Excessive daytime sleepiness and vascular events: The Three City Study
Article first published online: 23 JAN 2012
Copyright © 2011 American Neurological Association
Annals of Neurology
Volume 71, Issue 5, pages 661–667, May 2012
How to Cite
Blachier, M., Dauvilliers, Y., Jaussent, I., Helmer, C., Ritchie, K., Jouven, X., Tzourio, C., Amouyel, P., Besset, A., Ducimetiere, P. and Empana, J.-P. (2012), Excessive daytime sleepiness and vascular events: The Three City Study. Ann Neurol., 71: 661–667. doi: 10.1002/ana.22656
- Issue published online: 20 APR 2012
- Article first published online: 23 JAN 2012
- Accepted manuscript online: 31 OCT 2011 06:44AM EST
- Manuscript Accepted: 14 OCT 2011
- Manuscript Revised: 13 SEP 2011
- Manuscript Received: 13 APR 2011
We assessed whether excessive daytime sleepiness (EDS) at baseline was associated with subsequent coronary heart disease (CHD) and stroke events.
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.
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).
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.