Abstract
Objective:
To examine 1) the associations between history of cardio-cerebrovascular diseases (CVD) and insomnia complaints and excessive daytime sleepiness (EDS), and 2) the relationships between sleep complaints and future CVD in persons over 65.
Methods:
CVD was assessed at baseline and during two, four, and six-year follow-up in 5494 non-demented subjects. Self-reported insomnia complaints (poor sleep quality, difficulty in initiating sleep, difficulty in maintening 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. A past-history of CVD 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 ≥3 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 that the relationships between sleep complaints and CVD could be complex. Insomnia complaints are more likely 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.
Publication types
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Research Support, Non-U.S. Gov't
MeSH terms
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Aged
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Aged, 80 and over
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Cardiovascular Diseases / complications*
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Cerebrovascular Disorders / complications*
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Female
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Humans
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Male
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Prospective Studies
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Sleep Initiation and Maintenance Disorders / complications*
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Sleep Stages*
Grants and funding
The 3C Study is conducted under a partnership agreement between Inserm, the Victor Segalen–Bordeaux II University and Sanofi-Synthélabo and was supported by the Fondation pour la Recherche Médicale, the Caisse Nationale Maladie des Travailleurs Salariés, Direction Générale de la Santé, MGEN, Institut de la Longévité, Agence Française de Sécurité Sanitaire des Produits de Santé, 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 Génopôle received a grant from Eisai. Part of this project is financed by two grants from the Agence Nationale de la Recherche (ANR) (projects 07-LVIE-004 and 06-PNRA-005). Isabelle Jaussent, Dr. Jean Bouyer, Dr. Marie-Laure Ancelin, Dr. Catherine Helmer and Dr. Alain Besset report no disclosures. Dr. Jean-Philippe Empana has received consultancy honoraria from Lundbeck and speaker honoraria from Pfizer. Dr. Karen Ritchie serves on scientific advisory boards for the Biomedical Research Centre, King’s College London, and MRC Strategic Steering Committee (Longitudinal Health and Aging Research Unit); and serves on the editorial advisory boards of the International Journal of Geriatric Psychiatry, Dementia, International Psychogeriatrics, Journal of Clinical and Experimental Gerontology, Psychogeriatrics, Neuronale, Neurologie-Psychiatrie- Gériatrie, and Gerontology. Dr. Christophe Tzourio has received fees from the Fondation Plan Alzheimer, the Fondation de Recherche sur l’Hypertension Artérielle, and the ABBOTT company for participating in scientific committees. He has also received investigator-initiated research funding from the French National Research Agency (ANR) and the Fondation Plan Alzheimer for the 3C study. He serves on the editorial advisory board of Neuroepidemiology, Journal of Hypertension, and Journal of Alzheimer’s disease. Pr. Yves Dauvilliers has received funds for speaking and board engagements with UCB pharma, Cephalon, Jazz, Novartis, and Bioprojet. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.