Study on the Management of COMISA (COMISA-PEC)

July 31, 2026 updated by: University Hospital, Grenoble
COMISA, the combination of obstructive sleep apnea (OSA) and insomnia, is a frequent and burdensome condition. Many patients with OSA experience clinically significant insomnia symptoms, and a substantial proportion of individuals with chronic insomnia also meet criteria for OSA. This comorbidity is associated with more severe symptoms, more complex diagnostic pathways, and reduced adherence to continuous positive airway pressure (CPAP) therapy. This study aims to better understand COMISA and evaluate whether adding daridorexant to CPAP treatment can improve treatment adherence and overall patient outcomes.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Obstructive Sleep Apnea Syndrome (OSA) and insomnia are the two most prevalent sleep disorders, and they frequently coexist. Approximately 30-50% of patients with OSA present clinically significant insomnia symptoms, while 30-40% of individuals with chronic insomnia also meet diagnostic criteria for OSA. This comorbid presentation, known as COMISA (Combined Insomnia and Sleep Apnea), has been increasingly recognized in recent research.

COMISA is associated with a higher symptom burden, greater impairment in daily functioning, and more complex diagnostic and therapeutic decision-making. Importantly, patients with COMISA show reduced acceptance and adherence to continuous positive airway pressure (CPAP) therapy compared with patients who have OSA alone. Current clinical approaches often treat each disorder separately, resulting in fragmented care rather than integrated, evidence-based management strategies tailored to COMISA.

This study aims to better characterize COMISA and explore interactions between therapeutic interventions. Specifically, it will assess whether concomitant administration of daridorexant, an orexin receptor antagonist indicated for insomnia, can improve CPAP adherence and enhance overall treatment effectiveness in patients with COMISA.

This is a minimal-risk interventional clinical trial evaluating a real-world therapeutic management strategy in patients with COMISA. Daridorexant and PAP are prescribed as part of routine care; the study-specific procedures consist of a structured follow-up.

Study Type

Interventional

Enrollment (Estimated)

150

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • France
      • Marseille, France, 13003
        • Hôpital Européen Marseille
        • Principal Investigator:
          • Hervé PEGLIASCO, Dr
      • Metz, France, 57070
        • Centre Médical Les Jasmins
        • Principal Investigator:
          • Khier AMRANI, Dr
      • Paris, France, 75013
        • Hôpital de la Pitié Salpêtrière - AP-HP
        • Principal Investigator:
          • Maxime PATOUT, Dr
      • Rennes, France, 35700
        • Polyclinique Saint-Laurent - Hospitalité Saint-Thomas de Villeneuve
        • Principal Investigator:
          • Arnaud PRIGENT, Dr

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Adult patient diagnosed with COMISA, defined by an apnea-hypopnea index (AHI) ≥ 15 events/hour and an Insomnia Severity Index (ISI) score ≥ 15, newly diagnosed and naïve to CPAP therapy and daridorexant treatment (no treatment for > 5 years).
  • Prescription of continuous positive airway pressure (CPAP) therapy combined with a prescription of daridorexant.
  • Patient has provided informed consent to participate in the study.
  • Patient is affiliated with a national health insurance system.

Exclusion Criteria:

  • Severe hepatic impairment (contraindication to daridorexant treatment).
  • Refusal of CPAP therapy and/or refusal of daridorexant treatment.
  • Individuals covered under Articles L1121-5 to L1121-8 of the French Public Health Code.
  • Staff members who have a hierarchical relationship with the principal investigator.
  • Any patient who, in the opinion of the investigator, would be unable to comply with study procedures or the study schedule.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Other: Standard therapeutic management with Daridorexant and CPAP in COMISA
Patients with COMISA receiving sequential treatment with Daridorexant and CPAP as part of routine care, with protocolized follow-up and questionnaires (IDSIQ).
Drug: Daridorexant 50 mg
Daridorexant initiated for 1 month before CPAP and prescribed as part of routine care.
Device: Continuous Positive Air Pressure (CPAP)
PAP therapy initiated after 1 month of Daridorexant, according to standard clinical practice.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
To evaluate, in patients diagnosed with COMISA and treated with CPAP, the impact of daridorexant on CPAP adherence at 4 months compared with patients not receiving daridorexant.
Time Frame: 4 months
CPAP adherence will be assessed at the 4-month routine follow-up visit and defined as the average nightly CPAP usage (hours per night) from treatment initiation to the follow-up evaluation.
4 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
To evaluate, in patients diagnosed with COMISA and treated with CPAP, the impact of daridorexant on CPAP adherence at 12 months compared with patients not receiving daridorexant
Time Frame: 12 months
CPAP adherence will be assessed at the routine 12-month follow-up visit and defined as the average nightly CPAP usage (hours per night) from treatment initiation to the 12-month evaluation.
12 months
To evaluate the change in total IDSIQ score in patients with COMISA treated with CPAP and daridorexant.
Time Frame: Baseline (Week -1 before first dose of daridorexant), Week 1 after daridorexant initiation, Week -1 before CPAP initiation, Week 1 after CPAP initiation, 4 months, 12 months.

The variation in IDSIQ scores will be assessed across the following dimensions:

  • Effect of daridorexant: Difference between the baseline mean (week -1 before first dose of daridorexant) and the mean obtained during Week 1 after daridorexant initiation.
  • Effect of CPAP while on daridorexant: Difference between the mean obtained during the week preceding CPAP initiation (Week -1 before CPAP) and the mean obtained during Week 1 after CPAP initiation.
  • Follow-up at 4 months: Difference between the mean obtained during the week preceding the 4-month visit and the baseline mean.
  • Follow-up at 12 months: Difference between the mean obtained during the week preceding the 12-month visit and the baseline mean.
Baseline (Week -1 before first dose of daridorexant), Week 1 after daridorexant initiation, Week -1 before CPAP initiation, Week 1 after CPAP initiation, 4 months, 12 months.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University Hospital, Grenoble

Collaborators

Hôpital Européen Marseille
Polyclinique Saint-Laurent - Hospitalité Saint-Thomas de Villeneuve
Centre Médical les Jasmins "Poumon et Sommeil"
Hôpital de la Pitié Salpêtrière - AP-HP

Investigators

  • Principal Investigator: Jean-Louis PEPIN, Pr, GRENOBLE ALPES UNIVERSITY HOSPITAL

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

August 1, 2026

Primary Completion (Estimated)

June 1, 2028

Study Completion (Estimated)

February 1, 2029

Study Registration Dates

First Submitted

July 28, 2026

First Submitted That Met QC Criteria

July 31, 2026

First Posted (Actual)

August 4, 2026

Study Record Updates

Last Update Posted (Actual)

August 4, 2026

Last Update Submitted That Met QC Criteria

July 31, 2026

Last Verified

July 1, 2026

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2026-A01048-43
  • 38RC25.0417 (Other Identifier: Grenoble Alpes University Hospital)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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