Daytime sleepiness and risk of stroke and vascular disease

Findings from the Northern Manhattan Study (NOMAS)

Bernadette Boden-Albala, Eric T. Roberts, Carl Bazil, Yeseon Moon, Mitchell S V Elkind, Tatjana Rundek, Myunghee C. Paik, Ralph L. Sacco

Research output: Contribution to journalArticle

Abstract

Background-Recent studies have suggested that poor quality and diminished quantity of sleep may be independently linked to vascular events although prospective and multiethnic studies are limited. This study aimed to explore the relationship between daytime sleepiness and the risk of ischemic stroke and vascular events in an elderly, multiethnic prospective cohort. Methods and Results-As part of the Northern Manhattan Study, the Epworth Sleepiness Scale was collected during the 2004 annual follow-up. Daytime sleepiness was trichotomized using previously reported cut points of no dozing, some dozing, and significant dozing. Subjects were followed annually for a mean of 5.1 years. Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals for stroke, myocardial infarction, and death outcomes. We obtained the Epworth Sleepiness Scale on 2088 community residents. The mean age was 73.5 ± 9.3 years; 64% were women; 17% were white, 20% black, 60% Hispanic, and 3% were other. Over 44% of the cohort reported no daytime dozing, 47% some dozing, and 9% significant daytime dozing. Compared with those reporting no daytime dozing, individuals reporting significant dozing had an increased risk of ischemic stroke (hazard ratio, 2.74 [95% confidence interval, 1.38-5.43]), all stroke (3.00 [1.57-5.73]), the combination of ischemic stroke, myocardial infarction, and vascular death (2.38 [1.50-3.78]), and all vascular events (2.48 [1.57-3.91]), after adjusting for medical comorbidities. Conclusions-Daytime sleepiness is an independent risk factor for stroke and other vascular events. These findings suggest the importance of screening for sleep problems at the primary care level.

Original languageEnglish (US)
Pages (from-to)500-507
Number of pages8
JournalCirculation: Cardiovascular Quality and Outcomes
Volume5
Issue number4
DOIs
StatePublished - Jul 2012

Fingerprint

Vascular Diseases
Stroke
Blood Vessels
Sleep
Myocardial Infarction
Confidence Intervals
Hispanic Americans
Proportional Hazards Models
Comorbidity
Primary Health Care
Prospective Studies

Keywords

  • Epidemiology
  • Ischemic stroke
  • Race/ethnicity
  • Sleep
  • Vascular disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Daytime sleepiness and risk of stroke and vascular disease : Findings from the Northern Manhattan Study (NOMAS). / Boden-Albala, Bernadette; Roberts, Eric T.; Bazil, Carl; Moon, Yeseon; Elkind, Mitchell S V; Rundek, Tatjana; Paik, Myunghee C.; Sacco, Ralph L.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 5, No. 4, 07.2012, p. 500-507.

Research output: Contribution to journalArticle

Boden-Albala, Bernadette ; Roberts, Eric T. ; Bazil, Carl ; Moon, Yeseon ; Elkind, Mitchell S V ; Rundek, Tatjana ; Paik, Myunghee C. ; Sacco, Ralph L. / Daytime sleepiness and risk of stroke and vascular disease : Findings from the Northern Manhattan Study (NOMAS). In: Circulation: Cardiovascular Quality and Outcomes. 2012 ; Vol. 5, No. 4. pp. 500-507.
@article{260c85839e7f40ab881b62ddb39915d8,
title = "Daytime sleepiness and risk of stroke and vascular disease: Findings from the Northern Manhattan Study (NOMAS)",
abstract = "Background-Recent studies have suggested that poor quality and diminished quantity of sleep may be independently linked to vascular events although prospective and multiethnic studies are limited. This study aimed to explore the relationship between daytime sleepiness and the risk of ischemic stroke and vascular events in an elderly, multiethnic prospective cohort. Methods and Results-As part of the Northern Manhattan Study, the Epworth Sleepiness Scale was collected during the 2004 annual follow-up. Daytime sleepiness was trichotomized using previously reported cut points of no dozing, some dozing, and significant dozing. Subjects were followed annually for a mean of 5.1 years. Cox proportional hazards models were used to calculate hazard ratios and 95{\%} confidence intervals for stroke, myocardial infarction, and death outcomes. We obtained the Epworth Sleepiness Scale on 2088 community residents. The mean age was 73.5 ± 9.3 years; 64{\%} were women; 17{\%} were white, 20{\%} black, 60{\%} Hispanic, and 3{\%} were other. Over 44{\%} of the cohort reported no daytime dozing, 47{\%} some dozing, and 9{\%} significant daytime dozing. Compared with those reporting no daytime dozing, individuals reporting significant dozing had an increased risk of ischemic stroke (hazard ratio, 2.74 [95{\%} confidence interval, 1.38-5.43]), all stroke (3.00 [1.57-5.73]), the combination of ischemic stroke, myocardial infarction, and vascular death (2.38 [1.50-3.78]), and all vascular events (2.48 [1.57-3.91]), after adjusting for medical comorbidities. Conclusions-Daytime sleepiness is an independent risk factor for stroke and other vascular events. These findings suggest the importance of screening for sleep problems at the primary care level.",
keywords = "Epidemiology, Ischemic stroke, Race/ethnicity, Sleep, Vascular disease",
author = "Bernadette Boden-Albala and Roberts, {Eric T.} and Carl Bazil and Yeseon Moon and Elkind, {Mitchell S V} and Tatjana Rundek and Paik, {Myunghee C.} and Sacco, {Ralph L.}",
year = "2012",
month = "7",
doi = "10.1161/CIRCOUTCOMES.111.963801",
language = "English (US)",
volume = "5",
pages = "500--507",
journal = "Circulation: Cardiovascular Quality and Outcomes",
issn = "1941-7713",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Daytime sleepiness and risk of stroke and vascular disease

T2 - Findings from the Northern Manhattan Study (NOMAS)

AU - Boden-Albala, Bernadette

AU - Roberts, Eric T.

AU - Bazil, Carl

AU - Moon, Yeseon

AU - Elkind, Mitchell S V

AU - Rundek, Tatjana

AU - Paik, Myunghee C.

AU - Sacco, Ralph L.

PY - 2012/7

Y1 - 2012/7

N2 - Background-Recent studies have suggested that poor quality and diminished quantity of sleep may be independently linked to vascular events although prospective and multiethnic studies are limited. This study aimed to explore the relationship between daytime sleepiness and the risk of ischemic stroke and vascular events in an elderly, multiethnic prospective cohort. Methods and Results-As part of the Northern Manhattan Study, the Epworth Sleepiness Scale was collected during the 2004 annual follow-up. Daytime sleepiness was trichotomized using previously reported cut points of no dozing, some dozing, and significant dozing. Subjects were followed annually for a mean of 5.1 years. Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals for stroke, myocardial infarction, and death outcomes. We obtained the Epworth Sleepiness Scale on 2088 community residents. The mean age was 73.5 ± 9.3 years; 64% were women; 17% were white, 20% black, 60% Hispanic, and 3% were other. Over 44% of the cohort reported no daytime dozing, 47% some dozing, and 9% significant daytime dozing. Compared with those reporting no daytime dozing, individuals reporting significant dozing had an increased risk of ischemic stroke (hazard ratio, 2.74 [95% confidence interval, 1.38-5.43]), all stroke (3.00 [1.57-5.73]), the combination of ischemic stroke, myocardial infarction, and vascular death (2.38 [1.50-3.78]), and all vascular events (2.48 [1.57-3.91]), after adjusting for medical comorbidities. Conclusions-Daytime sleepiness is an independent risk factor for stroke and other vascular events. These findings suggest the importance of screening for sleep problems at the primary care level.

AB - Background-Recent studies have suggested that poor quality and diminished quantity of sleep may be independently linked to vascular events although prospective and multiethnic studies are limited. This study aimed to explore the relationship between daytime sleepiness and the risk of ischemic stroke and vascular events in an elderly, multiethnic prospective cohort. Methods and Results-As part of the Northern Manhattan Study, the Epworth Sleepiness Scale was collected during the 2004 annual follow-up. Daytime sleepiness was trichotomized using previously reported cut points of no dozing, some dozing, and significant dozing. Subjects were followed annually for a mean of 5.1 years. Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals for stroke, myocardial infarction, and death outcomes. We obtained the Epworth Sleepiness Scale on 2088 community residents. The mean age was 73.5 ± 9.3 years; 64% were women; 17% were white, 20% black, 60% Hispanic, and 3% were other. Over 44% of the cohort reported no daytime dozing, 47% some dozing, and 9% significant daytime dozing. Compared with those reporting no daytime dozing, individuals reporting significant dozing had an increased risk of ischemic stroke (hazard ratio, 2.74 [95% confidence interval, 1.38-5.43]), all stroke (3.00 [1.57-5.73]), the combination of ischemic stroke, myocardial infarction, and vascular death (2.38 [1.50-3.78]), and all vascular events (2.48 [1.57-3.91]), after adjusting for medical comorbidities. Conclusions-Daytime sleepiness is an independent risk factor for stroke and other vascular events. These findings suggest the importance of screening for sleep problems at the primary care level.

KW - Epidemiology

KW - Ischemic stroke

KW - Race/ethnicity

KW - Sleep

KW - Vascular disease

UR - http://www.scopus.com/inward/record.url?scp=84864585468&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84864585468&partnerID=8YFLogxK

U2 - 10.1161/CIRCOUTCOMES.111.963801

DO - 10.1161/CIRCOUTCOMES.111.963801

M3 - Article

VL - 5

SP - 500

EP - 507

JO - Circulation: Cardiovascular Quality and Outcomes

JF - Circulation: Cardiovascular Quality and Outcomes

SN - 1941-7713

IS - 4

ER -