Sleep Determinants Of Incident Cardiovascular Events: A prospective Population-based Study

Introduction Although several cross-sectional studies suggest an association between sleep-disordered breathing (SDB) and increased cardiovascular (CV) risk, recent large randomized controlled trials failed to show beneficial effects of positive airway pressure treatment in SDB patients. This study aimed to assess the sleep determinants of incident cardiovascular events in a general population sample. Methods HypnoLaus is a prospective middle-to-older-age population-based cohort in which subjective sleep characteristics (assessed by questionnaires) and objective sleep parameters (by complete polysomnography at home), and CV profile were assessed at baseline and after a 5-years follow-up. A local committee adjudicated the development of any CV event (including myocardial infarction, acute coronary syndromes or stroke) following international recommendations. Pittsburgh Sleep Quality Index (PSQI) score >5 was used to define poor sleep quality. Fast Fourier transformation of non-rapid eye movement (NREM) electroencephalographam (EEG) assessed relative power spectrum components according to the EEG bands: delta (1-4 Hz), theta (5-8 Hz), alpha (8-12 Hz), sigma (12-16 Hz), and beta (18-30 Hz). Autonomic activation during sleep was evaluated through pulse wave amplitude (PWA)-drops based on the photoplethysomnographic signal of pulse oximetry. A validated algorithm automatically detected PWA-drops >30% lasting >4 heartbeats, providing its mean duration (s) and index (number per hour of sleep). Multivariable-adjusted COX regressions were used for statistical analysis. Results Of the 1,939 participants (56.4±17.7 years, 53.0% women) free of any CV disease at baseline, 74 (3.8%) developed a CV event over a 5-year follow-up. After adjustment for age, sex, body mass index, baseline systolic blood pressure, smoking, alcohol, metabolic syndrome, dyslipidemia, and hypertension, the following sleep parameters were independently associated with the development of incident CV events: PWA-drop index (HR for 1 event/h increase: 0.986 [0.974 - 0.999], p=0.033), NREM delta EEG power (HR for 1% increase: 0.951 [0.918 - 0.985], p=0.005), and PSQI>5 (HR vs PSQI≤5: 2.275 [1.342 - 3.855], p=0.002). Conclusion Impaired vascular reactivity assessed by PWA variations, low NREM delta power, and subjective poor sleep quality are independent predictors of incident CV events in the HypnoLaus cohort. Support (If Any) Leenaards fournation, FBM, and SNF.