title: Influence of sleep disturbances on age at onset and long-term incidence of major cardiovascular events: the MONICA-Brianza and PAMELA cohort studies.
abstract: We examined the prospective associations of sleep disturbances and sleep duration with the long-term incidence of major cardiovascular disease (CVD) events, in a large cohort of Italian adult men.
  
  
  
  A total of 2277 men aged 35-74 years of age and CVD free at baseline from the MONICA-Brianza and PAMELA population-based cohorts were followed up for a median of 17 years, for first coronary heart disease (CHD) or ischemic stroke events (fatal or nonfatal; n = 293). Sleep disturbances, based on the Jenkins Sleep Questionnaire, were categorized as none/some, moderate, or severe. Sleep durations were ≤6 hours (short), seven to eight hours, and ≥9 hours (long) per night.
  
  
  
  At baseline, 855 men (38%) either reported sleep disturbances or were short or long sleepers. The presence of severe sleep disturbances increased the risk of first CVD (hazard ratio [HR] = 1.80, 95% confidence interval [CI] = 1.07-3.03) and CHD events (HR = 1.97, 95% CI = 1.09-3.56), in particular from the age of 48 years onward. In comparison to men sleeping seven to eight hours, long sleepers experienced a higher CVD risk (HR = 1.56, 95% CI = 1.10-2.22), due mainly to ischemic strokes, and starting at older ages (≥60 years). A joint effect between disturbed sleep and short sleep duration on CVD and CHD events was also observed. Adjustments for physical activity and depression did not substantially modify these associations.
  
  
  
  Severe sleep disturbances and long sleep duration were associated with specific CVD endpoints and age at onset, potentially suggesting distinct underlying mechanisms. A short questionnaire discriminating different levels of sleep disturbances and sleep duration should be routinely adopted in CVD prevention programs to identify men at increased risk for early-onset events.
authors.affiliation: EPIMED Research Centre - Epidemiology and Preventive Medicine, Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy; Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Gianfagna
authors.affiliation: EPIMED Research Centre - Epidemiology and Preventive Medicine, Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Veronesi
authors.affiliation: EPIMED Research Centre - Epidemiology and Preventive Medicine, Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy.
authors.forename: Lorenza
authors.initials: L
authors.lastname: Bertù
authors.affiliation: Department of Health Sciences, University of Milano Bicocca, Monza, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Cesana
authors.affiliation: Department of Health Sciences, University of Milano Bicocca, Monza, Italy; IRCCS Multimedica, Sesto San Giovanni, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Grassi
authors.affiliation: Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg; Division of Health Sciences, University of Warwick Medical School, Coventry, United Kingdom.
authors.forename: Saverio
authors.initials: S
authors.lastname: Stranges
authors.affiliation: EPIMED Research Centre - Epidemiology and Preventive Medicine, Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy; Psychiatric Division, Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy.
authors.forename: Camilla
authors.initials: C
authors.lastname: Callegari
authors.affiliation: EPIMED Research Centre - Epidemiology and Preventive Medicine, Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy. Electronic address: marco.ferrario@uninsubria.it.
authors.forename: Marco M
authors.initials: MM
authors.lastname: Ferrario
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: Cardiovascular risk; Coronary artery diseases; Depression; Epidemiology; Sleep disorders; Stroke