Sleep complaints and cardio-cerebrovascular diseases in the elderly: A 6-year prospective study

Abstract

Introduction While sleep disturbances may contribute to the development of cardio- cerebrovascular diseases (CVD), few studies have examined the association of sleep complaints (insomnia complaints and excessive daytime sleepiness (EDS)) with history of CVD and incident CVD in persons over 65. Materials and methods CVD was assessed at baseline and at the two, four, and six-year follow-ups in 5494 non-demented subjects. Self-reported insomnia complaints (poor sleep quality, difficulty in initiating sleep, difficulty in maintaining 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. Results At baseline, 748 participants had a past-history of CVD which 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 >2 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]). Conclusion Our results suggest a complex relationship between sleep complaints and CVD. Insomnia complaints are more likely to be 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. Acknowledgements The 3C Study is conducted under a partnership agreement between Inserm, the Bordeaux II University and Sanofi- Synthelabo and was supported by the FRM, the CNMTS, DGS, MGEN, Institut de la Longevite, AFSSPS, the Regional Governments of Aquitaine, Bourgogne and Languedoc-Roussillon and, the Fondation de France, the Ministry of Research-Inserm Programme Cohorts and collection of biological material). The Lille received a grant from Eisai. Part of this project is financed by two grants from the ANR.