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Excessive daytime sleepiness and vascular events: The Three City Study
Author(s) -
Blachier Martin,
Dauvilliers Yves,
Jaussent Isabelle,
Helmer Catherine,
Ritchie Karen,
Jouven Xavier,
Tzourio Christophe,
Amouyel Philippe,
Besset Alain,
Ducimetiere Pierre,
Empana JeanPhilippe
Publication year - 2012
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.22656
Subject(s) - medicine , stroke (engine) , hazard ratio , confidence interval , proportional hazards model , confounding , prospective cohort study , population , cohort , cohort study , physical therapy , mechanical engineering , environmental health , engineering
Objective: We assessed whether excessive daytime sleepiness (EDS) at baseline was associated with subsequent coronary heart disease (CHD) and stroke events. Methods: 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. Results: 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). Interpretation: 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.