Excessive Daytime Sleepiness and Cardiovascular Mortality in US Adults: A NHANES 2005–2008 Follow-Up Study

Abstract

Purpose: Excessive daytime sleepiness is highly prevalent and has been associated with increased risk of cardiovascular diseases, but evidence for its association with cardiovascular mortality is limited and inconsistent. We aimed to determine whether excessive daytime sleepiness is independently associated with cardiovascular mortality in general adult population. Patients and Methods: A prospective study of 10,330 adult participants (aged ≥20 years) from National Health and Nutrition Examination Survey (NHANES) 2005-2006 and 2007-2008 was followed up until December 31st, 2015. Excessive daytime sleepiness was defined as the self-reported feeling of being overly sleepy often or always during the day. Cox proportional hazard ratios (HRs) with 95% confidence interval (CI) were estimated to assess risk for cardiovascular mortality. Results: A total of 10,330 participants with mean age of 47.3 years (95% CI, 46.0 to 48.1) were included in this analysis. Approximately, 18.5% of US adults reported excessive daytime sleepiness. Over a mean follow-up of 8.3 years, 262 cardiovascular deaths occurred. Participants with excessive daytime sleepiness had 2.85-times greater risk (95% CI, 1.33-6.09) of cardiovascular death than those without daytime sleepiness in multivariable analysis corrected for sociodemographic factors, comorbidities and cardiovascular risk factors including depression. Further adjustment for self-reported sleep disorders and sleep duration only slightly attenuated this association (HR, 2.55; 95% CI, 1. 23-5.27). No interactions between excessive daytime sleepiness and age, sex or cardiovascular disease at study entry were observed (all Ps>0.05). Conclusion: Excessive daytime sleepiness is highly prevalent among US adults and is independently associated with an approximately two-and-a-half-fold increased risk of cardiovascular mortality in a large national sample. Screening for excessive daytime sleepiness may be a simple and cost-effective tool for identifying individuals at high risk of cardiovascular death.

Monocyte-to-high-density lipoprotein-cholesterol ratio (MHR) and the risk of all-cause and cardiovascular mortality: a nationwide cohort study in the United States

“…Mortality status was ascertained by the NHANES-linked National Death Index record, and detailed information is available on the NCHS data linkage webpage [ 23 ]. The outcomes of this study, including all-cause and cardiovascular mortality, were defined referring to the International Classification of Diseases, 10th Revision (ICD-10) [ 24 ]. The follow-up time was recorded from the survey participation date until the 31st December 2015.…”

Evaluation of Sleep Habits and Disturbances Among US Adults, 2017-2020

“…On the basis of data from adults aged 18 years and older from the National Health Interview Survey from 2002 to 2012, of trouble sleeping increased from 17.5% to 19.2%, and excessive daytime sleepiness increased from 9.80% to 12.7% 34. Cross-sectional data of NHANES showed that the prevalence of trouble sleeping in 2005 to 2018 was 27.74%, and the prevalence of excessive daytime sleepiness in 2005 to 2008 was 18.5% 35,36. These increases may have been influenced by single-item questionnaires in our study, which used a broader definition.…”

Excessive daytime sleepiness: an emerging marker of cardiovascular risk

“…Indeed, our analysis of the National Health and Nutrition Examination Survey dataset reports EDS is associated with a near threefold increase in cardiovascular mortality after adjustment for cardiovascular risk factors, comorbidities and sleep disorders. Of note, the magnitude of this risk was reduced marginally (HR=2.85–2.55) after the model was further adjusted for self-reported sleep duration (figure 1)34 supporting conclusions drawn using the UK Biobank 35. Collectively, it is important to identify which community-based studies adjust for sleep habits, or prior diagnosis of sleep disorders, to best understand the role of EDS per se in patients’ cardiovascular risk profiles.…”

“…Sleepiness was quantified by the frequency individuals felt overly sleepy within a month; >1 (no excessive daytime sleepiness (EDS)), 1–4 (mild EDS) or 5–30 (EDS). Reprinted with permission from Li et al 34…”