Excessive daytime sleepiness and vascular events: The Three City Study

• Published in: Annals of neurology Vol. 71; no. 5; pp. 661 - 667
• Main Authors: Blachier, Martin, Dauvilliers, Yves, Jaussent, Isabelle, Helmer, Catherine, Ritchie, Karen, Jouven, Xavier, Tzourio, Christophe, Amouyel, Philippe, Besset, Alain, Ducimetiere, Pierre, Empana, Jean-Philippe
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.05.2012; Wiley-Liss; Wiley Subscription Services, Inc; Wiley
• Subjects: Aged; Biological and medical sciences; Cardiovascular disease; Cohort Studies; Confidence intervals; Coronary Disease - complications; Coronary Disease - epidemiology; Disorders of Excessive Somnolence - complications; Disorders of Excessive Somnolence - epidemiology; Drug therapy; Female; Health risk assessment; Humans; Hypertension; Life Sciences; Male; Medical sciences; Middle Aged; Neurology; Proportional Hazards Models; Stroke - complications; Stroke - epidemiology; Vascular diseases and vascular malformations of the nervous system; Sleep disorder; Excessive daytime sleepiness; Nervous system diseases; Neurological disorder
• ISSN: 0364-5134; 1531-8249; 1531-8249
• DOI: 10.1002/ana.22656

Objective: We assessed whether excessive daytime sleepiness (EDS) at baseline was associated with subsequent coronary heart disease (CHD) and stroke events. Methods: The Three City Study, a French population‐based multicenter prospective study, included 7,007 subjects aged ≥65 years with no personal history of CHD, stroke, or dementia, and self‐rated EDS as never, rare, regular, or frequent in response to a face‐to‐face questionnaire. Hazard ratios (HRs) for the first episode of stroke and CHD over 6 years were estimated using a Cox proportional hazards model with age as the time scale. Results: The mean age of the cohort was 73.7 years (standard deviation, 5.37), 63% were women, and 13.3% and 4.3% reported regular and frequent EDS, respectively. After a median follow‐up period of 5.1 years, 372 subjects experienced a first event, either stroke (122 subjects) or a CHD event (250 subjects). The increased risk of CHD and stroke was confined to the group with frequent EDS, and was 1.73× as much as in the group that reported never having EDS (HR, 1.73; 95% confidence interval [CI], 1.15–2.60), after adjustment for confounding and mediating factors. This association was seen in those without hypertension but not in those with hypertension at baseline (p for interaction = 0.01). Moreover, the association with frequent EDS was statistically significant for stroke (HR, 2.10; 95% CI, 1.13–3.89) but not for CHD (HR, 1.51; 95% CI, 0.87–2.61). Interpretation: The current study suggests that frequent EDS is independently associated with future vascular events and stroke in particular in healthy community‐dwelling elderly subjects. ANN NEUROL 2011.