목적: This study aims to explore the clinical implications of COMISA (co- morbid insomnia and sleep apnea) and propose effective treatment strategies. Additionally, it seeks to investigate COMISA patient characteristics through retrospective analysis. 방법:A literature review was conducted to assess the pathophysiology and bidirectional interactions between obstructive sleep apnea (OSA) and chronic insomnia disorder. A retrospective analysis was performed on patients who underwent polysomnography (PSG) at our institution. Patient demographics, sleep parameters, and symptom severity were compared between simple OSA and COMISA groups. 결과:COMISA is prevalent among OSA patients, with overlapping mechanisms such as sleep fragmentation, hypoxic burden, hyperarousal state, and bidirectional symptom exacerbation. A total of 116 patients were analyzed, including 40 simple OSA and 76 COMISA cases. COMISA patients exhibited a higher female proportion compared to the simple OSA group. Additionally, COMISA patients showed increased REM-related respiratory events. Sleep efficiency and sleep latency did not significantly differ between groups due to the impact of the lab-based PSG environment, but the Insomnia Severity Index demonstrated statistical significance. 결론:Unrecognized OSA may exist in many chronic insomnia patients. COMISA patients may have lower adherence to PAP therapy, the gold standard treatment for OSA. Investigating the relationship between OSA and insomnia can enhance our understanding of both conditions. Future research should focus on optimizing diagnostic and therapeutic approaches for COMISA, particularly considering novel metrics such as hypoxic burden and OSA endotyping.