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Sleep disturbance, stroke, and heart disease events: evidence from the Caerphilly cohort
  1. Peter Elwood,
  2. Melissa Hack,
  3. Janet Pickering,
  4. Janie Hughes,
  5. John Gallacher

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Objective:
To test the hypothesis that sleep disorders are relevant to the risk of ischaemic stroke and ischaemic heart disease events in older men.

Design:
A cohort study.

Setting:
The Caerphilly cohort, a representative population sample of older men in South Wales, UK.

Participants:
1986 men aged 55–69 years completed a questionnaire on sleep patterns with help from their partners. This asked about symptoms of disturbed sleep: insomnia, snoring, restless legs, obstructive sleep apnoea, and about daytime sleepiness. During the following 10 years 107 men experienced an ischaemic stroke and 213 had an ischaemic heart disease event.

Main results:
Up to one third of the men reported at least one symptom suggestive of sleep disturbance, and one third reported daytime sleepiness. Compared with men who reported no such symptoms, the adjusted relative odds of an ischaemic stroke were significantly increased in men with any sleep disturbance, the strongest association being with sleep apnoea (relative odds 1.97; 1.26 to 3.09). The association with daytime sleepiness was not significant for stroke. Relations with ischaemic heart disease events were all raised in men with symptoms of sleep disturbance, but none was significant, other than daytime sleepiness (relative odds 1.41; 1.04 to 1.92). There were no significant relations with blood pressure.

Conclusion:
The risk of an ischaemic stroke is increased in men whose sleep is frequently disturbed, and daytime sleepiness is associated with a significant increase in ischaemic heart disease events.