TY - JOUR
T1 - Sleep Patterns and the Risk of Acute Stroke
T2 - Results from the INTERSTROKE International Case-Control Study
AU - INTERSTROKE collaborators
AU - Mc Carthy, Christine Eileen
AU - Yusuf, Salim
AU - Judge, Conor
AU - Alvarez-Iglesias, Alberto
AU - Hankey, Graeme J
AU - Oveisgharan, Shahram
AU - Damasceno, Albertino
AU - Iversen, Helle Klingenberg
AU - Rosengren, Annika
AU - Avezum, Alvaro
AU - Lopez-Jaramillo, Patricio
AU - Xavier, Denis
AU - Wang, Xingyu
AU - Rangarajan, Sumathy
AU - O'Donnell, Martin
N1 - Publisher Copyright:
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.
PY - 2023/5/23
Y1 - 2023/5/23
N2 - BACKGROUND AND OBJECTIVES: Symptoms of sleep disturbance are common, and may represent important modifiable risk factors for stroke. We evaluated the association between a spectrum of sleep disturbance symptoms and risk of acute stroke in an international setting.METHODS: INTERSTROKE is an international case-control study of patients presenting with first acute stroke and controls matched by age (+/- 5 years) and sex. Sleep symptoms in the previous month were assessed via a questionnaire. Conditional logistic regression estimated the association between sleep disturbance symptoms and acute stroke, expressed as odds ratios and 95% confidence intervals. The primary model adjusted for age, occupation, marital status and modified-Rankin Scale at baseline, with subsequent models adjusting for potential mediators (behavioural/disease risk factors).RESULTS: Overall, 4,496 matched participants were included, with 1,799 of participants having experienced an ischemic stroke and 439 an intracerebral haemorrhage. Short sleep (<5hrs: 3.15, 2.09-4.76), long sleep (>9hr: 2.67, 1.89-3.78), impaired quality (1.52, 1.32-1.75), difficulty getting to sleep (1.32, 1.13-1.55) or maintaining sleep (1.33, 1.15-1.53), unplanned napping (1.59, 1.31-1.92), prolonged napping (>1hr: 1.88, 1.49-2.38), snoring (1.91, 1.62-2.24), snorting (2.64, 2.17-3.20) and breathing cessation (2.87, 2.28-2.60) were all significantly associated with increased odds of acute stroke in the primary model. A derived Obstructive Sleep Apnoea (OSA) score of 2-3 (2.67, 2.25-3.15) and cumulative sleep symptoms (>5: 5.06, 3.67-6.97) were also associated with a significantly increased odds of acute stroke, with the latter showing a graded association. Following extensive adjustment, significance was maintained for the majority of symptoms (not difficulty getting to/maintaining sleep and unplanned napping), with similar findings for stroke subtypes.DISCUSSION: We found that sleep disturbance symptoms were common, and associated with a graded increased risk of stroke. These symptoms may be a marker of increased individual risk, or represent independent risk factors. Future clinical trials are warranted to determine the efficacy of sleep interventions in stroke prevention.
AB - BACKGROUND AND OBJECTIVES: Symptoms of sleep disturbance are common, and may represent important modifiable risk factors for stroke. We evaluated the association between a spectrum of sleep disturbance symptoms and risk of acute stroke in an international setting.METHODS: INTERSTROKE is an international case-control study of patients presenting with first acute stroke and controls matched by age (+/- 5 years) and sex. Sleep symptoms in the previous month were assessed via a questionnaire. Conditional logistic regression estimated the association between sleep disturbance symptoms and acute stroke, expressed as odds ratios and 95% confidence intervals. The primary model adjusted for age, occupation, marital status and modified-Rankin Scale at baseline, with subsequent models adjusting for potential mediators (behavioural/disease risk factors).RESULTS: Overall, 4,496 matched participants were included, with 1,799 of participants having experienced an ischemic stroke and 439 an intracerebral haemorrhage. Short sleep (<5hrs: 3.15, 2.09-4.76), long sleep (>9hr: 2.67, 1.89-3.78), impaired quality (1.52, 1.32-1.75), difficulty getting to sleep (1.32, 1.13-1.55) or maintaining sleep (1.33, 1.15-1.53), unplanned napping (1.59, 1.31-1.92), prolonged napping (>1hr: 1.88, 1.49-2.38), snoring (1.91, 1.62-2.24), snorting (2.64, 2.17-3.20) and breathing cessation (2.87, 2.28-2.60) were all significantly associated with increased odds of acute stroke in the primary model. A derived Obstructive Sleep Apnoea (OSA) score of 2-3 (2.67, 2.25-3.15) and cumulative sleep symptoms (>5: 5.06, 3.67-6.97) were also associated with a significantly increased odds of acute stroke, with the latter showing a graded association. Following extensive adjustment, significance was maintained for the majority of symptoms (not difficulty getting to/maintaining sleep and unplanned napping), with similar findings for stroke subtypes.DISCUSSION: We found that sleep disturbance symptoms were common, and associated with a graded increased risk of stroke. These symptoms may be a marker of increased individual risk, or represent independent risk factors. Future clinical trials are warranted to determine the efficacy of sleep interventions in stroke prevention.
UR - http://www.scopus.com/inward/record.url?scp=85159789317&partnerID=8YFLogxK
U2 - 10.1212/WNL.0000000000207249
DO - 10.1212/WNL.0000000000207249
M3 - Article
C2 - 37019662
SN - 0028-3878
VL - 100
SP - E2191-E2203
JO - Neurology
JF - Neurology
IS - 21
ER -