Daytime sleepiness and risk of stroke and vascular disease: findings from the Northern Manhattan Study (NOMAS).
BACKGROUND
Recent studies have suggested that poor quality and diminished quantity of sleep may be independently linked to vascular events although prospective and multiethnic studies are limited. This study aimed to explore the relationship between daytime sleepiness and the risk of ischemic stroke and vascular events in an elderly, multiethnic prospective cohort.


RESULTS
As part of the Northern Manhattan Study, the Epworth Sleepiness Scale was collected during the 2004 annual follow-up. Daytime sleepiness was trichotomized using previously reported cut points of no dozing, some dozing, and significant dozing. Subjects were followed annually for a mean of 5.1 years. Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals for stroke, myocardial infarction, and death outcomes. We obtained the Epworth Sleepiness Scale on 2088 community residents. The mean age was 73.5 ± 9.3 years; 64% were women; 17% were white, 20% black, 60% Hispanic, and 3% were other. Over 44% of the cohort reported no daytime dozing, 47% some dozing, and 9% significant daytime dozing. Compared with those reporting no daytime dozing, individuals reporting significant dozing had an increased risk of ischemic stroke (hazard ratio, 2.74 [95% confidence interval, 1.38-5.43]), all stroke (3.00 [1.57-5.73]), the combination of ischemic stroke, myocardial infarction, and vascular death (2.38 [1.50-3.78]), and all vascular events (2.48 [1.57-3.91]), after adjusting for medical comorbidities.


CONCLUSIONS
Daytime sleepiness is an independent risk factor for stroke and other vascular events. These findings suggest the importance of screening for sleep problems at the primary care level.
Department of Health Policy, Mount Sinai School of Medicine, New York, NY, USA. bernadette.boden-albala@mountsinai.org
Bernadette
B
Boden-Albala
Eric T
ET
Roberts
Carl
C
Bazil
Yeseon
Y
Moon
Mitchell S V
MS
Elkind
Tatjana
T
Rundek
Myunghee C
MC
Paik
Ralph L
RL
Sacco
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012890:Sleep; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality; D013997:Time Factors; D014504:Urban Health / Q000208:ethnology; D014652:Vascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality