Year: 2026
Type: article
Abstract: Nocturnal yawning may represent a subtle clinical marker of arousal instability in patients with sleep-disordered breathing (SDB), potentially unveiling latent comorbid insomnia and sleep apnea (COMISA) phenotypes, and expanding the interpretative scope of sleep-related behaviors.The recent case report by Michałek et al. describes a rare and intriguing cooccurrence of yawning during sleep in a patient with obstructive sleep apnea (OSA) and sleep bruxism (SB). 1 The researchers' hypothesis of a hypoxiatriggered arousal mechanism is compelling and well-grounded in the observed polysomnographic patterns.Nonetheless, it would be interesting to integrate further reflections that may expand and enrich the interpretation of this complex behavioral constellation.One critical angle that deserves consideration is the possible presence of insomnia-related physiology, particularly within the framework of comorbid insomnia and sleep apnea (COMISA).Although this diagnosis has not been formally addressed, some reported features, such as marked sleep fragmentation, microarousals and low adherence to positive airway pressure (PAP) therapy, are often part of some COMISA phenotypes and may reflect a background of sleep-state hyperarousal, which is frequently observed in those patients.2 Indeed, it has been recently proposed that COMISA encompasses a heterogeneous spectrum, with emerging interest in identifying clinical phenotypes. 2 While such phenotypic models are still in the hypothesis-building stage and require stronger empirical validation, the existence of subclinical insomnia manifested through subtle neurophysiological and behavioral mechanisms, even in the absence of subjective complaints, is increasingly recognized as a relevant issue in both clinical practice and sleep research.3 In this context, the observed nocturnal yawning might be not only a direct response to hypoxia, but also a behavioral expression of the underlying arousal instability, which could reflect a latent insomniac phenotype with challenging aspects from the clinical point of view.This possibility highlights an often-overlooked dimension in sleep medicine -the presence of non-overt insomnia traits that nonetheless modulate sleep architecture, treatment adherence and the emergence of sleep-related motor behaviors.4 Moreover, COMISA patients frequently show the dysregulation of sleep-wake transitions, a state that can facilitate Cite asMeira e Cruz M. Yawning as a clinical clue?Revisiting COMISA phenotypes in sleep-disordered breathing.
Source: Dental and Medical Problems
DOI: 10.17219/dmp/209575
Author: Miguel Meira e Cruz
Language: English
Topic: Sleep and related disorders
Subfield: Experimental and Cognitive Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: diamond
OpenAlex ID: W7123727093