The WHO MONICA-psychosocial program: the risk of developing cardiovascular diseases in the population with sleep disorders in Russia/Siberia (gender characteristics)

Objective: To determine the gender differences influence sleep disorders on the risk of myocardial infarction (MI) and stroke for 16 years in the open population 25-64 years in Russia / Siberia. Materials and methods. As part of the screening program III WHO «MONICA-psychosocial» surveyed a random representative sample of the population of both sexes aged 25-64 in Novosibirsk in 1994 (men: n = 657, 44,3 ± 0,4 years, the response - 82.1%; women : n = 689, 45.4 ± 0.4 years, the response - 72.5%). screened survey program included: registration of socio-demographic data, the definition of sleep disorders. Investigation of sleep disturbances (SD) were carried out using Jenkins scale. Were excluded all women and men diagnosed with cardio - vascular disease (ischemic heart disease, cerebrovascular disease, hypertension, myocardial infarction, diabetes mellitus) that occurred before or during the screening. The analysis included 384 women and 190 were men aged 25-64 in the initial years. Term prospective study of participants was 16 years. During the period of observation in the cohort were identified for the first time emerged 15 cases of MI in women and 30 in men, as well as new-onset stroke 35 cases in women and 22 in men. Statistical analysis was performed using SPSS version 11.5 software package. To test the statistical significance of differences between groups were used: the criterion of "chi-squared» χ2 Pearson. To estimate the hazard ratio (HR) and 95% CI (confidence interval) (minimum-maximum), taking into account the different time controls, used univariate and multivariate regression model of Cox proportional hazards (Cox-regression). The reliability in all kinds of analysis has been adopted at the level of significance p≤0,05. Results. In an open population of people aged 25-64 years at 48.6% of men and 65.9% of women had sleep disorders (χ2 = 24.427 df = 1, p = 0.0001). Univariate Cox regression analysis showed an increase risk of myocardial infarction among those with UA for a 16-year period to 2.4 (95% CI 1.1-5.3; p <0.05) fold. Receipt SD effect on the risk of myocardial infarction among women. In multivariate Cox regression model, we also did not get to influence the risk of CVD in women HR = 2,09 (95% CI 0.23- 18.75; p> 0,05). In men, in a tendency to increase the risk of MI was observed in the multivariate analysis, Cox 1.08 (95% CI 0.4- 4.7; p <0.05) times. The risk of myocardial infarction among men never married was 3 (95% CI 1.9- 9; p <0.0001) times that of divorced persons HR = 4.3 (95% CI 2.1- 8.9) and the highest risk was among widowed men HR = 7.5 (95% CI 2.5 to 22; p <0,0001). In the presence of SD the risk of myocardial infarction in men 55-64 years of higher HR = 6.4 (95% CI 2-21; P <0,01), than women in the same age category HR = 2,6 (95% CI 1.06 - 6,5; P <0,05), in comparison with persons 25-54 years without SD. In univariate Cox regression analysis for 16-year period in patients with SD stroke risk was higher among men HR = 3 (95% CI 1.2-7,6; p <0,05), HR = 1 than among women, 9 (95% CI 1,03 -3,7; p <0,05). Multivariate Cox regression analysis revealed that among individuals with HC risk of stroke among men HR = 2.8 (95% CI 1,1- 7,1; p <0,05) and women HR = 2,7 (95% CI 1,4-5,42; P <0,01) is approximately the same. Widowed men with SD had an increased risk of stroke HR = 1.9 (95% CI 1,2-3; P <0,01). stroke risk was higher in men with incomplete secondary / primary education HR = 5,3 (95% CI 1,4- 19,1; p <0,01), than women HR = 4,2 (95% CI 1 , 25- 14; p <0,05). There was an increase in the risk of stroke in women with a secondary education and have trouble sleeping HR = 3.7 (95% CI 1,1 - 11,9; P <0,05). We found no difference in the risk of stroke in patients with SD in the older age group of 55-64 between men HR = 2,1 (95% CI 1,09- 5,6; p <0,05) and women HR = 2 (95% CI 1,05-4,8; P <0,001) . Conclusion: We determined that sleep disorders are a risk factor for myocardial infarction in men only; stroke - both men and women. Negative social gradient increases the risk of cardio - vascular disease in patients with sleep disorders.