Abstract P313: Excessive Daytime Sleepiness in Older British Men: An Early Marker of Heart Failure
Background: Sleep disturbance is common, especially amongst older adults. The association between night-time sleep duration, cardiovascular disease (CVD), metabolic disorders and mortality has been extensively reported, with studies showing a U-shaped association. Less is known about the influence of daytime sleep and attention has more recently turned to excessive daytime sleepiness which has been associated with increased CVD, heart failure and mortality. We aimed to investigate the association between sleep patterns and cardiovascular risk markers in older adults including metabolic risk markers, cardiac markers and early markers of atherosclerosis [arterial stiffness and carotid intima-media thickness (CIMT)] with particular focus on day sleep.
Methods: Cross sectional study of 1722 surviving men aged 71-92 examined in 2010-2012 across 24 British towns, from a prospective study initiated in 1978-1980. Men with a history of heart attack or heart failure (n = 251) were excluded from the analysis. Self-reported sleep duration (night and day) was based on a questionnaire; insomnia was defined as self-reported difficulty falling asleep. Participants were invited for a physical examination which included non-invasive assessment of vascular measures including CIMT and arterial stiffness (carotid distensibility and pulse wave velocity (PWV)).
Results: Analysis of the data confirmed previous reports of a U-shaped association between night-time sleep duration and HbA1c, even following adjustment for confounding factors including age, BMI, physical activity and social class. Men who reported insomnia had significantly higher mean triglyceride, glucose and insulin (p = 0.02, 0.04 and 0.01 in the age-adjusted model). Increasing daytime sleep duration was associated with higher fasting glucose and insulin levels which remained significant (p = 0.02 and 0.01 respectively) after adjustment for prevalent diabetes. Compared to those with no daytime sleep, men with daytime sleep > 1 hour had a higher risk of raised N-terminal pro brain natriuretic peptide (NT-proBNP) of ≥400pg/ml, the diagnostic threshold for heart failure [OR (95% CI) = 1.88 (1.15, 3.1)], reduced lung function (forced expiratory volume in 1s) and elevated von Willebrand factor (vWF), a marker of endothelial dysfunction. These patterns were not seen for night-time sleep or insomnia. Sleeping patterns were unrelated to CIMT and arterial stiffness.
Conclusions: Day sleep of > 1 hour may be an early indicator of heart failure. Clinically, this is important in the assessment of older patients who seek medical advice for excessive daytime sleepiness, in whom indicators of heart failure should be sought and further investigations carried out if necessary.
Author Disclosures: S. Zonoozi: None. S. Ramsay: None. O. Papacosta: None. L. Lennon: None. E.A. Ellins: None. J.P. Halcox: None. P.H. Whincup: None. S.G. Wannamethee: None.
- © 2016 by American Heart Association, Inc.