Health

Sleepiness may heighten death risk in elderly

A new study supports earlier findings that link sleep disorders with a number of physical ills.

By Susan J. Landers — Posted March 16, 2009

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Healthy elderly people who reported that they regularly felt very sleepy during the day may have a higher risk of dying from cardiovascular disease than do their less sleepy compatriots, according to a study published online Feb. 26 in Stroke: Journal of the American Heart Assn.

For six years, the researchers followed more than 8,000 elderly people living in three French cities. They found that those who were sleepy had a 33% increase in the relative risk of overall death compared with those who were not sleepy.

This heightened risk held true even when the researchers adjusted for age, gender, body mass index, previous cardiovascular disease and cardiovascular risk factors. Sleepiness also was equally predictive of mortality in those who snored loudly and those who did not.

As the world's population ages, determining the health risks that affect elderly patients will become a frequent concern. Difficulty sleeping may be among those risks.

"Taken together, these data indicate that excessive daytime sleepiness, a frequent symptom in the elderly, is not so benign a symptom," said lead author Jean-Philippe Empana, MD, PhD, a researcher at Inserm, the French Public Institute on Health and Medical Research, in Villejuif.

"The clinical implications of the study might be that practitioners should be particularly aware of the sleep symptoms their patients are reporting, in particular a regular and frequent excessive daytime sleepiness." The findings are not surprising, Dr. Empana said, as other studies on this topic came to a similar conclusion.

Alejandro Chediak, MD, past president of the American Academy of Sleep Medicine, agreed. "The relationship was brought up in the 2006 Institute of Medicine report," he noted. That report, "Sleep Disorders and Sleep Deprivation," said, "The cumulative long-term effects of sleep loss and sleep disorders have been associated with a wide range of deleterious health consequences, including an increased risk of hypertension, diabetes, obesity, heart attack and stroke."

"Although sleep apnea gets all the press, sleep loss, regardless of how it occurs -- for example, by working two jobs and not allowing yourself the opportunity to sleep -- has been demonstrated to have health consequences if allowed to go on for a number of years," Dr. Chediak said.

Need for more education

The American Medical Association also has taken note of the harms wrought by sleepiness and has policy focused on the dangers of driving while drowsy. The AMA also supports the inclusion of education on sleep deprivation and fatigue during medical residency training as well as its inclusion as an essential part of medical education.

Currently, medical school includes about an hour of education on sleep and focuses on sleep apnea, Dr. Chediak said.

In Dr. Empana's study, the average participant's age was 74, and 60% were women. At the onset of the study, participants completed a questionnaire derived from the Epworth Sleepiness Scale, a validated questionnaire to assess daytime sleepiness.

Although results point to an association between excessive daytime sleepiness and an increased risk of cardiovascular death, the reason is still unknown. "We are far from having a clear explanation," Dr. Empana said.

The researchers said it remained unclear if sleep complaints are a symptom of an underlying disease or whether the sleepiness triggers or worsens a disease. "The main aim is to be aware of sleep complaints and to look for them routinely in the elderly, because it may be associated with a worse prognosis," he said.

Back to top


External links

"Excessive Daytime Sleepiness Is an Independent Risk Indicator for Cardiovascular Mortality in Community-Dwelling Elderly," abstract, Stroke online Feb. 26 (link)

Back to top


ADVERTISEMENT

ADVERTISE HERE


Featured
Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story


Read story

Goodbye

American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story


Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story


Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story


Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story


Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story


Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story


Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story