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Sleep Med. 2016 May;21:126-32. doi: 10.1016/j.sleep.2016.01.007. Epub 2016 Feb 12.

Influence of sleep disturbances on age at onset and long-term incidence of major cardiovascular events: the MONICA-Brianza and PAMELA cohort studies.

Author information

1
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.
2
EPIMED Research Centre - Epidemiology and Preventive Medicine, Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy.
3
Department of Health Sciences, University of Milano Bicocca, Monza, Italy.
4
Department of Health Sciences, University of Milano Bicocca, Monza, Italy; IRCCS Multimedica, Sesto San Giovanni, Italy.
5
Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg; Division of Health Sciences, University of Warwick Medical School, Coventry, United Kingdom.
6
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.
7
EPIMED Research Centre - Epidemiology and Preventive Medicine, Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy. Electronic address: marco.ferrario@uninsubria.it.

Abstract

OBJECTIVE:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSION:

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.

KEYWORDS:

Cardiovascular risk; Coronary artery diseases; Depression; Epidemiology; Sleep disorders; Stroke

PMID:
27448483
DOI:
10.1016/j.sleep.2016.01.007
[Indexed for MEDLINE]

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