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Excessive Daytime Sleepiness and Vascular Events The Three City Study.pdf

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Excessive Daytime Sleepiness and Vascular Events The Three City Study

ORIGINAL ARTICLE Excessive Daytime Sleepiness and Vascular Events: The Three City Study Martin Blachier, MD,1 Yves Dauvilliers, MD, PhD,2,3 Isabelle Jaussent, PhD,2 Catherine Helmer, MD, PhD,4 Karen Ritchie, MD, PhD,2,5 Xavier Jouven, MD, PhD,1,6 Christophe Tzourio, MD, PhD,7 Philippe Amouyel, MD, PhD,8 Alain Besset, PhD,2 Pierre Ducimetiere, PhD,9 and Jean-Philippe Empana, MD, PhD1 Objective: We assessed whether excessive daytime sleepiness (EDS) at baseline was associated with subsequent coronary heart disease (CHD) and stroke events. Methods: The Three City Study, a French population-based multicenter prospective study, included 7,007 subjects aged 65 years with no personal history of CHD, stroke, or dementia, and self-rated EDS as never, rare, regular, or frequent in response to a face-to-face questionnaire. Hazard ratios (HRs) for the first episode of stroke and CHD over 6 years were estimated using a Cox proportional hazards model with age as the time scale. Results: The mean age of the cohort was 73.7 years (standard deviation, 5.37), 63% were women, and 13.3% and 4.3% reported regular and frequent EDS, respectively. After a median follow-up period of 5.1 years, 372 subjects experienced a first event, either stroke (122 subjects) or a CHD event (250 subjects). The increased risk of CHD and stroke was confined to the group with frequent EDS, and was 1.73 as much as in the group that reported never having EDS (HR, 1.73; 95% confidence interval [CI], 1.15–2.60), after adjustment for confounding and mediating factors. This association was seen in those without hypertension but not in those with hypertension at baseline (p for interaction ? 0.01). Moreover, the association with frequent EDS was statistically significant for stroke (HR, 2.10; 95% CI, 1.13–3.89) but not for CHD (HR, 1.51; 95% CI, 0.87–2.61). Interpretation: The current study suggests that frequent EDS is independently associated with future vascular events and stroke in particular in healthy commu