Insomnia, Daytime Sleepiness and Cardio-Cerebrovascular Diseases in the Elderly: A 6-Year Prospective Study

Isabelle Jaussent,Yves Dauvilliers,Catherine Helmer,Marie-Laure Ancelin,Christophe Tzourio,Alain Besset,Jean Bouyer,Karen Ritchie,Jean-Philippe Empana,Angelo Scuteri

doi:10.1371/journal.pone.0056048

Abstract

ObjectiveTo examine 1) the associations between history of cardio-cerebrovascular diseases (CVD) and insomnia complaints and excessive daytime sleepiness (EDS), and 2) the relationships between sleep complaints and future CVD in persons over 65.MethodsCVD was assessed at baseline and during two, four, and six-year follow-up in 5494 non-demented subjects. Self-reported insomnia complaints (poor sleep quality, difficulty in initiating sleep, difficulty in maintening sleep, and early morning awakening), EDS and sleep medication use were evaluated at baseline. Logistic regression models and Cox proportional hazard models, with delayed entry and age of participants as the time scale, were adjusted for socio-demographic, lifestyle and clinical variables.ResultsAt baseline, 748 participants had a past-history of CVD. A past-history of CVD was associated with EDS (OR = 1.28 95%CI = [1.05–1.57]) and the number of insomnia complaints (OR = 1.26 95%CI = [1.03–1.55] for 1–2 insomnia complaints; OR = 1.32 95%CI = [1.03–1.71] for ≥3 complaints). In longitudinal analyses, neither the four components of insomnia nor the number of insomnia complaints were significantly associated with first or recurrent CVD events (n = 391 events). EDS was independently associated with future CVD events even after adjusting for prescribed sleep medication and past-history of CVD (HR = 1.35 95%CI = [1.06–1.71]).ConclusionOur results suggest that the relationships between sleep complaints and CVD could be complex. Insomnia complaints are more likely a consequence of CVD, whereas EDS appears to be a determinant of CVD independently of past-history of CVD. EDS screening may thus constitute a means of detecting persons at high risk of CVD.

Highlights

Cardio-cerebrovascular disease (CVD) remains the largest cause of morbidity and mortality among adults, worldwide. [1] Epidemiological studies have established smoking, alcohol use, high blood pressure, diabetes mellitus, hypercholesterolemia and obesity as the most important risk factors for both coronary heart disease (CHD) and stroke
Sleep disturbances may contribute to the development of CVD, they have not been included in models of cardiovascular risk prediction. [2,3,4,5] Insomnia and excessive daytime sleepiness (EDS) are frequent sleep complaints which increase with age. [5,6,7] few studies have examined prospectively the association between sleep disturbances and CVD in community-dwelling persons. [8,9,10,11] A large prospective study of over 50,000 adults without history of CVD followed-up over 11 years reported a significant association between insomnia symptoms and occurrence of acute myocardial infarction, but they found no association in participants over 65
[12] EDS was shown to be associated with an increased risk of incident CVD in the elderly without a history of CVD. [8,9,11,13] to our best knowledge no previous studies have examined these associations in subjects with a pasthistory of CVD, raising the question of whether insomnia and EDS precede or are a consequence of CVD

Summary

Introduction

Cardio-cerebrovascular disease (CVD) remains the largest cause of morbidity and mortality among adults, worldwide. [1] Epidemiological studies have established smoking, alcohol use, high blood pressure, diabetes mellitus, hypercholesterolemia and obesity as the most important risk factors for both coronary heart disease (CHD) and stroke. [8,9,11,13] to our best knowledge no previous studies have examined these associations in subjects with a pasthistory of CVD, raising the question of whether insomnia and EDS precede or are a consequence of CVD This large prospective study aims to examine the independent relationships between insomnia complaints, EDS and CVD events in community-dwelling persons over 65. These relationships can be complex as sleep complaints may be risk factors for CVD but some sleep complaints may be consecutive to CVD. These relationships can be complex as sleep complaints may be risk factors for CVD but some sleep complaints may be consecutive to CVD. [14] Within the present study we aimed to 1) examine retrospectively the associations between a past-history of CVD and insomnia complaints and EDS, and 2) study the associations between insomnia complaints and EDS, and future CVD events in subjects both with (recurrent CVD events) and without (first CVD events) a past-history of CVD

Methods

Results

Discussion

Conclusion