Sleep Patterns and the Risk of Acute Stroke : Results From the INTERSTROKE International Case-Control Study
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology..
BACKGROUND AND OBJECTIVES: Symptoms of sleep disturbance are common and may represent important modifiable risk factors of stroke. We evaluated the association between a spectrum of sleep disturbance symptoms and the risk of acute stroke in an international setting.
METHODS: The INTERSTROKE study 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 through a questionnaire. Conditional logistic regression estimated the association between sleep disturbance symptoms and acute stroke, expressed as odds ratios (ORs) and 95% CIs. The primary model adjusted for age, occupation, marital status, and modified Rankin scale at baseline, with subsequent models adjusting for potential mediators (behavioral/disease risk factors).
RESULTS: Overall, 4,496 matched participants were included, with 1,799 of them having experienced an ischemic stroke and 439 an intracerebral hemorrhage. Short sleep (<5 hours: OR 3.15, 95% CI 2.09-4.76), long sleep (>9 hours: OR 2.67, 95% CI 1.89-3.78), impaired quality (OR 1.52, 95% CI 1.32-1.75), difficulty getting to sleep (OR 1.32, 95% CI 1.13-1.55) or maintaining sleep (OR 1.33, 95% CI 1.15-1.53), unplanned napping (OR 1.48, 95% CI 1.20-1.84), prolonged napping (>1 hour: OR 1.88, 95% CI 1.49-2.38), snoring (OR 1.91, 95% CI 1.62-2.24), snorting (OR 2.64, 95% CI 2.17-3.20), and breathing cessation (OR 2.87, 95% CI 2.28-3.60) were all significantly associated with an increased odds of acute stroke in the primary model. A derived obstructive sleep apnea score of 2-3 (2.67, 2.25-3.15) and cumulative sleep symptoms (>5: 5.38, 4.03-7.18) were also associated with a significantly increased odds of acute stroke, with the latter showing a graded association. After an extensive adjustment, significance was maintained for most of the 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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:100 |
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| Enthalten in: |
Neurology - 100(2023), 21 vom: 23. Mai, Seite e2191-e2203 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Mc Carthy, Christine Eileen [VerfasserIn] |
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| Anmerkungen: |
Date Completed 24.05.2023 Date Revised 05.06.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1212/WNL.0000000000207249 |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM355243687 |
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| 100 | 1 | |a Mc Carthy, Christine Eileen |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Sleep Patterns and the Risk of Acute Stroke |b Results From the INTERSTROKE International Case-Control Study |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Completed 24.05.2023 | ||
| 500 | |a Date Revised 05.06.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. | ||
| 520 | |a BACKGROUND AND OBJECTIVES: Symptoms of sleep disturbance are common and may represent important modifiable risk factors of stroke. We evaluated the association between a spectrum of sleep disturbance symptoms and the risk of acute stroke in an international setting | ||
| 520 | |a METHODS: The INTERSTROKE study 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 through a questionnaire. Conditional logistic regression estimated the association between sleep disturbance symptoms and acute stroke, expressed as odds ratios (ORs) and 95% CIs. The primary model adjusted for age, occupation, marital status, and modified Rankin scale at baseline, with subsequent models adjusting for potential mediators (behavioral/disease risk factors) | ||
| 520 | |a RESULTS: Overall, 4,496 matched participants were included, with 1,799 of them having experienced an ischemic stroke and 439 an intracerebral hemorrhage. Short sleep (<5 hours: OR 3.15, 95% CI 2.09-4.76), long sleep (>9 hours: OR 2.67, 95% CI 1.89-3.78), impaired quality (OR 1.52, 95% CI 1.32-1.75), difficulty getting to sleep (OR 1.32, 95% CI 1.13-1.55) or maintaining sleep (OR 1.33, 95% CI 1.15-1.53), unplanned napping (OR 1.48, 95% CI 1.20-1.84), prolonged napping (>1 hour: OR 1.88, 95% CI 1.49-2.38), snoring (OR 1.91, 95% CI 1.62-2.24), snorting (OR 2.64, 95% CI 2.17-3.20), and breathing cessation (OR 2.87, 95% CI 2.28-3.60) were all significantly associated with an increased odds of acute stroke in the primary model. A derived obstructive sleep apnea score of 2-3 (2.67, 2.25-3.15) and cumulative sleep symptoms (>5: 5.38, 4.03-7.18) were also associated with a significantly increased odds of acute stroke, with the latter showing a graded association. After an extensive adjustment, significance was maintained for most of the symptoms (not difficulty getting to/maintaining sleep and unplanned napping), with similar findings for stroke subtypes | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 700 | 1 | |a Yusuf, Salim |e verfasserin |4 aut | |
| 700 | 1 | |a Judge, Conor |e verfasserin |4 aut | |
| 700 | 1 | |a Alvarez-Iglesias, Alberto |e verfasserin |4 aut | |
| 700 | 1 | |a Hankey, Graeme J |e verfasserin |4 aut | |
| 700 | 1 | |a Oveisgharan, Shahram |e verfasserin |4 aut | |
| 700 | 1 | |a Damasceno, Albertino |e verfasserin |4 aut | |
| 700 | 1 | |a Iversen, Helle Klingenberg |e verfasserin |4 aut | |
| 700 | 1 | |a Rosengren, Annika |e verfasserin |4 aut | |
| 700 | 1 | |a Avezum, Alvaro |e verfasserin |4 aut | |
| 700 | 1 | |a Lopez-Jaramillo, Patricio |e verfasserin |4 aut | |
| 700 | 1 | |a Xavier, Denis |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Xingyu |e verfasserin |4 aut | |
| 700 | 1 | |a Rangarajan, Sumathy |e verfasserin |4 aut | |
| 700 | 1 | |a O'Donnell, Martin |e verfasserin |4 aut | |
| 700 | 0 | |a for INTERSTROKE |e verfasserin |4 aut | |
| 700 | 1 | |a Diaz, Rafael |e investigator |4 oth | |
| 700 | 1 | |a Varigos, John |e investigator |4 oth | |
| 700 | 1 | |a Varigos, John |e investigator |4 oth | |
| 700 | 1 | |a Liu, Lisheng |e investigator |4 oth | |
| 700 | 1 | |a Zhang, Hongye |e investigator |4 oth | |
| 700 | 1 | |a Rumboldt, Zvonko |e investigator |4 oth | |
| 700 | 1 | |a Peñaherrera, Eenesto |e investigator |4 oth | |
| 700 | 1 | |a Diener, Hans-Christoper |e investigator |4 oth | |
| 700 | 1 | |a Pais, Prem |e investigator |4 oth | |
| 700 | 1 | |a Albaker, Osamah |e investigator |4 oth | |
| 700 | 1 | |a Yusoff, Khalid |e investigator |4 oth | |
| 700 | 1 | |a Ogah, Okechukwu |e investigator |4 oth | |
| 700 | 1 | |a Ogunniyi, Adesola |e investigator |4 oth | |
| 700 | 1 | |a Iqbal, Romaina |e investigator |4 oth | |
| 700 | 1 | |a Malaga, German |e investigator |4 oth | |
| 700 | 1 | |a Dans, Antonio |e investigator |4 oth | |
| 700 | 1 | |a Czlonkowska, Anna |e investigator |4 oth | |
| 700 | 1 | |a Ryglewicz, Danuta |e investigator |4 oth | |
| 700 | 1 | |a Pogosova, Nana |e investigator |4 oth | |
| 700 | 1 | |a Alhussein, Fawaz |e investigator |4 oth | |
| 700 | 1 | |a DeVilliers, Linda |e investigator |4 oth | |
| 700 | 1 | |a Elsayed, Amhed |e investigator |4 oth | |
| 700 | 1 | |a Nilanont, Yongchai |e investigator |4 oth | |
| 700 | 1 | |a Oguz, Aytekin |e investigator |4 oth | |
| 700 | 1 | |a Mondo, Charles |e investigator |4 oth | |
| 700 | 1 | |a Yusufali, Alfzalhussein |e investigator |4 oth | |
| 700 | 1 | |a Langhorne, Peter |e investigator |4 oth | |
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