title: Insomnia, daytime sleepiness and cardio-cerebrovascular diseases in the elderly: a 6-year prospective study.
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]).
  
  
  CONCLUSIONS
  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.
authors: Inserm, U1061, Montpellier, France.
authors: Isabelle
authors: I
authors: Jaussent
authors: Jean-Philippe
authors: JP
authors: Empana
authors: Marie-Laure
authors: ML
authors: Ancelin
authors: Alain
authors: A
authors: Besset
authors: Catherine
authors: C
authors: Helmer
authors: Christophe
authors: C
authors: Tzourio
authors: Karen
authors: K
authors: Ritchie
authors: Jean
authors: J
authors: Bouyer
authors: Yves
authors: Y
authors: Dauvilliers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications*; D002561:Cerebrovascular Disorders / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications*; D012894:Sleep Stages