on February 26, 2009
Published online before print February 26, 2009, doi: 10.1161/STROKEAHA.108.530824
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Submitted on July 5, 2008
From INSERM U909, Cardiovascular Epidemiology and Sudden Death (J.P.E., X.J., P.D.), Paris V University, IFR69-Paris Sud University, France; INSERM U888, La Colombiere Hospital (Y.D., K.R., A.B.), Montpellier, France; the Department of Neurology (Y.D.), Hôpital Gui de Chauliac, Montpellier, France; INSERM U593, Bordeaux 2 University (J.F.D.), Bordeaux, France; the Center of Preventive Cardiovascular Medicine (J.G.), Broussais Hospital, Paris, France; the Department of Cardiology (X.J.), G Pompidou European Hospital, Paris, France; INSERM U708, Pierre Marie Curie Paris 6 University (C.T.), La Salpetriere Hospital, Paris, France; and INSERM U744, Institut Pasteur de Lille (P.A.), Lille II University, Lille, France. * To whom correspondence should be addressed. E-mail: jean-philippe.empana{at}inserm.fr.
Background and Purpose—Excessive daytime sleepiness, one of the most frequent sleep complaints in the elderly, may affect survival, but inconsistent results have been observed in that population so far. We therefore estimated the risk of mortality for excessive daytime sleepiness (EDS) in community-dwelling elderly participating in the Three City Study. Methods—The Three City Study is a French population-based multicenter prospective study including 9294 subjects (60% women) aged Results—At baseline, 18.7% of the study participants had regular or frequent EDS. After 6 years of follow-up, 762 subjects had died including 260 from cancer and 196 from cardiovascular disease. EDS was associated with a significant 33% increased risk of mortality (95% CI: 1.13 to 1.61) after adjustment for age, gender, study center, body mass index, previous cardiovascular disease, Mini Mental State Examination score, and cardiovascular risk factors. Further adjustment for current use of medication for sleep and for depressive symptoms slightly diminished the HRs. EDS was equally predictive of mortality in those who snored loudly and in those who did not. EDS was related to cardiovascular mortality but not to mortality attributable to cancer. Conclusion—EDS might be independently associated with total and cardiovascular mortality in community-dwelling elderly.
Revised on September 8, 2008
Accepted on October 1, 2008
Excessive Daytime Sleepiness Is an Independent Risk Indicator for Cardiovascular Mortality in Community-Dwelling Elderly. The Three City Study
Jean-Philippe Empana MD, PhD*;
65 years at recruitment between 1999 to 2001. At baseline, 8269 subjects rated EDS and nocturnal sleep complaints as never, rare, regular, and frequent in response to an administered questionnaire and provided information on medication use for sleep or anxiety. Hazard ratios (HR) of EDS (regular or frequent) for mortality over 6 years were estimated by a Cox proportional hazard model.
Key words: epidemiology • elderly • sleep complaints • mortality