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. 2021 Jul 6:13:1049-1059.
doi: 10.2147/NSS.S319675. eCollection 2021.

Excessive Daytime Sleepiness and Cardiovascular Mortality in US Adults: A NHANES 2005-2008 Follow-Up Study

Jingen Li  1   2 , Naima Covassin  2 , Joshua M Bock  2 , Essa A Mohamed  2 , Lakshmi P Pappoppula  2 , Chilsia Shafi  2 , Francisco Lopez-Jimenez  2 , Virend K Somers  2
Affiliations

Excessive Daytime Sleepiness and Cardiovascular Mortality in US Adults: A NHANES 2005-2008 Follow-Up Study

Jingen Li et al. Nat Sci Sleep. .

Abstract

Purpose: Excessive daytime sleepiness is highly prevalent and has been associated with increased risk of cardiovascular diseases, but evidence for its association with cardiovascular mortality is limited and inconsistent. We aimed to determine whether excessive daytime sleepiness is independently associated with cardiovascular mortality in general adult population.

Patients and methods: A prospective study of 10,330 adult participants (aged ≥20 years) from National Health and Nutrition Examination Survey (NHANES) 2005-2006 and 2007-2008 was followed up until December 31st, 2015. Excessive daytime sleepiness was defined as the self-reported feeling of being overly sleepy often or always during the day. Cox proportional hazard ratios (HRs) with 95% confidence interval (CI) were estimated to assess risk for cardiovascular mortality.

Results: A total of 10,330 participants with mean age of 47.3 years (95% CI, 46.0 to 48.1) were included in this analysis. Approximately, 18.5% of US adults reported excessive daytime sleepiness. Over a mean follow-up of 8.3 years, 262 cardiovascular deaths occurred. Participants with excessive daytime sleepiness had 2.85-times greater risk (95% CI, 1.33-6.09) of cardiovascular death than those without daytime sleepiness in multivariable analysis corrected for sociodemographic factors, comorbidities and cardiovascular risk factors including depression. Further adjustment for self-reported sleep disorders and sleep duration only slightly attenuated this association (HR, 2.55; 95% CI, 1.23-5.27). No interactions between excessive daytime sleepiness and age, sex or cardiovascular disease at study entry were observed (all Ps>0.05).

Conclusion: Excessive daytime sleepiness is highly prevalent among US adults and is independently associated with an approximately two-and-a-half-fold increased risk of cardiovascular mortality in a large national sample. Screening for excessive daytime sleepiness may be a simple and cost-effective tool for identifying individuals at high risk of cardiovascular death.

Keywords: cardiovascular diseases; cardiovascular risk; cohort study; sleep disorders.

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Conflict of interest statement

VKS has served as a consultant for Respicardia, Baker Tilly, Bayer and Jazz Pharmaceuticals and serves on the Sleep Number Research Advisory Board. VKS also reports grants from Sleep Number, during the conduct of the study; personal fees from Bayer, personal fees from Respicardia, personal fees from Jazz Pharmaceuticals, and personal fees from Baker Tilly outside the submitted work. All other authors claimed no conflicts of interest.

Figures

Figure 1
Figure 1
Cox cumulative hazard function for cardiovascular mortality by degree of daytime sleepiness. The model was fully adjusted for socioeconomic factors, cardiovascular risk factors, comorbidities, sleep duration and sleep disorders. HR, hazard ratio; No daytime sleepiness was defined as never feeling overly sleepy during the day for last month; Mild daytime sleepiness was defined as rarely or sometimes (1 to 4 times a month) feeling overly sleepy during the day; Excessive daytime sleepiness was defined as often or almost always (5 to 30 times a month) feeling overly sleepy during the day.
Figure 2
Figure 2
Associations between EDS and risk of cardiovascular mortality stratified by sex, age and body mass index in fully adjusted model.
See this image and copyright information in PMC

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