Excessive daytime sleepiness: an emerging marker of cardiovascular risk

Abstract

Excessive daytime sleepiness (EDS) is classically viewed as a consequence of insufficient sleep or a symptom of sleep disorders. Epidemiological and clinical evidence have shown that patients reporting EDS in tandem with sleep disorders (e.g., obstructive sleep apnoea) are at greater cardiovascular risk than non-sleepy patients. While this may simply be attributable to EDS being present in patients with a more severe condition, treatment of sleep disorders does not consistently alleviate EDS, indicating potential aetiological differences. Moreover, not all patients with sleep disorders report EDS, and daytime sleepiness may be present even in the absence of any identifiable sleep disorder; thus, EDS could represent an independent pathophysiology. The purpose of this review is twofold: first, to highlight evidence that EDS increases cardiovascular risk in the presence of sleep disorders such as obstructive sleep apnoea, narcolepsy and idiopathic hypersomnia and second, to propose the notion that EDS may also increase cardiovascular risk in the absence of known sleep disorders, as supported by some epidemiological and observational data. We further highlight preliminary evidence suggesting systemic inflammation, which could be attributable to dysfunction of the gut microbiome and adipose tissue, as well as deleterious epigenetic changes, may promote EDS while also increasing cardiovascular risk; however, these pathways may be reciprocal and/or circumstantial. Additionally, gaps within the literature are noted followed by directions for future research.

Duration and Quality of Sleep and Risk of Self-reported Hearing Loss: The UK Biobank Study

“…Excessive daytime sleepiness is an emerging marker of cardiovascular risk, a condition that shares joint mechanisms with HL (Bock et al 2022). Moreover, insomnia is associated with increased systemic inflammation and increased atherosclerosis, which would cause thickening of the blood vessel walls and narrowing of the lumen, which would hinder adequate blood supply (Javaheri & Redline 2017).…”

The role of cardiovascular health and vascular events in the relationship between excessive daytime sleepiness and dementia risk

“…Most of these results suggest the potential role of cardiovascular burden in this association. Evidence from the literature has indicated that EDS was associated with metabolic diseases including obesity, diabetes mellitus, and hypertension (Akbaraly et al, 2015; Lindberg et al, 2007; Maugeri et al, 2018), and is a risk factor for cardiovascular morbidity and mortality (Bock et al, 2022; Ng et al, 2018). Given the well‐documented association between cardiovascular burden and dementia (Deckers et al, 2017; Kivipelto et al, 2005; Kuźma et al, 2018; Livingston et al, 2020; Wagner et al, 2018), it may be hypothesised that a poor cardiovascular health characterised by risky behaviours (smoking, physical inactivity, dietary unbalance), unhealthy biological risk factors (high blood lipids, high blood pressure, obesity, diabetes mellitus) and/or clinical vascular events might play a role in the association between EDS and dementia.…”

Proteomic Biomarkers of the Apnea Hypopnea Index and Obstructive Sleep Apnea: Insights into the Pathophysiology of Presence, Severity, and Treatment Response

“…High levels of sleep apnea, typically of the obstructive type, are associated with increased cardiovascular risk, notably increased risk of high blood pressure [ 7 ], increased vascular aging [ 8 ], heart failure [ 9 ], arrythmias [ 10 ], and stroke [ 11 ], effects that seem more correlated with hypoxia than with sleep fragmentation [ 10 , 12 ]. Sleep fragmentation, in contrast, correlates more with arousal disturbances and daytime sleepiness, although some authors have found higher cardiovascular risk in sleepy versus non sleepy OSA patients [ 10 , 13 ]. Timely diagnosis and treatment of OSA is imperative to the health and prognosis of millions.…”