Background and aim: Poor sleep quality has been found associated with increasing risk of cardiovascular diseases. We aim to estimate the long-term risk of first cardiovascular (CVD) event (coronary or ischemic stroke) in subjects with sleep disturbances in North-Italian cohorts. Methods: Four independent population-based cohorts were enrolled between 1986 and 1994 from the Brianza population (Northern Italy). At baseline LDL-, HDL-cholesterol, systolic blood pressure, diabetes and cigarette smoking were ascertained through standardized MONICA procedures. The study sample comprises 3047 men and 3097 women, aged 25 to 75 years and CVD-free at baseline, who were followed-up for incidence of first coronary and ischemic stroke events (fatal and non-fatal; MONICA validated). Sleep disturbances were assessed with the Jenkins Sleep Questionnaire, investigating sleep disturbances (4 items) in the last month, and then categorized in three classes: none-some (reference), moderate, severe/extreme. Age and CVD risk factors adjusted HRs for first CVD, coronary or ischemic stroke event were estimated in the overall sample, in men and women, from separate Cox models. Results: In a median 15 years of follow-up 437 first CVD events occurred (305 coronary and ischemic stroke). When adjusting for LDL- and HDL-cholesterol, systolic blood pressure, diabetes and cigarette smoking, the risk of first CVD events was higher in subjects with severe sleep disorders compared with none-some (HR=1.84; 95%CI:1.19-2.84). Gender-stratification confirms the association both in men and women, but only in men resulted statistically significant (HR=2.34; 95%CI:1.34-4.08). The association was prominent for ischemic strokes (HR=2.10; 95%CI:1.11-3.97) and less clear for coronary events. These associations resulted higher when the follow-up was shortened to 10 years. Conclusions: In this population of middle-aged CVD-free subjects from Northern Italy, severe sleep disturbances were associated with first CVD events. The risk was higher in men and when ischemic strokes were considered only.