Risk of Death in the Elderly with Excessive Daytime Sleepiness, Insomnia and Depression: Prospective Cohort Study in an Urban Population in Northeast Brazil

The close relationship between sleep regulation and cardiovascular events is one of the main focuses of research in contemporary medicine. Sleep habits and characteristics interfere with the cardiac rhythm and also with life expectancy, especially in the elderly. To estimate the risk of death and cardiovascular events in community-dwelling elderly individuals complaining of insomnia and excessive daytime sleepiness over eight years of follow-up. A prospective cohort was designed with 160 elderly, with the first wave occurring in 2009 and the second in 2017. Follow-up groups were determined by exposure or not to complaints of primary insomnia and excessive daytime sleepiness with or without snoring. The covariates gender, marital status, depression, hypertension and diabetes were controlled. The primary outcome was death and the secondary outcome was cardio-cerebrovascular events (CCV). Outcome risks were estimated by relative risk (RR) through Poisson regression, adopting α≤0.05. There were 40 (25.97%: 19.04-32.89) deaths over the period and 48 (30.76%: 23.52-38.01) CCV. Men had a higher risk (RR = 1.88; 1.01-3.50) of death. Depression (RR = 2.04; 1.06-3.89), insomnia severity (RR = 2.39; 1.52-4.56) and sleep latency between 16-30 minutes (RR = 3, 54; 1.26-9.94) and 31-60 minutes (RR = 2.23; 1.12-4.47) increased the risk of death independently in community-dwelling elderly. CCV were predicted only in the hypertensive and / or diabetic elderly (RR = 8.30; 1.98-34.82). Mortality in the elderly is influenced by the emotional state and difficulty in falling asleep, unlike CCVs, which are conditioned only by arterial and metabolic blood pressure conditions.