04727nas a2200481 4500008004100000022001400041245013400055210006900189260001300258300001100271490000700282520339800289653001603687653000903703653002203712653002803734653001903762653001103781653001803792653001803810653001103828653001403839653000903853653002603862653002603888653001503914653001703929653001603946653002603962653001703988653002504005653001204030653003104042653001804073100001704091700002104108700001504129700001704144700001504161700001904176700001504195856003504210 2000 eng d a0002-861400aDaytime sleepiness predicts mortality and cardiovascular disease in older adults. The Cardiovascular Health Study Research Group.0 aDaytime sleepiness predicts mortality and cardiovascular disease c2000 Feb a115-230 v483 a

INTRODUCTION: As part of the baseline examination in the Cardiovascular Health Study, sleep disturbance symptoms including snoring and daytime sleepiness, were assessed as potential risk factors or precipitants of cardiovascular disease (CVD). Because of the association of sleep disturbance with poorer health and the possible associations of sleep apnea with CVD, we hypothesized that those with poorer sleep or daytime sleepiness may be at increased risk of mortality or incident CVD.

SETTING: Participants (n = 5888) were recruited in 1989, with an additional minority cohort recruited in 1993, in four US communities for a cohort study designed to evaluate risk factors for cardiovascular disease.

METHODS: An interview-administered questionnaire regarding health and sleep habits with ongoing ascertainment of total mortality and cardiovascular disease morbidity and mortality, including total CVD morbidity and mortality, incident myocardial infarction, and congestive heart failure.

RESULTS: Daytime sleepiness was the only sleep symptom that was significantly associated with mortality in both men and women. The unadjusted hazard ratio was 2.12 (1.66, 2.72) in women and 1.40 (1.12, 1.73) in men. Men who reported difficulty falling asleep also had an increased mortality rate (HR = 1.43 (1.14, 1.80)) which was not seen in women. The risks were attenuated with adjustment for age but remained significant for daytime sleepiness in women (HR = 1.82 (1.42, 2.34)) and for difficulty falling asleep in men. (HR = 1.29 (1.03, 1.63)). Frequent awakenings, early morning awakening, and snoring were not associated with a significantly increased risk of mortality in these older men and women. Crude event rates were evaluated for total incident cardiovascular morbidity and mortality, incident myocardial infarction, and incident congestive heart failure (CHF). Incident CVD rates were higher in both men and women with daytime sleepiness. The aged adjusted HR was 1.35 (95% CI = 1.03, 1.76) in men and was 1.66 (95% CI = 1.28, 2.16) in women. Incident CVD was not higher in those with any other sleep disturbance including snoring. The risk of CVD events associated with daytime sleepiness was attenuated but remained significant in women after adjustment for age. Incident myocardial infarction (MI) rates were also higher in women with daytime sleepiness but were not significantly higher in men. Incident CHF rates were increased in both men and women with daytime sleepiness. In men, the age adjusted HR was 1.49 (95% CI, 1.12- 1.98) and in women, was 2.21 (95% CI, 1.64-2.98). Women reporting both daytime sleepiness and frequent awakening had a hazard ratio of 2.34 (95% CI, 1.66-3.29) for incident CHF compared with those with daytime sleepiness but without frequent awakening. This interaction was not found in men.

CONCLUSIONS: In this study, daytime sleepiness was the only sleep disturbance symptom that was associated with mortality, incident CVD morbidity and mortality, MI, and CHF. These findings were stronger in women than men, i.e., the associations persisted for mortality, CVD, and CHF in women after adjustment for age and other factors. Thus, a report of daytime sleepiness identifies older adults at increased risk for total and cardiovascular mortality, and is an independent risk factor in women.

10aAge Factors10aAged10aAged, 80 and over10aCardiovascular Diseases10aCohort Studies10aFemale10aHealth Status10aHeart Failure10aHumans10aIncidence10aMale10aMultivariate Analysis10aMyocardial Infarction10aOdds Ratio10aRisk Factors10aSex Factors10aSleep Apnea Syndromes10aSleep Stages10aSleep Wake Disorders10aSnoring10aSurveys and Questionnaires10aUnited States1 aNewman, A, B1 aSpiekerman, C, F1 aEnright, P1 aLefkowitz, D1 aManolio, T1 aReynolds, C, F1 aRobbins, J uhttps://chs-nhlbi.org/node/610