Effect of hypertension status on the association between sleep duration and stroke among middle‐aged and elderly population

Hu, Lihua; Huang, Xiao; Zhou, Wei; You, Chunjiao; Li, Juxiang; Li, Ping; Wu, Qinghua; Wang, Zengwu; Gao, Runlin; Bao, Huihui; Cheng, Xiaoshu

doi:10.1111/jch.13756

Cited by 6 publications

(8 citation statements)

References 38 publications

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“…A comparison of short sleep (� 6h) and long sleep duration (>8 h) were compared to normal sleep duration (6-8 h). Although this normal duration differs slightly from the recommendations of the US National Sleep Foundation and American Academy of Sleep Medicine [44], the proposed 6-8 h "normal" sleep duration for this population comes from recent studies of the association between sleep duration and CVD events in Chinese population [45,46].…”

Section: Plos Onementioning

confidence: 82%

Sleep duration is associated with vitamin D deficiency in older women living in Macao, China: A pilot cross-sectional study

Liang²,

et al. 2020

PLoS ONE

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Chinese women are known to have both a high prevalence of metabolic syndrome (MetS) and vitamin D deficiency (serum 25-hydroxyvitamin D (25OHD) <50 nmol/l). Associations between sleep duration and circulating 25OHD have recently been reported but, to our knowledge, these associations have not been studied in older Chinese populations. We thus investigated whether sleep duration was associated with vitamin D status in a population from Macao, China, and whether sleep duration modified the association between MetS and vitamin D deficiency. In 207 older (>55 years) Macanese, anthropometry, blood samples and validated questionnaires, including sleep duration and cardiovascular risk factors, were simultaneously collected. On multivariable categorical analyses, those women, not men, who had short sleep duration (�6 hours (h)) were at a 2-fold risk for vitamin D deficiency (both <50 nmol/L and <37 nmol/L; OR = 1.94, 95%CI 1.29-2.92; OR = 2.05, 95%CI 1.06-3.98, respectively) and those who had longer sleep duration (>8 h) were 3-fold more likely to have vitamin D deficiency (OR = 3.07, 95%CI 1.47-6.39; OR = 2.75, 95%CI 1.08-7.00, respectively) compared to those with normal sleep duration (6-8 h). Both women and men with MetS were 2-fold more likely to have vitamin D deficiency (women: OR = 2.04, 95%CI 1.31-3.17; OR = 2.15, 95%CI 1.11-4.17, respectively; men: OR = 2.01, 95%CI 1.23-3.28; OR = 2.04, 95%CI 1.00-4.29, respectively). Moreover, women with both short sleep duration and MetS had an increased risk of vitamin D deficiency (OR = 3.26, 95%CI 1.10-9.64). These associations were not found in those with longer sleep. Men with longer sleep and MetS had a 5-fold risk of vitamin D deficiency (OR = 5.22; 95%CI 2.70-10.12). This association was non-significant for men with shorter sleep. We conclude that both short and long sleep duration were associated with vitamin D deficiency in older Chinese women. Further research is needed in larger cohorts or with intervention studies to further examine the associations between reduced sleep, metabolic syndrome and vitamin D deficiency.

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Section: Plos Onementioning

confidence: 82%

Sleep duration is associated with vitamin D deficiency in older women living in Macao, China: A pilot cross-sectional study

Liang²,

et al. 2020

PLoS ONE

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“…The outcome was stroke (ischemic or hemorrhagic), excluding strokes caused by transient ischemic attacks (TIA), craniocerebral trauma, and intracranial tumors. 20 In this study, the medical history of stroke was a self-reported stroke, which was mainly collected through a questionnaire. By asking each participant whether there was a stroke, if so, when the stroke occurred, the symptoms at that time, what kind of treatment, and whether there were relevant medical records included discharge summary and imaging data.…”

Section: Discussionmentioning

confidence: 99%

“…The outcome was stroke (ischemic or hemorrhagic), excluding strokes caused by transient ischemic attacks (TIA), craniocerebral trauma, and intracranial tumors 20 . In this study, the medical history of stroke was a self‐reported stroke, which was mainly collected through a questionnaire.…”

Section: Methodsmentioning

confidence: 99%

The ankle–brachial index and risk of incident stroke in Chinese hypertensive population without atrial fibrillation: A cross‐sectional study

Shi

et al. 2020

J of Clinical Hypertension

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We aimed to evaluate the relation of the ankle–brachial index (ABI) with the prevalence of stroke and to examine any possible effect modifiers among hypertensive patients without atrial fibrillation. A total of 10 750 subjects with hypertension aged 27‐96 years were included in the current study. The outcome was a stroke. Odds ratios of stroke concerning ABI were calculated using multivariate logistic regression models. Among 10 750 hypertensive participants, 690 (6.42%) had a stroke. Multivariate logistic analyses showed that ABI was negatively correlated with the prevalence of stroke (per SD increment; adjusted OR, 0.88; 95% CI, 0.82‐0.94). Compared with participants in Q 1, the odds ratios (95% CI) for those in the Q2 (1.05 to 1.10), Q3 (1.10 to 1.15), and Q4 (≥1.15) were 0.71 (0.56, 0.90), 0.87 (0.70, 1.08), and 0.81 (0.65, 1.01), respectively. However, compared with higher ABI value, lower ABI value (<1.05) would significantly increase the odds of stroke (OR: 1.26, 95% CI [1.05‐1.50]), especially in the elderly over 65 years old. A generalized additive model and a smooth curve fitting showed that there existed an L‐shaped association between ABI and the prevalence of stroke. Our results suggest that an L‐shaped association between ABI and the prevalence of stroke was found in general hypertensive patients, with a turning point at about 1.05. Compared with higher ABI value, lower ABI value (<1.05) would significantly increase the prevalence of stroke (OR: 1.26, 95% CI [1.05‐1.50]), especially in the elderly over 65 years old.

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“…4,5 In the current issue of The Journal of Clinical Hypertension, the study by Dr Hua and colleagues aimed to examine the association between sleep duration and stroke risk in middle-aged and elderly population. 6 The cross-sectional study included 10 516 participants aged ≥45 years from the China Hypertension Survey study, a nationally representative cross-sectional survey designed to provide reliable and evidence-based data on the current status of hypertension and associated factors in Chinese adults. Longer sleep duration was associated with higher prevalence of stroke: the relationship resulted linear in non-hypertensive patients with a turning point of the smooth curve at 8 hours, whereas a threshold effect was found in hypertensive individuals.…”

mentioning

confidence: 99%

“…Longer sleep duration was associated with higher prevalence of stroke: the relationship resulted linear in non-hypertensive patients with a turning point of the smooth curve at 8 hours, whereas a threshold effect was found in hypertensive individuals. 6 Despite methodological issues inherent to the cross-sectional and self-reported nature of data, which may be subjected to recall biases and possible residual or unmeasured confounders, the study can offer intriguing insights for the understanding of behavioral contributors to stroke.…”

mentioning

confidence: 99%

Sleep and brain health

Lattanzi

Brigo

Silvestrini

2019

J of Clinical Hypertension

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Stroke is the second cause of death and one of the leading causes of disability. 1 Worldwide, fifteen million people suffer a stroke every year, nearly six million die, and around five million are left permanently disabled. 2,3 The identification of the risk factors of stroke, especially those that can be modified, is of paramount relevance to control the burden of cerebrovascular diseases. 4,5 In the current issue of The Journal of Clinical Hypertension, the study by Dr Hua and colleagues aimed to examine the association between sleep duration and stroke risk in middle-aged and elderly population. 6 The cross-sectional study included 10 516 participants aged ≥45 years from the China Hypertension Survey study, a nationally representative cross-sectional survey designed to provide reliable and evidence-based data on the current status of hypertension and associated factors in Chinese adults. Longer sleep duration was associated with higher prevalence of stroke: the relationship resulted linear in non-hypertensive patients with a turning point of the smooth curve at 8 hours, whereas a threshold effect was found in hypertensive individuals. 6 Despite methodological issues inherent to the cross-sectional and self-reported nature of data, which may be subjected to recall biases and possible residual or unmeasured confounders, the study can offer intriguing insights for the understanding of behavioral contributors to stroke. | S LEEP DUR ATI ON AND S TROK E RIS KSleep is a tightly regulated phenomenon that takes up approximately to one-third of our lifetime. Although the actual purposes of sleep are still to be fully elucidated, there is indisputable evidence that it serves essential functions and affects many physiological processes.The average need for adults is between 7 and 9 hours of sound sleep per day on a regular basis, and deviations from such rhythm can have negative consequences for health. Epidemiological studies investigating the putative effect of habitual sleep on cerebrovascular risk demonstrated a J-shaped association between sleep duration and stroke incidence. Both insufficient and excessive sleep are predictors for future stroke, and the association is stronger for long than short sleep. 7 It has been estimated that every 1-hour increase in sleep duration can increase the risk of stroke by 10%-15% and individuals sleeping more than 8 hours can be approximately 50% more susceptible to stroke than those with normal sleep duration through 10 years of observation. 8Notably, this trend has been consistently identified across studies irrespective of nationality or ethnicity and after the adjustment for potential confounders like education, employment status, family income, depression, physical activities, and sleep-disordered breathing-related symptoms.Interestingly, sleep duration can significantly affect the traditional risk factors for stroke. The Sleep Hearth Health Study was the first one to suggest that the relationship between sleep duration and hypertension follows a U-shaped curve, being both sho...

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Effect of hypertension status on the association between sleep duration and stroke among middle‐aged and elderly population

Cited by 6 publications

References 38 publications

Sleep duration is associated with vitamin D deficiency in older women living in Macao, China: A pilot cross-sectional study

Sleep duration is associated with vitamin D deficiency in older women living in Macao, China: A pilot cross-sectional study

The ankle–brachial index and risk of incident stroke in Chinese hypertensive population without atrial fibrillation: A cross‐sectional study

Sleep and brain health

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