The Three City study, published in Stroke, by the American Heart Association (Thursday, February 26), found that elderly people who reported excessive day time sleepiness have a 49 % relative risk increase of cardiovascular death (from cerebrovascular disease, myocardial infarction and heart failure) , compared to those who do not report sleepiness.
"Based on this study asking patients the simple question of whether they feel sleepy during the day, is a useful way of identifying a subgroup of elderly patients at higher risk of cardiovascular disease who require a more thorough follow up," said Professor Guy DeBacker, from the Division of Cardiology at the University of Gent, Belgium, and former chair of the European Society of Cardiology Joint Prevention Committee.
Professor Torben Jorgensen, from the Research Centre for Prevention and Health, Glostrup, Denmark, commented: "The study offers the opportunity to practice prevention by investigating the underlying causes of patient's sleep problems, and then introducing lifestyle changes with the intention of preventing later cardiovascular complications."
The Three City study represents the largest yet investigation exploring the prospective association between EDS and mortality in the community dwelling elderly, and the only study yet to have been conducted in Europe – all the other studies were undertaken in North America. Criticisms of the study include a low responder rate (37%) that could introduce an element of bias, and the fact that it lacked objective measures of day time sleepiness (such as polysomnography readings), instead using self reported patient responses.
"The subjects with EDS were less educated and had a lower income so there were differences between the two groups in "socioeconomic status", which was not accounted for in the multivariate analysis. SES is a strong independent predictive factor for total and for cause specific mortality, and it might be that the difference between the two groups is just the effect of socioeconomic differences," said DeBacker.
Both DeBacker and Jorgensen say the results are "hypothesis generating", and that the data needs to be confirmed in other large scale studies in different populations before any changes should be made to existing guidelines.
"Overall the study population had a particularly low number of cardiovascular deaths, suggesting that the French paradox may be in operation. We need to be asking identical questions to different populations to see if we still get the same effect," said DeBacker.
Jorgensen added that he would like to see future trials where EDS patients were randomised to receive sleep interventions or not, to see if cardiovascular complications might be prevented.
The Three-City Study led by Jean-Philippe Empana from Inserm, (the French Public Institute on Health and Medical Research) and colleagues followed 9,294 community dwelling people aged over 65 (who did not live in nursing homes or other care facilities). In face to face interview, participants were asked if they had never, rarely, regularly or frequently experienced excessive sleepiness during the day. People diagnosed with dementia at baseline were excluded, providing an overall study population of 8,269 people.
Investigators found even after adjusting for other risk factors,(such as age, gender, body mass index and previous cardiovascular disease), people who experienced excessive day time sleepiness had a 49 % increase in relative risk of cardiovascular death, and a 33 % increase in the relative risk of overall death.
Earlier studies have suggested that atherosclerosis might mediate the association between EDS and cardiovascular death, and that EDS might be associated with sympathetic tone activation.
However, when investigators undertook ultrasound examination of the carotid artery in two-thirds of participants, they found no difference in carotid plaque burden between people with and without EDS. Additionally resting heart rate, a simple marker of increased sympathetic tone activation, was no different among people with or without EDS.
Such data, say the authors, leaves them unclear as to whether sleep complaints are a symptom of underlying cardiovascular disease or whether sleepiness triggers or worsens disease.
"These data may have clinical implications adding to the body evidence that EDS is not a benign but rather an important risk marker for midterm mortality in community dwelling elderly," they conclude, adding that simple questionnaires incorporating questions on sleeping patterns should become part of routine examinations in the elderly.
ESC Press Office | EurekAlert!
Further reports about: > Cardiology > EDS > Health > Prevention > atherosclerosis > cardiovascular death > cardiovascular disease > cerebrovascular disease > daytime sleepiness > heart failure > hypothesis generating > myocardial infarction > polysomnography readings > risk factor > sleepiness triggers > socioeconomic differences > socioeconomic status > vascular disease > worsens disease
Study suggests possible new target for treating and preventing Alzheimer's
02.12.2016 | Oregon Health & Science University
The first analysis of Ewing's sarcoma methyloma opens doors to new treatments
01.12.2016 | IDIBELL-Bellvitge Biomedical Research Institute
A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.
Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...
In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.
“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...
The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.
The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...
Broadband rotational spectroscopy unravels structural reshaping of isolated molecules in the gas phase to accommodate water
In two recent publications in the Journal of Chemical Physics and in the Journal of Physical Chemistry Letters, researchers around Melanie Schnell from the Max...
The efficiency of power electronic systems is not solely dependent on electrical efficiency but also on weight, for example, in mobile systems. When the weight of relevant components and devices in airplanes, for instance, is reduced, fuel savings can be achieved and correspondingly greenhouse gas emissions decreased. New materials and components based on gallium nitride (GaN) can help to reduce weight and increase the efficiency. With these new materials, power electronic switches can be operated at higher switching frequency, resulting in higher power density and lower material costs.
Researchers at the Fraunhofer Institute for Solar Energy Systems ISE together with partners have investigated how these materials can be used to make power...
16.11.2016 | Event News
01.11.2016 | Event News
14.10.2016 | Event News
02.12.2016 | Medical Engineering
02.12.2016 | Agricultural and Forestry Science
02.12.2016 | Physics and Astronomy