title: Excessive daytime sleepiness is associated with longer culprit lesion and adverse outcomes in patients with coronary artery disease.
abstract: OBJECTIVE
  We assessed whether excessive daytime sleepiness was associated with coronary plaque phenotype and subsequent adverse cardiovascular events.
  
  
  METHODS
  Prospective cohort study. Intravascular ultrasound (IVUS) examination of the culprit coronary stenosis was performed. The Epworth Sleepiness Scale (ESS) questionnaire was administered, and the patients were divided into 2 groups-(1) sleepier and (2) less sleepy-based on the ESS score. Adverse cardiovascular outcomes were defined as cardiac death, myocardial infarction, stroke, unplanned revascularization, or heart failure admission.
  
  
  RESULTS
  One hundred seventeen patients undergoing urgent or non-urgent coronary angiography were recruited. Compared with the less sleepy group (ESS ≤ 10, n = 87), the sleepier group (ESS > 10, n = 30) had higher serum levels of total cholesterol and of low-density-lipoprotein cholesterols (p < 0.05 for both). The IVUS examinations indicated coronary stenoses were longer in the sleepier group than in the less sleepy group (p = 0.011). The cumulative incidence of adverse cardiovascular events at 16-month follow-up was higher in the sleepier than the less sleepy group (12.5% versus 6.9%, p = 0.03). Cox regression analysis adjusting for age and smoking showed increased hazard of adverse cardiovascular events in sleepier group as compared to less sleepy group (HR = 3.44, 95% CI 1.01-11.72).
  
  
  CONCLUSIONS
  In patients presenting with coronary artery disease, excessive daytime sleepiness based on ESS > 10 was associated with longer culprit lesions and future adverse cardiovascular events.
authors: Department of Cardiology, National University Heart Centre, Singapore ; Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore.
authors: Chi-Hang
authors: CH
authors: Lee
authors: Wai-Yee
authors: WY
authors: Ng
authors: William
authors: W
authors: Hau
authors: Hee-Hwa
authors: HH
authors: Ho
authors: Bee-Choo
authors: BC
authors: Tai
authors: Mark Y
authors: MY
authors: Chan
authors: A Mark
authors: AM
authors: Richards
authors: Huay-Cheem
authors: HC
authors: Tan
mesh_terms: D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging; D023921:Coronary Stenosis / Q000097:blood / Q000150:complications; D006970:Disorders of Excessive Somnolence / Q000097:blood / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications; D063868:Patient Outcome Assessment; D058226:Plaque, Atherosclerotic / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D012846:Singapore; D011795:Surveys and Questionnaires; D018084:Ultrasonography, Interventional / Q000379:methods
chemical_list: D002784:Cholesterol
keywords: Sleepiness; coronary artery disease; intravascular ultrasound; outcomes