Gangwisch James E, Rexrode Kathryn, Forman John P, Mukamal Kenneth, Malaspina Dolores, Feskanich Diane
Columbia University, College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA.
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Brigham and Women's Hospital, Department of Medicine, Division of Preventive Medicine, Boston, MA, USA.
Sleep Med. 2014 Jul;15(7):782-8. doi: 10.1016/j.sleep.2014.04.001. Epub 2014 Apr 13.
The objective of this study was to determine whether daytime sleepiness is independently associated with coronary heart disease (CHD) and stroke or whether the positive association is explained by short sleep duration, disturbed sleep, and circadian disruption, conditions that are associated with cardiometabolic risk factors for vascular events.
Longitudinal analyses of data from the Nurses' Health Study II comprising 84,003 female registered nurses aged 37-54 at baseline were conducted in 2001 with follow-up until 2009. Multivariate Cox regression was used to explore the relationship between reported daytime sleepiness and the incidence of either CHD or stroke (n=500 cases).
Women who reported daytime sleepiness almost every day, compared with rarely/never, had an elevated adjusted risk of cardiovascular disease (CVD) (hazard ratio (HR)=1.58, 95% confidence interval (CI) 1.15-2.17). Controlling for sleep variables (sleep duration, snoring, shift work, and sleep adequacy) or potential metabolic biological mediators of disrupted sleep (diabetes, hypercholesterolemia, and hypertension) appreciably attenuated the relationship (HR=1.17, 95% CI 0.84-1.65; and HR=1.34, 95% CI 0.97-1.85, respectively). Controlling for both sleep variables and metabolic risk factors eliminated an independent association (HR=1.09, 95% CI 0.77-1.53). A similar pattern was observed for CHD and stroke individually.
Daytime sleepiness was not an independent risk factor for CVD in this cohort of women, but rather, was associated with sleep characteristics and metabolic abnormalities that are risk factors for CVD.
本研究旨在确定日间嗜睡是否与冠心病（CHD）和中风独立相关，或者这种正相关是否由短睡眠时间、睡眠障碍和昼夜节律紊乱所解释，这些情况与血管事件的心脏代谢危险因素相关。
对护士健康研究II的数据进行纵向分析，该研究包括84,003名基线年龄为37 - 54岁的女性注册护士，于2001年进行，随访至2009年。采用多变量Cox回归来探讨报告的日间嗜睡与CHD或中风发病率（n = 500例）之间的关系。
与很少/从不报告日间嗜睡的女性相比，几乎每天报告日间嗜睡的女性心血管疾病（CVD）的校正风险升高（风险比（HR）= 1.58，95%置信区间（CI）1.15 - 2.17）。控制睡眠变量（睡眠时间、打鼾、轮班工作和睡眠充足情况）或睡眠中断潜在的代谢生物介质（糖尿病、高胆固醇血症和高血压）可明显减弱这种关系（HR分别为1.17，95% CI 0.84 - 1.65；以及HR为1.34，95% CI 0.97 - 1.85）。同时控制睡眠变量和代谢危险因素可消除独立关联（HR = 1.09，95% CI 0.77 - 1.53）。CHD和中风单独分析时也观察到类似模式。
在这组女性中，日间嗜睡不是CVD的独立危险因素，而是与作为CVD危险因素的睡眠特征和代谢异常相关。
