Nature and Science of Sleep (Aug 2021)

Objectively Measured Sleep Characteristics and Incidence of Ischemic Stroke: The Sleep Heart Health Study

  • Zhao B,
  • Wu Y,
  • Jin X,
  • Yang L,
  • Yang J,
  • Ma X,
  • Yan B

Journal volume & issue
Vol. Volume 13
pp. 1485 – 1494

Abstract

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Binbin Zhao,1,* Yanhua Wu,2,* Xiaoying Jin,1 Lihong Yang,2 Jian Yang,1,2 Xiancang Ma,1 Bin Yan1,2 1Department of Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China; 2Department of Clinical Research Center, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China*These authors contributed equally to this workCorrespondence: Bin YanDepartment of Clinical Research Center, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of ChinaTel +86 2985323614Email [email protected]: Sleep disorders are associated with the prevalence of stroke. However, there is limited evidence regarding the association between objectively measured sleep characteristics and ischemic stroke.Methods: Ischemic stroke was assessed during the mean follow-up period of 11 years in the Sleep Heart Health Study. Sleep parameters such as wake after sleep onset (WASO) and sleep efficiency (SE) were objectively measured based on in-home polysomnography records. Multivariable Cox regression analysis was utilized to examine the relationship between objective sleep characteristics and ischemic stroke incidence.Results: This study involved 4204 participants (1978 males and 2226 females, 63.8± 11.1 years). The incidence of ischemic stroke increased in individuals with long WASO, poor SE, and short sleep duration. Multivariable Cox regression analysis showed that WASO within the fourth quartile (hazard ratio [HR] 3.771, 95% confidence interval [CI] 1.805– 7.877, P< 0.001), third quartile (HR 3.009, 95% CI 1.433– 6.317, P=0.004), and second quartile (HR 3.108, 95% CI 1.470– 6.568, P=0.003) had a higher incidence of ischemic stroke than WASO within the first quartile. Poor SE (< 80.0%) was also found to be a predictor for ischemic stroke (HR 2.220, 95% CI 1.244– 3.960, P=0.007). Additionally, a short sleep duration (< 6 h) was associated with an increased risk of ischemic stroke (HR 1.725, 95% CI 1.026– 2.899, P=0.040).Conclusion: Our results revealed a relationship between WASO, SE, and sleep duration and ischemic stroke. Therefore, these sleep characteristics may be adequate predictors for the incidence of ischemic stroke.Keywords: sleep characteristics, ischemic stroke, polysomnography, Sleep Heart Health Study

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