Background
This study aimed to examine the association between self-reported sleep disordered
breathing (SDB) (“awaken short of breath or with a headache”) and mortality in a large
and ethnically diverse group of community-dwelling elderly people.
Methods
A total of 1288 participants, 65 years and older, were examined longitudinally. Sleep
problems were estimated using the Medical Outcomes Study Sleep Scale examining sleep
disturbance, snoring, awaken short of breath or with a headache, sleep adequacy, and
sleep somnolence. Cox regression analysis was used to examine the association between
sleep problems and mortality. Age, gender, education, ethnicity, and body mass index
were included as covariates. In further analyses we included hypertension, diabetes,
heart disease, and stroke as additional covariates.
Results
The participants were followed for up to 6 years (mean = 2.9, standard deviation = 1.1),
and 239 (18.6%) participants died during the follow-up. In unadjusted models, SDB
at the initial visit was associated with mortality (hazard ratio [HR] = 1.37; 95%
confidence interval [CI] 1.21-1.55; P < .0001). After adjusting for all the covariates, the relationship between SDB and
mortality remained significant (HR = 1.48; 95% CI 1.29-1.70; P < .0001). Participants with Caribbean-Hispanic ancestry have higher risk for mortality.
Conclusions
Our results suggest that SDB is a risk factor for mortality in a large and ethnically
diverse group of older adults, independent of demographic and clinical factors. Further
research is needed to examine the underlying mechanisms of this association.
Key Words
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Article info
Publication history
Published online: April 01, 2016
Accepted:
March 3,
2016
Received:
September 23,
2015
Footnotes
Funding: The National Institute on Aging of the National Institute of Health provided financial support for the WHICAP study in the form of a grant: R01AG037212, AG042483.
Conflict of interest: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
Authors' contribution/disclosures: Angeliki Tsapanou: study design, interpretation of the results, preparation of the manuscript, statistical analysis. Dr. Tsapanou reports no disclosure. Yian Gu: study design, interpretation of the results, preparation of the manuscript, statistical analysis. Dr. Gu reports no disclosure. Deirdre O'Shea: drafting the manuscript. Dr. O'Shea reports no disclosure. Jennifer Manly: drafting the manuscript. Dr. Manly reports no disclosure. Nicole Schupf: study design. Dr Schupf reports no disclosure. Nikolaos Scarmeas: study design, interpretation of the results, preparation of the manuscript, statistical analysis. Dr. Scarmeas reports no disclosure. Yaakov Stern: study design, interpretation of the results, preparation of the manuscript, data analysis. Dr. Stern reports no disclosure.
Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent: Informed consent was obtained from all individual participants included in the study.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.03.008
Copyright
© 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.
