Sleep duration, midday napping, and sleep quality and incident stroke

Zhou, Lue; Yu, Kuai; Yang, Liangle; Wang, Hao; Xiao, Yang; Qiu, Gaokun; Liu, Xuezhen; Yuan, Yu; Bai, Yansen; Li, Xiulou; Yang, Handong; He, Meian; Wang, Chongjian; Wu, Tangchun; Zhang, Xiaomin

doi:10.1212/wnl.0000000000008739

Cited by 110 publications

(111 citation statements)

References 38 publications

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“…Findings of our cohort study are consistent with other observational studies 4 , 6 , 7 , 21 and demonstrate an increased risk of total stroke and ischemic stroke associated with long sleep, though the association was rather weak. However, our MR analyses did not confirm the observational findings which may indicate that residual confounding (eg, from chronic health conditions, such as obesity or obstructive sleep apnea) may have biased the results of observational studies.…”

Section: Discussionsupporting

confidence: 92%

Sleep Duration and Stroke

Titova

Michaëlsson

Larsson

2020

Stroke

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Background and Purpose: Studies of sleep duration in relation to specific types of stroke are scarce. Moreover, the results are inconclusive and causality remains unclear. Our objective was to investigate whether sleep duration is associated with risk of stroke and its types using observational and Mendelian randomization designs. Methods: The prospective study included 79 881 women and men (45–79 years of age) who were followed up for incident stroke or death over a mean follow-up of 14.6 years (1 164 646 person-years) through linkage to Swedish Registers. For the Mendelian randomization study, single-nucleotide polymorphisms associated with sleep duration were identified from a genome-wide association study. Summarized data for genetic associations with stroke were obtained from publicly available data of the MEGASTROKE and the International Stroke Genetics Consortia. Results: Compared with normal sleep duration, long sleep (≤9 hours per day) was associated with increased risk of total and ischemic stroke (hazard ratios [95% CI], 1.12 [1.03–1.22] and 1.14 [1.03–1.24], respectively), whereas short sleep (<7 h/d) was linked to higher risk of intracerebral hemorrhage (hazard ratio [95% CI], 1.21 [1.03–1.41]). The 2-sample Mendelian randomization analysis supported no causal association of short or long sleep duration with ischemic stroke as a whole. Conclusions: In a prospective study, long sleep duration was associated with increased risk of total and ischemic stroke, whereas short sleep was linked to increased risk of intracerebral hemorrhage. However, the Mendelian randomization analysis did not show a significant detrimental effect of short or long sleep duration on the risk of total stroke or stroke types.

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Section: Discussionsupporting

confidence: 92%

Sleep Duration and Stroke

Titova

Michaëlsson

Larsson

2020

Stroke

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“…As the rst study to explore association between napping and HUA in Chinese rural adults, we also further found the joint effect of snoring frequency and napping duration on HUA. Some previous study had found the combined effect of napping or sleep quality and night sleep duration on some metabolic diseases [15,35]. Similarly, in the current study, we observed that habitual snoring (≥ 3 days/week) combined with longer daytime napping (≥ 61 min) increased 63% risk of HUA in total participants (66% for men and 63% for men), though no signi cant joint effects of snoring frequency and night sleep duration or daytime napping and night sleep duration existed.…”

Section: Discussionmentioning

confidence: 99%

“…In this study, we also observed that daytime napping was independently associated with increased SUA level and risk of HUA. Many studies have reported that daytime napping or sleep duration was associated with metabolic diseases [12][13][14][15]. But few studies have evaluated the relationship of sleep variables such as daytime napping and night sleep duration with HUA.…”

Section: Discussionmentioning

confidence: 99%

“…SUA level was measured by ROCHE Cobas C501 automatic biochemical analyzer with enzymatic colorimetric method. De nition of HUA was determined as SUA level >417μmol/L (7.0 mg/dL) and >357μmol/L (6.0 mg/dL) for men and women, respectively [15].…”

Section: De Nition Of Huamentioning

confidence: 99%

“…Only a recent study evaluated the cross-sectional association between snoring and SUA concentration and HUA in China [11], but it was limited in urban adults. Meantime, a growing number of epidemiological studies also have reported that longer sleep duration and daytime napping were independently or jointly associated with an increased prevalence of hyperglycemia, hypertension and incident heart failure and stroke [12][13][14][15], but the association of napping or sleep duration with HUA remain unclear. Additionally, as a sleep disorder marker, whether snoring can confound or modify the association between napping or sleep duration and HUA remains unknown.…”

mentioning

confidence: 99%

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Associations of Snoring, Daytime Napping and Night Sleep Duration With Hyperuricemia in Rural Chinese Adults: the Henan Rural Cohort Study

Dong

Liu

Zhang

et al. 2020

Preprint

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Background. Evidence on the association of snoring, daytime napping or sleep duration with hyperuricemia (HUA) was limited, especially in the resources-poor areas. This study aimed to investigate the independent and joint effect of snoring frequency, daytime napping and sleep duration with prevalence of HUA in rural Chinese adults. Methods. 29,643 participants aged 18-79 years were included from baseline survey of the Henan Rural Cohort Study. Sleep variables were assessed using the Pittsburgh Sleep Quality Index (PSQI). Multivariate logistic regression and linear regression models with HUA and serum uric acid level as dependent variables were conducted, respectively. Results. Of the 29,643 included adults, 3498 suffered from HUA. Compared to never snoring, the adjusted odds ratio (OR) and 95% confidence interval (CI) of HUA for rare snoring, occasional snoring and habitual snoring were 1.35 (1.17, 1.56), 1.30 (1.14, 1.47) and 1.59 (1.47, 1.73), respectively. Compared with no napping, participants who had daytime napping of 61-90 and >91 min were associated with 29% and 30% increase in prevalence of HUA, respectively. But in night sleep duration groups, no significant associations were observed (all P>0.05). The positive associations between snoring and HUA were attenuated in older, female adults and those with chronic disease conditions. The joint of habitual snoring and longer daytime napping (≥61min) increased 63% prevalence on HUA. Conclusion. Snoring or daytime napping may independently increase the prevalence of HUA and serum uric acid (SUA) level. Moreover, habitual snoring and longer daytime napping might be jointly associated with a higher prevalence of HUA.Clinical Trial Registration The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). http://www.chictr.org.cn/showproj.aspx?proj=11375

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Changes in Sleep Patterns, Genetic Susceptibility, and Incident Cardiovascular Disease in China

Diao,

Liu,

Lyu

et al. 2024

JAMA Netw Open

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ImportanceThe associations of changes in sleep patterns with incident cardiovascular disease (CVD) are not fully elucidated, and whether these associations are modified by genetic susceptibility remains unknown.ObjectivesTo investigate the associations of 5-year changes in sleep patterns with incident CVD and whether genetic susceptibility modifies these associations.Design, Setting, and ParticipantsThis prospective cohort study of the Dongfeng-Tongji cohort was conducted from 2008 to 2018 in China. Eligible participants included those with complete sleep information at baseline survey (2008-2010) and the first follow-up survey (2013); participants who had no CVD or cancer in 2013 were prospectively assessed until 2018. Statistical analysis was performed in November 2023.ExposuresFive-year changes in sleep patterns (determined by bedtime, sleep duration, sleep quality, and midday napping) between 2008 and 2013, and polygenic risk scores (PRS) for coronary heart disease (CHD) and stroke.Main Outcomes and MeasuresIncident CVD, CHD, and stroke were identified from 2013 to 2018. Cox proportional hazards regression models were applied to estimate hazard ratios (HRs) and 95% CIs.ResultsAmong 15 306 individuals (mean [SD] age, 65.8 [7.4] years; 8858 [57.9%] female and 6448 male [42.1%]), 5474 (35.78%) had persistent unfavorable sleep patterns and 3946 (25.8%) had persistent favorable sleep patterns. A total of 3669 incident CVD cases were documented, including 2986 CHD cases and 683 stroke cases, over a mean (SD) follow-up of 4.9 (1.5) years. Compared with those with persistent unfavorable sleep patterns, individuals with persistent favorable sleep patterns over 5 years had lower risks of incident CVD (HR, 0.80; 95% CI, 0.73-0.87), CHD (HR, 0.84; 95% CI, 0.76-0.92), and stroke (HR, 0.66; 95% CI, 0.54-0.82) in the subsequent 5-year period. No significant effect modification by PRS was observed for sleep pattern change and CHD or stroke risk. However, sleep pattern changes and PRS were jointly associated with the CHD and stroke risk in a dose-dependent manner, with the lowest risk being among those with persistent favorable sleep patterns combined with low PRS (HR for CHD, 0.65; 95% CI, 0.52-0.82 and HR for stroke, 0.48; 95% CI, 0.29-0.79).Conclusions and RelevanceIn this cohort study of middle-aged and older Chinese adults, individuals with persistent favorable sleep patterns had a lower CVD risk, even among those with higher genetic risk. These findings highlight the importance of maintaining favorable sleep patterns for CVD prevention.

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Sleep duration, midday napping, and sleep quality and incident stroke

Cited by 110 publications

References 38 publications

Sleep Duration and Stroke

Sleep Duration and Stroke

Associations of Snoring, Daytime Napping and Night Sleep Duration With Hyperuricemia in Rural Chinese Adults: the Henan Rural Cohort Study

Changes in Sleep Patterns, Genetic Susceptibility, and Incident Cardiovascular Disease in China

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