSA. Dementia (OR: 10.59; 95% CI: 6.41–17.5), leukemia and lymphoma (OR: 7.49; 95% CI: 2–28.1), chronic pulmonary disease (OR: 7.24; 95% CI: 5.33–9.83), hemiplegia or stroke sequelae (OR: 6.33; 95% CI: 3.3–12.16), and renal failure (OR: 6.10; 95% CI: 3.97–9.36) were associated with severe OSA. Conclusion: The most prevalent comorbidities were hypertension, smoking, and cardiovascular disease, with a higher incidence in patients with severe OSA. Additionally, a significant association was observed between certain comorbidities and mortality, particularly conditions such as renal failure and dementia. Malignant or neoplastic diseases were related to severe OSA.