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Volume 09 No. 12
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Accepted Papers

Scientific Investigations

Excessive Daytime Sleepiness is Associated with Longer Culprit Lesion and Adverse Outcomes in Patients with Coronary Artery Disease

Chi-Hang Lee, M.D.1,2; Wai-Yee Ng, B.Sc.3; William Hau, Ph.D.2; Hee-Hwa Ho, MB.BS.4; Bee-Choo Tai, Ph.D.2,3; Mark Y. Chan, MB.BS.1,2; A. Mark Richards, M.D., Ph.D.1,2; Huay-Cheem Tan, MB.BS.1
1Department of Cardiology, National University Heart Centre, Singapore; 2Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; 3Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore; 4Department of Cardiology, Tan Tock Seng Hospital, Singapore

Study Objectives:

We assessed whether excessive daytime sleepiness was associated with coronary plaque phenotype and subsequent adverse cardiovascular events.


Prospective cohort study. Intravascular ultrasound (IVUS) examination of the culprit coronary stenosis was performed. The Epworth Sleepiness Scale (ESS) questionnaire was administered, and the patients were divided into 2 groups—(1) sleepier and (2) less sleepy—based on the ESS score. Adverse cardiovascular outcomes were defined as cardiac death, myocardial infarction, stroke, unplanned revascularization, or heart failure admission.


One hundred seventeen patients undergoing urgent or non-urgent coronary angiography were recruited. Compared with the less sleepy group (ESS ≤ 10, n = 87), the sleepier group (ESS > 10, n = 30) had higher serum levels of total cholesterol and of low-density-lipoprotein cholesterols (p < 0.05 for both). The IVUS examinations indicated coronary stenoses were longer in the sleepier group than in the less sleepy group (p = 0.011). The cumulative incidence of adverse cardiovascular events at 16-month follow-up was higher in the sleepier than the less sleepy group (12.5% versus 6.9%, p = 0.03). Cox regression analysis adjusting for age and smoking showed increased hazard of adverse cardiovascular events in sleepier group as compared to less sleepy group (HR = 3.44, 95% CI 1.01-11.72).


In patients presenting with coronary artery disease, excessive daytime sleepiness based on ESS > 10 was associated with longer culprit lesions and future adverse cardiovascular events.


Lee CH; Ng WY; Hau W; Ho HH; Tai BC; Chan MY; Richards AM; Tan HC. Excessive daytime sleepiness is associated with longer culprit lesion and adverse outcomes in patients with coronary artery disease. J Clin Sleep Med 2013;9(12):1267-1272.

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