Daytime sleepiness provides red flag for cardiovascular disease

Clinicians should be alert to patients reporting "excessive" day time sleepiness (EDS), says the European Society of Cardiology, after a French study found healthy elderly people who regularly report feeling sleepy during the day have a significantly higher risk of dying from cardiovascular disease.

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.

VIA : Physorg