Sleepiness may heighten death risk in elderly

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.

This content was published online only.

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