Autonomic Nervous System Activity and Decline as Prognostic Indicators of Cardiovascular and Cerebrovascular Events: The ‘PROOF’ Study

Barthélémy, Jean‐Claude; Pichot, Vincent; Dauphinot, Virginie; Celle, Sébastien; Laurent, Bernard; Garcin, Arnauld; Maudoux, Delphine; Kerleroux, J.; Lacour, Jean‐René; Kossovsky, Michel P.; Gaspoz, Jean‐Michel; Roche, Frédéric

doi:10.1159/000108914

Cited by 111 publications

(85 citation statements)

References 116 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The details of the PROOF study have been previously described. 13 Briefly, the subjects were recruited from SaintEtienne, France, from 2001 to 2003 and were eligible if they were 65 y old at the inclusion date. The exclusion criteria were defined as follows: previous myocardial infarction, arrhythmia, cardiac pacemaker, stroke, neurological or psychiatric disease, insulin-dependent diabetes, chronic obstructive pulmonary disease, cerebral magnetic resonance results suggesting neurological diseases or initial dementia, and current residence in institutions.…”

Section: Populationmentioning

confidence: 99%

“…The Prognostic Indicator of Cardiovascular and Cerebrovascular Events (PROOF) study 13 provides an opportunity to examine the association between OS and self-reported sleep quality and duration in a larger sample of community-dwelling elderly with homogenous age, without insomnia complaints, and with no report of major health disease or previous diagnosis or treatment for OS. Sleep duration was assessed using a validated sleep questionnaire for self-reported sleep, i.e., the Pittsburgh Sleep Quality Index (PSQI), 14 that assesses more…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Does Subjective Sleep Affect Bone Mineral Density in Older People with Minimal Health Disorders? The PROOF Cohort

Martin

Labeix

Garet

et al. 2016

Journal of Clinical Sleep Medicine

Self Cite

View full text Add to dashboard Cite

Study Objectives: Clinical and epidemiological studies suggest a relation between bone mineral density (BMD) and self-assessment of sleep with an effect on bone formation and osteoporosis (OS) risk in short and long sleepers. This study explores this association in a large sample of older subjects. Methods: We examined 500 participants without insomnia complaints aged 65.7 ± 0.8 y. Each participant had a full evaluation including anthropometric measurement, clinical examination and measurements of BMD at the lumbar spine and femoral sites by dual-energy X-ray absorptiometry. The daily energy expenditure (DEE) was measured by the Population Physical Activity Questionnaire. Sleep duration and quality were evaluated by the Pittsburgh Sleep Quality Index. The subjects were stratified into three groups according to sleep duration, i.e., short (< 6 h), normal (6-8 h), and long (≥ 8 h) sleepers. Results: Osteopenia was found in 40% of the subjects at the femoral level and 43% at the vertebral level. The prevalence of OS was lower both at femoral (8%) and vertebral (12%) levels. Short, normal, and long sleepers accounted for 29%, 40%, and 31% of subjects, respectively. After adjustments for metabolic, anthropometric, and DEE, multinomial logistic regression analysis indicated that long sleepers were more likely to have femoral neck OS with a slight effect of DEE at vertebral spine. Conclusions: In a sample of older subjects, self-reported long sleep was the best predictor of OS risk at the femoral level. This finding suggests an association between OS and self-reported sleep duration in older subjects. Clinical Trial Registration: NCT 00759304 and NCT 00766584 Keywords: sleep duration, sleep quality, osteoporosis, bone mineral density, older people Citation: Saint Martin M, Labeix P, Garet M, Thierry T, Barthélémy JC, Collet P, Roche F, Sforza E. Does subjective sleep affect bone mineral density in older people with minimal health disorders? The PROOF cohort.

show abstract

Section: Populationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Does Subjective Sleep Affect Bone Mineral Density in Older People with Minimal Health Disorders? The PROOF Cohort

Martin

Labeix

Garet

et al. 2016

Journal of Clinical Sleep Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…The design of the PROOF study has been previously published. 10 In this study, we excluded subjects who were being treated for hypertension at inclusion (with angiotensin-converting enzyme inhibitors, angiotensinreceptor blockers, b-blockers, diuretics, calcium channel blockers or other antihypertensive drugs). This information was collected through subjects' selfreport and confirmed by physicians' prescriptions.…”

Section: Study Populationmentioning

confidence: 99%

Autonomic nervous system activity is independently associated with the risk of shift in the non-dipper blood pressure pattern

et al. 2010

Self Cite

View full text Add to dashboard Cite

An insufficient decrease in nocturnal blood pressure (BP) is a known factor in cardiovascular mortality. We aimed to determine whether autonomic nervous system (ANS) activity and its change over 2 years were associated with a shift to non-dipper status, independently of initial BP, in a general elderly population. From participants in the PROOF study, 600 subjects untreated for hypertension were selected (age at baseline: 65 years, men: 41.5%). Dipper/non-dipper status was defined using repeated measures of 24-h ambulatory BP at baseline and 2 years later. ANS activity was evaluated on the basis of 24-h heart rate variability at both examinations. Among the 454 dipper subjects at baseline, 26.2% became non-dippers. Multivariate analysis showed that a +1 between-subject s.d. increase in the very low frequency at baseline was associated with a decreased odds ratio for the shift to non-dipper status 2 years later (OR¼0.61 [0.41-0.91], P¼0.02). The within-subject change between the two measurements of day and night systolic BP and day diastolic BP also contributed significantly to the risk of shift to non-dipper status. Our results suggest that impaired ANS activity precedes an insufficient decrease in nocturnal BP independent of hypertension status. Keywords: ambulatory blood pressure; heart rate variability; non-dipper; sympathetic nervous activity INTRODUCTION An insufficient decrease in nocturnal blood pressure (BP) (nondipping) is recognized as a marker of end-organ damage and a predictor of cardiovascular and all-cause mortality, independently of hypertension status. 1-3 Our understanding of the pathophysiologic factors that may be involved in the mechanisms of the circadian variation of BP and the non-dipping pattern remains incomplete. Among the suspected determinants, autonomic nervous system (ANS) activity is shown to be associated with arterial BP level and involved in the control of the circadian variation of BP. 4,5 Previous cross-sectional studies have shown that ANS activity, evaluated by heart rate variability (HRV), was reduced in non-dipper, untreated hypertensive subjects. 6,7 A possible explanation of the nocturnal decrease in BP is that it results from a reduction of sympathetic nervous activity and impaired circadian rhythm in sympatho-vagal balance during sleep. 8,9 We aimed to assess whether ANS activity indices and their changes over 2 years, as evaluated by 24-h HRV, were associated with a shift to non-dipper status among subjects identified as dippers at study entry in a general elderly population not treated for hypertension.

show abstract

“…The present investigation is part of the PROOF study, a population-based cohort study of 1,011 (61% females) volunteers aged 65¡1 yrs living in the town of Saint-Etienne (France) who were enrolled to assess whether an age-related decrease in autonomic nervous system activity could represent an independent risk for cardiovascular mortality, silent and symptomatic ischaemic stroke, myocardial infarction and newonset heart failure [30]. An ancillary study addressing the association between SDB and cardiovascular and cerebrovascular morbidity during a 7-yr follow-up was proposed to participants (SYNAPSE study).…”

Section: Populationmentioning

confidence: 99%

Association between C-reactive protein and unrecognised sleep-disordered breathing in the elderly

Roche¹,

Jm²,

Pichot³

et al. 2009

Eur Respir J

View full text Add to dashboard Cite

Elevated levels of C-reactive protein (CRP) have been reported in patients with sleep-disordered breathing (SDB) and may represent an inflammatory marker of cardiovascular risk. However, the association of CRP with SBD in presumed healthy elderly subjects is unknown.In total, 851 (58.5% females) 68-yr-old subjects, who were free of any known cardiac or sleep disorders, were prospectively examined. Subjects underwent unattended polygraphy, and the apnoea/hypopnoea index (AHI) and oxyhaemoglobin desaturation index (ODI) were assessed. Elevated levels of CRP were found on the morning after the sleep study in patients with more severe SDB. A significant correlation was found between CRP levels, time spent at night with arterial oxygen saturation ,90% and ODI. No association was found between CRP levels and AHI. After adjustments for body mass index, smoking status, hypertension, diabetes and dyslipidaemia, a significant association remained between CRP levels and ODI .10 events?h -1 .CRP levels were frequently increased in a large sample of elderly subjects free of major cardiovascular disease. CRP levels were not correlated with the AHI and the indices of sleep fragmentation; the ODI .10 events?h -1 was the strongest predictor of raised CRP level.The present results suggest that, in the elderly, intermittent hypoxaemia may underlie inflammatory processes leading to cardiovascular morbidity. KEYWORDS: C-reactive protein, elderly, hypoxaemia, inflammation, sleep apnoea O bstructive sleep apnoea syndrome (OSAS) is a highly prevalent disorder affecting 2-4% of the general population and is considered an independent risk factor for cardiovascular diseases [1-3], particularly hypertension, coronary artery disease, heart failure and stroke [4,5]. Furthermore, newly diagnosed OSAS patients, free of classical cardiovascular risk factors, such as hypertension, diabetes and smoking, may have early signs of atherosclerosis [6]. Although the pathophysiology of cardiovascular risk is mutifactorial, sympathetic hypertonia [7], endothelial dysfunction [8, 9] and insulin resistance [10] have been postulated as factors initiating and sustaining inflammatory microvascular alterations and therefore atherosclerosis [11,12]. In middle-aged OSAS patients, C-reactive protein (CRP), a marker of inflammation in atherosclerotic lesions [13], is elevated in severe cases [14] and decreases after treatment with nasal continuous positive airway pressure [15]. Despite the putative role of CRP in cardiovascular risk in OSAS, studies conducted to date have yielded contradictory results, with some showing an independent association with disease severity in adults [16][17][18][19] and children [20,21], and others showing no relationship [22,23]. Moreover, the association between obesity and CRP [24] raised the question as to whether elevated CRP reflects the effects of obesity or whether it is specific to OSAS itself.In the elderly, the prevalence of sleep-disordered breathing (SDB) is estimated to be higher than in middle-aged subjects. AN...

show abstract

Autonomic Nervous System Activity and Decline as Prognostic Indicators of Cardiovascular and Cerebrovascular Events: The ‘PROOF’ Study

Cited by 111 publications

References 116 publications

Does Subjective Sleep Affect Bone Mineral Density in Older People with Minimal Health Disorders? The PROOF Cohort

Does Subjective Sleep Affect Bone Mineral Density in Older People with Minimal Health Disorders? The PROOF Cohort

Autonomic nervous system activity is independently associated with the risk of shift in the non-dipper blood pressure pattern

Association between C-reactive protein and unrecognised sleep-disordered breathing in the elderly

Contact Info

Product

Resources

About