Abstract
Objective
Excessive daytime sleepiness (EDS) is a prevalent phenomenon in adults, and although
cohort studies have reported an association between EDS and adverse health outcomes,
the results are inconclusive. This meta-analysis summarizes the evidence from longitudinal
cohort studies on the relationship between EDS and the risk of cardiovascular disease
(CVD) or all-cause mortality.
Design
A meta-analysis of prospective cohort studies was conducted.
Setting and Participants
We searched for relevant longitudinal cohort studies published through September 2019
using Web of Science, PubMed, Medline, and SciELO.
Measures
The relative risk (RR) of EDS was pooled in random-effects or fixed-effects meta-analyses.
Subgroup, sensitivity, and meta-regression analyses were performed to identify heterogeneous
sources. Publication bias was assessed using the Begg and Egger tests.
Results
Seventeen studies (153,909 participants) were included. The mean follow-up was 5.4
(range, 2–13.8) years. The pooled relative risks of EDS were 1.28 [95% confidence
interval (CI) 1.09–1.50] for total CVD events, 1.28 (95% CI 1.12–1.46) for coronary
heart disease (CHD), 1.52 (95% CI 1.10–2.12) for stroke, 1.47 (95% CI 1.09–1.98) for
CVD mortality, and 1.23 (95% CI 1.13–1.33) for all-cause mortality. Subgroup analyses
by mean age, region, follow-up time, EDS assessment method, and year of publication
yielded similar results.
Conclusions and Implications
EDS is a modest but statistically significant predictor for CVD events, coronary heart
disease, stroke, and CVD and all-cause mortality. However, its prognostic value warrants
further investigation to identify those at highest risk of mortality and in need of
intervention to improve outcomes.
Keywords
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Article info
Publication history
Published online: July 18, 2020
Footnotes
L.W., Q.L. and M.H. contributed equally to this work and share first authorship.
This study was supported by a grant from Department of Science and Technology of Xinjiang Uygur Autonomous Region of China (grant number 2017B03015).
The authors declare no conflicts of interest.
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