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Dėdelė A, Nikiforov N, Miškinytė A. Relationship of trihalomethane in drinking water with hypertension and arrhythmia among young and middle-aged adults in Petropavlovsk, Kazakhstan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:2463-2475. [PMID: 37669752 DOI: 10.1080/09603123.2023.2254251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 08/29/2023] [Indexed: 09/07/2023]
Abstract
There are no studies investigating the association of chlorinated drinking water with the risk of cardiovascular diseases (CVDs) among young and middle-aged adults. This study was aimed to assess the associations between trihalomethanes (THMs) in drinking water and the risk of CVDs in in the target group in Petropavlovsk, Kazakhstan. 448 dwellers of Petropavlovsk were asked about their demographic, socioeconomic, lifestyle, behavioural characteristics, and drinking water preferences. THMs exposure was assessed to each participant based on their residence address. We used multivariable logistic regression analysis to assess the risk of CVDs in young and middle-aged adults. The results showed that the risk of hypertension in the adjusted logistic regression model was increased by 68% and a 2.7-fold in the second and third THM tertiles, respectively. Participants in the second and third THM exposure tertiles had a 2.3-fold and a 4.8-fold increase in the risk of arrhythmia.
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Affiliation(s)
- Audrius Dėdelė
- Department of Environmental Sciences, Faculty of Natural Sciences, Vytautas Magnus University, Akademija, Lithuania
| | - Nazim Nikiforov
- Department of Science, Kozybayev University, Petropavl, Kazakhstan
| | - Auksė Miškinytė
- Department of Environmental Sciences, Faculty of Natural Sciences, Vytautas Magnus University, Akademija, Lithuania
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Khanji MY, Karim S, Cooper J, Chahal A, Aung N, Somers VK, Neubauer S, Petersen SE. Impact of Sleep Duration and Chronotype on Cardiac Structure and Function: The UK Biobank Study. Curr Probl Cardiol 2023; 48:101688. [PMID: 36906161 DOI: 10.1016/j.cpcardiol.2023.101688] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023]
Abstract
Sleep duration and chronotype have been associated with increased morbidity and mortality. We assessed for associations between sleep duration and chronotype on cardiac structure and function. UK Biobank participants with CMR data and without known cardiovascular disease were included. Self-reported sleep duration was categorized as short (<7 h/d), normal (7-9 h/d) and long (>9 h/d). Self-reported chronotype was categories as "definitely morning" or "definitely evening." Analysis included 3903 middle-aged adults: 929 short, 2924 normal and 50 long sleepers; with 966 definitely-morning and 355 definitely-evening chronotypes. Long sleep was independently associated with lower left ventricular (LV) mass (-4.8%, P = 0.035), left atrial maximum volume (-8.1%, P = 0.041) and right ventricular (RV) end-diastolic volume (-4.8%, P = 0.038) compared to those with normal sleep duration. Evening chronotype was independently associated with lower LV end-diastolic volume (-2.4%, P = 0.021), RV end-diastolic volume (-3.6%, P = 0.0006), RV end systolic volume (-5.1%, P = 0.0009), RV stroke volume (RVSV -2.7%, P = 0.033), right atrial maximal volume (-4.3%, P = 0.011) and emptying fraction (+1.3%, P = 0.047) compared to morning chronotype. Sex interactions existed for sleep duration and chronotype and age interaction for chronotype even after considering potential confounders. In conclusion, longer sleep duration was independently associated with smaller LV mass, left atrial volume and RV volume. Evening chronotype was independently associated with smaller LV and RV and reduced RV function compared to morning chronotype. Sex interactions exist with cardiac remodeling most evident in males with long sleep duration and evening chronotype. Recommendations for sleep chronotype and duration may need to be individualized based on sex.
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Affiliation(s)
- Mohammed Y Khanji
- William Harvey Research Institute, NIHR Barts Biomedical Centre, Queen Mary University London, Charterhouse Square, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK; Newham University Hospital, Barts Health NHS Trust, London, UK.
| | - Shahid Karim
- William Harvey Research Institute, NIHR Barts Biomedical Centre, Queen Mary University London, Charterhouse Square, London, UK; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Jackie Cooper
- William Harvey Research Institute, NIHR Barts Biomedical Centre, Queen Mary University London, Charterhouse Square, London, UK
| | - Anwar Chahal
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Centre, Queen Mary University London, Charterhouse Square, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford, UK
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Centre, Queen Mary University London, Charterhouse Square, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
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杨 若, 王 梦, 李 春, 于 欢, 王 小, 吴 俊, 王 斯, 王 伽, 陈 大, 吴 涛, 胡 永. [Interaction between ischemic stroke risk loci identified by genome-wide association studies and sleep habits]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2022; 54:412-420. [PMID: 35701116 PMCID: PMC9197694 DOI: 10.19723/j.issn.1671-167x.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To explore the relationship between sleep habits (sleep duration, sleep efficiency, sleep onset timing) and ischemic stroke, and whether there is an interaction between sleep habits and ischemic stroke susceptibility gene loci. METHODS A questionnaire survey, physical examination, blood biochemical testing and genotyping were conducted among rural residents in Beijing, and the gene loci of ischemic stroke suggested by previous genome-wide association studies (GWAS) were screened. Multivariable generalized linear model was used to analyze the correlation between sleep habits, sleep-gene interaction and ischemic stroke. RESULTS A total of 4 648 subjects with an average age of (58.5±8.7) years were enrolled, including 1 316 patients with ischemic stroke. Compared with non-stroke patients, stroke patients with sleep duration ≥9 hours, sleep efficiency < 80%, and sleep onset timing earlier than 22:00 accounted for a higher proportion (P < 0.05). There was no significant association between sleep duration and risk of ischemic stroke (OR=1.04, 95%CI: 0.99-1.10, P=0.085). Sleep efficiency was inversely associated with the risk of ischemic stroke (OR=0.18, 95%CI: 0.06-0.53, P=0.002). The risk of ischemic stroke in the subjects with sleep efficiency < 80% was 1.47-fold (95%CI: 1.03-2.10, P=0.033) of that in the subjects with sleep efficiency ≥80%. Falling asleep earlier than 22:00 was associated with 1.26 times greater risk of stroke than falling asleep between 22:00 and 22:59 (95%CI: 1.04-1.52, P=0.017). Multifactorial adjustment model showed that rs579459 on ABO gene had an interaction with sleep time (P for interaction =0.040). When there were two T alleles for rs579459 on the ABO gene, those who fell asleep before 22:00 had 1.56 times (95%CI: 1.20-2.04, P=0.001) the risk of stroke compared with those who fell asleep between 22:00 and 22:59, and there was no significant difference when the number of pathogenic alleles was 0 or 1. In the model adjusted only for gender, age and family structure, sleep duration and the number of T allele rs2634074 on PITX2 gene had an interaction with ischemic stroke (P for interaction=0.033). CONCLUSION Decreased sleep efficiency is associated with increased risk of ischemic stroke, and falling asleep earlier than 22:00 is associated with higher risk of ischemic stroke. Sleep onset timing interacted with rs579459 in ABO gene and the risk of ischemic stroke. Sleep duration and PITX2 rs2634074 may have a potential interaction with ischemic stroke risk.
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Affiliation(s)
- 若彤 杨
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 梦莹 王
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 春男 李
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 欢 于
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 小文 王
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 俊慧 吴
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 斯悦 王
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 伽婷 王
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 大方 陈
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 涛 吴
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 永华 胡
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
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杨 若, 王 梦, 李 春, 于 欢, 王 小, 吴 俊, 王 斯, 王 伽, 陈 大, 吴 涛, 胡 永. [Interaction between ischemic stroke risk loci identified by genome-wide association studies and sleep habits]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2022; 54:412-420. [PMID: 35701116 PMCID: PMC9197694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Indexed: 08/30/2024]
Abstract
OBJECTIVE To explore the relationship between sleep habits (sleep duration, sleep efficiency, sleep onset timing) and ischemic stroke, and whether there is an interaction between sleep habits and ischemic stroke susceptibility gene loci. METHODS A questionnaire survey, physical examination, blood biochemical testing and genotyping were conducted among rural residents in Beijing, and the gene loci of ischemic stroke suggested by previous genome-wide association studies (GWAS) were screened. Multivariable generalized linear model was used to analyze the correlation between sleep habits, sleep-gene interaction and ischemic stroke. RESULTS A total of 4 648 subjects with an average age of (58.5±8.7) years were enrolled, including 1 316 patients with ischemic stroke. Compared with non-stroke patients, stroke patients with sleep duration ≥9 hours, sleep efficiency < 80%, and sleep onset timing earlier than 22:00 accounted for a higher proportion (P < 0.05). There was no significant association between sleep duration and risk of ischemic stroke (OR=1.04, 95%CI: 0.99-1.10, P=0.085). Sleep efficiency was inversely associated with the risk of ischemic stroke (OR=0.18, 95%CI: 0.06-0.53, P=0.002). The risk of ischemic stroke in the subjects with sleep efficiency < 80% was 1.47-fold (95%CI: 1.03-2.10, P=0.033) of that in the subjects with sleep efficiency ≥80%. Falling asleep earlier than 22:00 was associated with 1.26 times greater risk of stroke than falling asleep between 22:00 and 22:59 (95%CI: 1.04-1.52, P=0.017). Multifactorial adjustment model showed that rs579459 on ABO gene had an interaction with sleep time (P for interaction =0.040). When there were two T alleles for rs579459 on the ABO gene, those who fell asleep before 22:00 had 1.56 times (95%CI: 1.20-2.04, P=0.001) the risk of stroke compared with those who fell asleep between 22:00 and 22:59, and there was no significant difference when the number of pathogenic alleles was 0 or 1. In the model adjusted only for gender, age and family structure, sleep duration and the number of T allele rs2634074 on PITX2 gene had an interaction with ischemic stroke (P for interaction=0.033). CONCLUSION Decreased sleep efficiency is associated with increased risk of ischemic stroke, and falling asleep earlier than 22:00 is associated with higher risk of ischemic stroke. Sleep onset timing interacted with rs579459 in ABO gene and the risk of ischemic stroke. Sleep duration and PITX2 rs2634074 may have a potential interaction with ischemic stroke risk.
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Affiliation(s)
- 若彤 杨
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 梦莹 王
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 春男 李
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 欢 于
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 小文 王
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 俊慧 吴
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 斯悦 王
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 伽婷 王
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 大方 陈
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 涛 吴
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 永华 胡
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
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Cai Y, Chen M, Zhai W, Wang C. Interaction between trouble sleeping and depression on hypertension in the NHANES 2005-2018. BMC Public Health 2022; 22:481. [PMID: 35277151 PMCID: PMC8917766 DOI: 10.1186/s12889-022-12942-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/28/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hypertension, trouble sleeping and depression, as three major public health problems, were closely related. This study evaluated the independent association of trouble sleeping and depression with hypertension and interaction effect between trouble sleeping and depression on hypertension in Americans. METHOD The data of this cross-sectional study was from the 2005-2018 National Health and Nutritional Examination Survey (NHANES) with hypertension, depression, trouble sleeping and confounding factor information. Multivariate logistic regression model and subgroup analyses of depression severity were conducted to assess the relationship between trouble sleeping and depression on hypertension. Relative excess risk due to interaction (RERI), attributable proportion of interaction (AP) and synergy index (S) were utilized to assess the additive interaction. RESULTS A total of 30,434 participants (weighted n = 185,309,883) were examined with 16,304 (49.37%) known hypertensive subjects. Compared with participants without trouble sleeping, those with trouble sleeping had a higher risk of hypertension [OR = 1.359 (95% CI: 1.229-1.503)]. We also found the significant association of depression with an increased risk of hypertension [OR = 1.276 (95% CI: 1.114-1.462)], compared with those without depression. Moreover, there was a significant interaction between trouble sleeping and depression on hypertension risk [RERI = 0.528 (95% CI: 0.182-0.873), AP = 0.302 (95% CI: 0.140-0.465), S = 3.413 (95% CI: 1.301-8.951)]. CONCLUSION There was a synergistic interaction between trouble sleeping and depression on hypertension, especially the significant synergistic effect between moderate depression and trouble sleeping on hypertension. The results suggested that improving the psychological status and trouble sleeping of patients may be beneficial to the prevention and treatment of hypertension.
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Affiliation(s)
- Yingjie Cai
- Department of General Medicine, Shandong Province, Yantai Qishan Hospital, No.62, Huanshan Road, Qishan Street, Zhifu District, Yantai, 264000, People's Republic of China.
| | - Manshuang Chen
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong Province, P.R. China
| | - Weixia Zhai
- Department of General Medicine, Shandong Province, Yantai Qishan Hospital, No.62, Huanshan Road, Qishan Street, Zhifu District, Yantai, 264000, People's Republic of China
| | - Chunhui Wang
- Department of Intensive Care Unit, Yantai Qishan Hospital, Yantai, 264000, Shandong Province, P.R. China
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The Effect of Body Weight on Sleep Quality and Sleep Duration in Adolescents. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.1015273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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The association of actigraphy-assessed sleep duration with sleep blood pressure, nocturnal hypertension, and nondipping blood pressure: the coronary artery risk development in young adults (CARDIA) study. J Hypertens 2021; 39:2478-2487. [PMID: 34738991 DOI: 10.1097/hjh.0000000000002956] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Nocturnal hypertension and nondipping systolic blood pressure (SBP) are associated with increased cardiovascular disease (CVD) risk. Short and long sleep duration (SSD and LSD) are also associated with increased CVD risk and may be risk factors for nocturnal hypertension and nondipping SBP. We examined the association between SSD and LSD with sleep BP, nocturnal hypertension, and nondipping SBP among 647 white and African American Coronary Artery Risk Development in Young Adults (CARDIA) study participants who completed 24-h ambulatory BP monitoring, wrist actigraphy, and sleep diaries in 2015-2016. METHODS The times when participants were asleep and awake were determined from actigraphy complemented by sleep diaries. Nocturnal hypertension was defined as sleep BP ≥120/70 mmHg and nondipping SBP as mean sleep-to-awake SBP ratio >0.90. Sleep duration was categorized as SSD (<6 h), normal sleep duration (NSD: 6-8.9 h), and LSD (≥9 h). RESULTS The prevalence of SSD and LSD were 13.9 and 21.1%, respectively. Compared to participants with NSD, participants with LSD had higher mean sleep SBP (2.1 mmHg, 95% confidence interval [CI] 0.2, 4.1 mmHg) and diastolic BP (1.7 mmHg, 95% CI 0.5, 3.0 mmHg). Participants with LSD had a higher prevalence of nocturnal hypertension (prevalence ratio [PR]: 1.26, 95% CI 1.03-1.54) and nondipping SBP (PR 1.33, 95% CI 1.03-1.72) compared to participants with NSD. There was no evidence of an association between SSD and sleep SBP or DBP, nocturnal hypertension, or nondipping SBP. CONCLUSIONS These findings suggest that LSD may be associated with nocturnal hypertension and nondipping SBP.
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Caceres BA, Hickey KT, Heitkemper EM, Hughes TL. An intersectional approach to examine sleep duration in sexual minority adults in the United States: findings from the Behavioral Risk Factor Surveillance System. Sleep Health 2019; 5:621-629. [PMID: 31377249 DOI: 10.1016/j.sleh.2019.06.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 05/20/2019] [Accepted: 06/18/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Investigate sexual identity differences in sleep duration and the multiplicative effect of sexual identity and race/ethnicity among US adults. DESIGN Cross-sectional. PARTICIPANTS The sample consisted of 267,906 participants from the Behavioral Risk Factor Surveillance System. MEASUREMENTS Sleep duration was categorized as very short (≤4 hours), short (5-6 hours), adequate (7-8 hours), or long (≥9 hours). Sex-stratified multinomial logistic regressions were used to examine sexual identity differences in sleep duration. We then examined sleep duration by comparing sexual minorities to (1) same-race/-ethnicity heterosexuals and (2) White participants with the same sexual identity. RESULTS Sexual minority women had higher odds of very short sleep compared to heterosexual women, regardless of race/ethnicity. Black gay men had higher rates of very short sleep but lower rates of long sleep relative to Black heterosexual men. Latino and Asian/Pacific Islander bisexual men reported higher rates of short sleep than their heterosexual counterparts. Black lesbian and other-race bisexual women were more likely to have very short sleep than their heterosexual peers. Black lesbian women also had higher rates of long sleep. Analyses examining racial/ethnic differences by sexual identity found that Black and Latino gay men reported higher rates of very short sleep compared to White gay men. Black bisexual women had higher rates of short sleep duration than White bisexual women. CONCLUSIONS More research is needed to understand how to promote sleep health among sexual minorities, particularly racial/ethnic minorities, and the impact of inadequate sleep duration on health outcomes in this population.
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Affiliation(s)
- Billy A Caceres
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032.
| | - Kathleen T Hickey
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032
| | - Elizabeth M Heitkemper
- Department of Biomedical Informatics, Columbia University, 622 W 168th St, PH20, New York, NY 10032
| | - Tonda L Hughes
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032
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Javaheri S, Zhao YY, Punjabi NM, Quan SF, Gottlieb DJ, Redline S. Slow-Wave Sleep Is Associated With Incident Hypertension: The Sleep Heart Health Study. Sleep 2019; 41:4565433. [PMID: 29087522 DOI: 10.1093/sleep/zsx179] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
We sought to quantify the association between slow-wave (stage N3) sleep and hypertension in a large cohort of middle-aged men and women. Data from 1850 participants free of baseline hypertension from the Sleep Heart Health Study were analyzed. The primary exposure was percentage of N3 sleep on baseline in-home polysomnography and the primary outcome was incident hypertension, defined as systolic blood pressure ≥ 140 mm Hg, diastolic blood pressure ≥ 90 mm Hg, and/or use of any blood pressure lowering medications at follow-up. Multivariable logistic regression models were adjusted for study site, age, sex, race, waist circumference, tobacco use, alcohol use, apnea-hypopnea index, nocturnal oxygen desaturation, sleep duration, sleep efficiency, and arousal index. Mean age was 59.4 ± 10.1 years and 55.5% were female. The mean baseline systolic and diastolic blood pressure was 118.8 and 70.6 mm Hg, respectively. Approximately 30% of the sample developed hypertension during a mean follow-up of 5.3 years. In the multi-adjusted model, participants in quartiles 1 (<9.8%) and 2 (9.8%-17.7%) of N3 sleep had significantly greater odds of incident hypertension compared with those in quartile 3 (17.7%-25.2%) (OR 1.69, 95% CI 1.21-2.36, p = .002 and OR 1.45, 95% CI 1.04-2.00, p = .03, respectively). No significant effect modification by sex on the N3-hypertension association was observed. In conclusion, compared with intermediate levels of N3 sleep (overlapping the "normal" adult range), lower levels of percent N3 sleep are associated with increased odds of incident hypertension in both men and women, independent of potential confounders, including indices of sleep apnea and sleep fragmentation.
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Affiliation(s)
- Sogol Javaheri
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ying Y Zhao
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Stuart F Quan
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Asthma and Airways Disease Research Center, University of Arizona, Tucson, AZ
| | - Daniel J Gottlieb
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,VA Boston Healthcare System, Boston, MA
| | - Susan Redline
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Caceres BA, Hickey KT. Examining Sleep Duration and Sleep Health Among Sexual Minority and Heterosexual Adults: Findings From NHANES (2005-2014). Behav Sleep Med 2019; 18:345-357. [PMID: 30916580 PMCID: PMC6764923 DOI: 10.1080/15402002.2019.1591410] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objectives: This study proposed to examine sexual identity differences in sleep duration and sleep health (use of sleep medications or sedatives, trouble sleeping, and diagnosis of sleeping disorders) among American adults. Methods: Data from the National Health and Nutrition Examination Survey (2005-2014) were used. Sex-stratified multiple logistic regression models were used to compare sleep duration and sleep health between sexual minority (gay/lesbian, bisexual, not-sure) and heterosexual participants, adjusted for predetermined covariates. Heterosexual participants were the reference group. Results: The analytic sample included 16,332 participants. No differences in sleep duration or sleep health were detected when gay and bisexual men were compared to heterosexual men. Not-sure men had significantly higher rates of adequate sleep duration than heterosexual men (aOR 2.35 [1.16-4.79]. Compared to heterosexual women, bisexual women reported higher rates of short sleep duration (aOR 1.29 [95% CI = 1.01-1.65]). Bisexual women were also more likely than heterosexual women to use sleep medication or sedatives (aOR 1.85 [95% CI = 1.19-2.88]), to have ever told a health professional they had trouble sleeping (aOR 1.64 [95% CI = 1.15-2.34), and to have been told by a health professional they had a sleeping disorder (aOR 2.38 [95% CI = 1.50-3.80). Lesbian and not-sure women exhibited no differences in sleep duration or sleep health compared to heterosexual women. Conclusions: Findings suggest there is a need to promote sleep health and further investigate sleeping disorders among bisexual women. Additional research should incorporate objective measures of sleep health and examine whether sleep health is associated with chronic disease in sexual minorities.
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Affiliation(s)
- Billy A. Caceres
- Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032
| | - Kathleen T. Hickey
- Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032,
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Li G, Feng D, Wang Y, Fu J, Han L, Li L, Grant SFA, Li M, Li M, Gao S. Loss of Cardio-Protective Effects at the CDH13 Locus Due to Gene-Sleep Interaction: The BCAMS Study. EBioMedicine 2018; 32:164-171. [PMID: 29903569 PMCID: PMC6020797 DOI: 10.1016/j.ebiom.2018.05.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 12/17/2022] Open
Abstract
Left ventricular mass index (LVMI) provides a metric for cardiovascular disease risk. We aimed to assess the association of adiponectin-related genetic variants resulting from GWAS in East Asians (loci in/near CDH13, ADIPOQ, WDR11FGF, CMIP and PEPD) with LVMI, and to examine whether sleep duration modified these genetic associations in youth. The 559 subjects aged 15–28 years were recruited from the Beijing Child and Adolescent Metabolic Syndrome study. Among the six loci, CDH13 rs4783244 was significantly correlated with adiponectin levels (p = 8.07 × 10−7). The adiponectin-rising allele in rs4783244 locus was significantly associated with decreased LVMI (p = 6.99 × 10−4) after adjusting for classical cardiovascular risk factors, and further for adiponectin levels, while no significant association was found between the other loci and LVMI. Moreover, we observed a significant interaction effect between rs4783244 and sleep duration (p = .005) for LVMI; the genetic association was more evident in long sleep duration while lost in short sleep duration. Similar interaction was found in the subgroup analysis using longitudinal data (p = .025 for interaction). In this young Chinese population, CDH13 rs4783244 represents a key locus for cardiac structure, and confers stronger cardio-protection in longer sleep duration when contrasted with short sleep duration. CDH13 rs4783244 represents a key locus for cardiac structure. The effect of CDH13 rs4783244 on reduced left ventricular mass index is significantly modified by sleep duration. Short sleep may contribute to the loss of CDH13 locus-mediated cardio-protective effects.
We analyzed the associations of five adiponectin-associated genetic variants with left-ventricular mass index (LVMI), a cardiovascular risk factor, in a population of 559 youth. We found a significant protective association of CDH13 rs4783244 with decreased LVMI, independent of adiponectin and other conventional risk factors. Sleep duration has previously been described as a risk factor for increased LVMI in this population, therefore, we assessed modification of this association in CDH13 by sleep duration, and found that short sleep attenuated the cardio-protective effect of this SNP. Our study provides important insights into pathologic mechanisms and prevention strategies for early risk of cardiovascular disease.
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Affiliation(s)
- Ge Li
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health and Family Planning Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730, China
| | - Dan Feng
- Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100043, China
| | - Yonghui Wang
- Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100043, China
| | - Junling Fu
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health and Family Planning Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730, China
| | - Lanwen Han
- Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100043, China
| | - Lujiao Li
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health and Family Planning Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730, China
| | - Struan F A Grant
- Division of Endocrinology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania; Philadelphia, PA 19104, USA; Division of Human Genetics, The Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Mingyao Li
- Departments of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ming Li
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health and Family Planning Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730, China.
| | - Shan Gao
- Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100043, China.
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Lippman S, Gardener H, Rundek T, Seixas A, Elkind MSV, Sacco RL, Wright CB, Ramos AR. Short sleep is associated with more depressive symptoms in a multi-ethnic cohort of older adults. Sleep Med 2017; 40:58-62. [PMID: 29221780 PMCID: PMC5726583 DOI: 10.1016/j.sleep.2017.09.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/26/2017] [Accepted: 09/08/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To evaluate cross-sectional and prospective associations between short and long sleep duration and depressive symptoms in older adults (aged >65 years). METHODS The data from a subsample of the racially/ethnically diverse Northern Manhattan Study were analyzed. Depressive symptoms were assessed twice with the Center for Epidemiologic Studies Depression Scale (CES-D), approximately 5 years apart. The presence of depressive symptoms was defined as a CES-D score ≥16 or use of antidepressants. Self-reports of short (<6 h), intermediate (6-8 h) and long (≥9 h) sleep were assessed prior to the initial CES-D. Logistic regression was used to evaluate the cross-sectional associations between short and long sleep durations with depressive symptoms, using intermediate sleep as the reference. The prospective association between sleep duration and depression in a sample of participants without depressive symptoms at first CES-D was also analyzed. All models were adjusted for demographic, behavioral, and vascular risk factors. RESULTS The initial sample consisted of 1110 participants: 62% women, 69% Hispanic, 17% black, 14% white. Short sleep was reported by 25%, intermediate sleep by 65%, and long sleep by 9%. Depressive symptoms were described in 25% of the initial sample. Short sleep, but not long sleep, was associated with depressive symptoms at baseline (adjusted OR 1.8, 95% CI 1.3-2.6), and at follow-up (adjusted OR 1.9, 95% CI 1.1-3.5; median follow-up = 5.1 years). CONCLUSION Short sleep duration had a cross-sectional and prospective association with depressive symptoms in an urban multi-ethnic cohort of older adults.
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Affiliation(s)
- Suzanne Lippman
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hannah Gardener
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tatjana Rundek
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Azizi Seixas
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Mitchell S V Elkind
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ralph L Sacco
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Clinton B Wright
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Alberto R Ramos
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
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He Q, Sun H, Wu X, Zhang P, Dai H, Ai C, Shi J. Sleep duration and risk of stroke: a dose-response meta-analysis of prospective cohort studies. Sleep Med 2016; 32:66-74. [PMID: 28366344 DOI: 10.1016/j.sleep.2016.12.012] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 11/17/2016] [Accepted: 12/05/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Suboptimal sleep duration has been considered to increase the risk of stroke incidence. Thus we aimed to conduct a dose-response meta-analysis to examine the association between sleep duration and stroke incidence. METHODS We searched PubMed, Web of science and the Cochrane Library to identify all prospective studies evaluating the association of sleep duration and nonfatal and/or fatal stroke incidence. Then, restricted cubic spline functions and piecewise linear functions were used to evaluate the nonlinear and linear dose-response association between them. RESULTS We included a total of 16 prospective studies enrolling 528,653 participants with 12,193 stroke events. Nonlinear dose-response meta-analysis showed a J-shaped association between sleep duration and total stroke with the lowest risk observed with sleeping for 7 h. Considering people sleeping for 7 h as reference, long sleepers had a higher predicted risk of total stroke than short sleepers [the pooled risk ratios (95% confidence intervals): 4 h: 1.17 (0.99-1.38); 5 h: 1.17 (1.00-1.37); 6 h: 1.10 (1.00-1.21); 8 h: 1.17 (1.07-1.28); 9 h: 1.45 (1.23-1.70); 10 h: 1.64 (1.4-1.92); pnonlinearity<0.001]. Short sleep durations were only significantly associated with nonfatal stroke and with total stroke in the subgroups of structured interview and non-Asian countries. Additionally, we found a slightly decreased risk of ischemic stroke among short sleepers. For piecewise linear trends, compared to 7 h, every 1-h increment of sleep duration led to an increase of 13% [the pooled risk ratios (95% confidence intervals): 1.13 (1.07-1.20); p < 0.001] in risk of total stroke. CONCLUSION Both in nonlinear and piecewise linear dose-response meta-analyses, long sleep duration significantly increased the risk of stroke incidence.
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Affiliation(s)
- Qiao He
- Department of Clinical Epidemiology, Institute of Cardiovascular Diseases and Center of Evidence Based Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China; Center of Evidence Based Medicine, Liaoning Province & China Medical University, Shenyang, China
| | - Hao Sun
- Department of Clinical Epidemiology, Institute of Cardiovascular Diseases and Center of Evidence Based Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China; Center of Evidence Based Medicine, Liaoning Province & China Medical University, Shenyang, China
| | - Xiaomei Wu
- Department of Clinical Epidemiology, Institute of Cardiovascular Diseases and Center of Evidence Based Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China; Center of Evidence Based Medicine, Liaoning Province & China Medical University, Shenyang, China
| | - Peng Zhang
- Department of Clinical Epidemiology, Institute of Cardiovascular Diseases and Center of Evidence Based Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China; Center of Evidence Based Medicine, Liaoning Province & China Medical University, Shenyang, China
| | - Huixu Dai
- Department of Clinical Epidemiology, Institute of Cardiovascular Diseases and Center of Evidence Based Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China; Center of Evidence Based Medicine, Liaoning Province & China Medical University, Shenyang, China
| | - Cong Ai
- Department of Clinical Epidemiology, Institute of Cardiovascular Diseases and Center of Evidence Based Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China; Center of Evidence Based Medicine, Liaoning Province & China Medical University, Shenyang, China
| | - Jingpu Shi
- Department of Clinical Epidemiology, Institute of Cardiovascular Diseases and Center of Evidence Based Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China; Center of Evidence Based Medicine, Liaoning Province & China Medical University, Shenyang, China.
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Ramos AR, Tarraf W, Daviglus M, Davis S, Gallo LC, Mossavar-Rahmani Y, Penedo FJ, Redline S, Rundek T, Sacco RL, Sotres-Alvarez D, Wright CB, Zee PC, González HM. Sleep Duration and Neurocognitive Function in the Hispanic Community Health Study/Study of Latinos. Sleep 2016; 39:1843-1851. [PMID: 27450689 DOI: 10.5665/sleep.6166] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 06/11/2016] [Indexed: 01/17/2023] Open
Abstract
STUDY OBJECTIVES To evaluate the association between sleep duration and neurocognitive function in a representative sample of middle-aged to older Hispanic/Latino adults in the US. We tested the hypothesis that sleep duration has a nonlinear, inverted U-shaped association with neurocognitive function. METHODS We performed a cross-sectional analysis from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) participants ages 45-74 years (n = 8,676). HCHS/SOL is a community-based cohort from four US urban areas sampled using a probability design from 2008-2011. Self-reported sleep duration was calculated as a weighted average of the difference between habitual wake and bedtimes assessed by separate questions for weekdays and weekends. Neurocognitive function was measured with standardized scores for Word (Phonemic) Fluency (WF), Brief-Spanish English Verbal learning test (B-SEVLT), and Digit Symbol Substitution (DSS) tests. RESULTS The mean age was 56.5 years; 55% were women; and 40.4% had less than high school education. Average sleep duration was 7.8 ± 1.7 hours. There was an inverted U-shaped association with sleep duration and WF, B-SEVLT sum, and the DSS, with no association with B-SEVLT delayed-recall. Participants with intermediate sleep duration had the best neurocognitive function, while long sleepers had worse neurocognitive function adjusting for demographic, behavioral, and medical factors, daytime sleepiness, and use of sleep medications. CONCLUSIONS Sleep duration had curvilinear inverted U-shaped associations with neurocognitive function, with worse scores among participants with longer sleep duration. These findings may provide a framework to further examine sleep duration in the prevention and treatment of neurocognitive disorders.
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Affiliation(s)
- Alberto R Ramos
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL
| | | | - Martha Daviglus
- University of Illinois at Chicago, Chicago, IL.,Northwestern University, Chicago, IL
| | - Sonia Davis
- Collaborative Studies Coordinating Center Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | | | | | | | | | - Tatjana Rundek
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL
| | - Ralph L Sacco
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL
| | - Daniela Sotres-Alvarez
- Collaborative Studies Coordinating Center Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Clinton B Wright
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL
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Long Sleep Duration and Risk of Ischemic Stroke and Hemorrhagic Stroke: the Kailuan Prospective Study. Sci Rep 2016; 6:33664. [PMID: 27633270 PMCID: PMC5025713 DOI: 10.1038/srep33664] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/30/2016] [Indexed: 02/04/2023] Open
Abstract
The objective of this study was to examine the relationship between sleep duration and ischemic and hemorrhagic stroke in a community-based cohort. The current analysis included 95,023 Chinese participants who were free of stroke at the baseline survey (2006–2007). Cox proportional hazards models were used to calculate hazard ratios (HRs) and their confidence intervals (CIs) for stroke, according to sleep duration. After a mean follow-up period of 7.9 years, 3,135 participants developed stroke (2,504 ischemic stroke and 631 hemorrhagic stroke). The full adjusted hazard ratio (95% CI) of total stroke (with 6–8 hours of night sleep being considered for the reference group) for individuals reporting greater than 8 hours was 1.29 (1.01–1.64). More significant association between long sleep duration and total stroke was found in the elderly (HR, 1.47; 95% CI, 1.05–2.07). Compared with participants getting 6–8 hours of sleep, only women who reported sleeping more than 8 hours per night were associated with hemorrhagic stroke (HR, 3.58; 95% CI, 1.28–10.06). This study suggested that long sleep duration might be a potential predictor/ marker for total stroke, especially in the elderly. And long sleep duration increased the risk of hemorrhagic stroke only in women.
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Ramos AR, Gardener H, Rundek T, Elkind MSV, Boden-Albala B, Dong C, Cheung YK, Stern Y, Sacco RL, Wright CB. Sleep disturbances and cognitive decline in the Northern Manhattan Study. Neurology 2016; 87:1511-1516. [PMID: 27590286 DOI: 10.1212/wnl.0000000000003168] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 06/16/2016] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To examine frequent snoring, sleepiness, and sleep duration with baseline and longitudinal performance on neuropsychological (NP) battery. METHODS The analysis consists of 711 participants of the Northern Manhattan Study (NOMAS) with sleep data and NP assessment (age 63 ± 8 years, 62% women, 18% white, 17% black, 67% Hispanic) and 687 with repeat NP testing (at a mean of 6 ± 2 years). The main exposures were snoring, sleepiness, and sleep duration obtained during annual follow-up. Using factor analysis-derived domain-specific Z scores for episodic memory, language, executive function, and processing speed, we constructed multivariable regression models to evaluate sleep symptoms with baseline NP performance and change in performance in each NP domain. RESULTS In the cross-sectional analysis, adjusting for demographics and the NOMAS vascular risk score, participants with frequent snoring had worse executive function (β = -12; p = 0.04) and processing speed (β = -13; p = 0.02), but no difference in with episodic memory or language. Those with severe daytime sleepiness (β = -26; p = 0.009) had worse executive function, but no changes in the other NP domains. There was no cross-sectional association between sleep duration and NP performance. Frequent snoring (β = -29; p = 0.0007), severe daytime sleepiness (β = -29; p = 0.05), and long sleep duration (β = -29; p = 0.04) predicted decline in executive function, adjusting for demographic characteristics and NOMAS vascular risk score. Sleep symptoms did not explain change in episodic memory, language, or processing speed. CONCLUSIONS In this race-ethnically diverse community-based cohort, sleep symptoms led to worse cognitive performance and predicted decline in executive function.
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Affiliation(s)
- Alberto R Ramos
- From the Department of Neurology, The Evelyn F. McKnight Brain Institute (A.R.R., H.G., T.R., C.D., R.L.S., C.B.W.), University of Miami Miller School of Medicine, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E., Y.S.), and Departments of Epidemiology (M.S.V.E.) and Biostatistics (Y.K.C.), Mailman School of Public Health, Columbia University; and New York University (B.B.-A.), New York
| | - Hannah Gardener
- From the Department of Neurology, The Evelyn F. McKnight Brain Institute (A.R.R., H.G., T.R., C.D., R.L.S., C.B.W.), University of Miami Miller School of Medicine, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E., Y.S.), and Departments of Epidemiology (M.S.V.E.) and Biostatistics (Y.K.C.), Mailman School of Public Health, Columbia University; and New York University (B.B.-A.), New York
| | - Tatjana Rundek
- From the Department of Neurology, The Evelyn F. McKnight Brain Institute (A.R.R., H.G., T.R., C.D., R.L.S., C.B.W.), University of Miami Miller School of Medicine, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E., Y.S.), and Departments of Epidemiology (M.S.V.E.) and Biostatistics (Y.K.C.), Mailman School of Public Health, Columbia University; and New York University (B.B.-A.), New York
| | - Mitchell S V Elkind
- From the Department of Neurology, The Evelyn F. McKnight Brain Institute (A.R.R., H.G., T.R., C.D., R.L.S., C.B.W.), University of Miami Miller School of Medicine, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E., Y.S.), and Departments of Epidemiology (M.S.V.E.) and Biostatistics (Y.K.C.), Mailman School of Public Health, Columbia University; and New York University (B.B.-A.), New York
| | - Bernadette Boden-Albala
- From the Department of Neurology, The Evelyn F. McKnight Brain Institute (A.R.R., H.G., T.R., C.D., R.L.S., C.B.W.), University of Miami Miller School of Medicine, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E., Y.S.), and Departments of Epidemiology (M.S.V.E.) and Biostatistics (Y.K.C.), Mailman School of Public Health, Columbia University; and New York University (B.B.-A.), New York
| | - Chuanhui Dong
- From the Department of Neurology, The Evelyn F. McKnight Brain Institute (A.R.R., H.G., T.R., C.D., R.L.S., C.B.W.), University of Miami Miller School of Medicine, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E., Y.S.), and Departments of Epidemiology (M.S.V.E.) and Biostatistics (Y.K.C.), Mailman School of Public Health, Columbia University; and New York University (B.B.-A.), New York
| | - Ying Kuen Cheung
- From the Department of Neurology, The Evelyn F. McKnight Brain Institute (A.R.R., H.G., T.R., C.D., R.L.S., C.B.W.), University of Miami Miller School of Medicine, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E., Y.S.), and Departments of Epidemiology (M.S.V.E.) and Biostatistics (Y.K.C.), Mailman School of Public Health, Columbia University; and New York University (B.B.-A.), New York
| | - Yaakov Stern
- From the Department of Neurology, The Evelyn F. McKnight Brain Institute (A.R.R., H.G., T.R., C.D., R.L.S., C.B.W.), University of Miami Miller School of Medicine, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E., Y.S.), and Departments of Epidemiology (M.S.V.E.) and Biostatistics (Y.K.C.), Mailman School of Public Health, Columbia University; and New York University (B.B.-A.), New York
| | - Ralph L Sacco
- From the Department of Neurology, The Evelyn F. McKnight Brain Institute (A.R.R., H.G., T.R., C.D., R.L.S., C.B.W.), University of Miami Miller School of Medicine, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E., Y.S.), and Departments of Epidemiology (M.S.V.E.) and Biostatistics (Y.K.C.), Mailman School of Public Health, Columbia University; and New York University (B.B.-A.), New York
| | - Clinton B Wright
- From the Department of Neurology, The Evelyn F. McKnight Brain Institute (A.R.R., H.G., T.R., C.D., R.L.S., C.B.W.), University of Miami Miller School of Medicine, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E., Y.S.), and Departments of Epidemiology (M.S.V.E.) and Biostatistics (Y.K.C.), Mailman School of Public Health, Columbia University; and New York University (B.B.-A.), New York.
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Akinseye OA, Ojike NI, Akinseye LI, Dhandapany PS, Pandi-Perumal SR. Association of Sleep Duration with Stroke in Diabetic Patients: Analysis of the National Health Interview Survey. J Stroke Cerebrovasc Dis 2016; 25:650-5. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.11.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/12/2015] [Accepted: 11/22/2015] [Indexed: 10/22/2022] Open
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Abstract
Inadequate sleep is increasingly pervasive, and the impact on health remains to be fully understood. The cardiovascular consequences alone appear to be substantial. This review summarizes epidemiologic evidence regarding the association between extremes of sleep duration and the prevalence and incidence of cardiovascular diseases. The adverse effects of experimental sleep loss on physiological functions are discussed, along with cardiovascular risk factors that may underlie the association with increased morbidity and mortality. Current data support the concept that inadequate sleep duration confers heightened cardiovascular risk. Thus implementation of preventative strategies may reduce the potential disease burden associated with this high-risk behavior.
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Affiliation(s)
- Naima Covassin
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA.
| | - Prachi Singh
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA
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Leger D, Bayon V, de Sanctis A. The role of sleep in the regulation of body weight. Mol Cell Endocrinol 2015; 418 Pt 2:101-7. [PMID: 26123586 DOI: 10.1016/j.mce.2015.06.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/02/2015] [Accepted: 06/05/2015] [Indexed: 12/14/2022]
Abstract
Sleep participates in the regulation of body weight. The amount of sleep and synchronization of the biological clock are both necessary to achieve the energy balance and the secretion of hormones that contribute to weight regulation. In this review, we first reconsider what normal physiological sleep is and what the normative values of sleep are in the general population. Second, we explain how the biological clock regulates the hormones that may be involved in weight control. Third, we provide some recent data on how sleep may be disturbed by sleep disorders or reduced by sleep debt with consequences on weight. Finally, we explore the relationships between sleep debt and obesity.
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Affiliation(s)
- Damien Leger
- Université Paris Descartes, Sorbonne Paris Cité, APHP, Hôtel Dieu, Centre du Sommeil et de la Vigilance de l'Hôtel Dieu de Paris, Equipe d'accueil VIFASOM EA, Paris, France.
| | - Virginie Bayon
- Université Paris Descartes, Sorbonne Paris Cité, APHP, Hôtel Dieu, Centre du Sommeil et de la Vigilance de l'Hôtel Dieu de Paris, Equipe d'accueil VIFASOM EA, Paris, France
| | - Alice de Sanctis
- Université Paris Descartes, Sorbonne Paris Cité, APHP, Hôtel Dieu, Centre du Sommeil et de la Vigilance de l'Hôtel Dieu de Paris, Equipe d'accueil VIFASOM EA, Paris, France
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Ramos AR, Seixas A, Dib SI. Obstructive sleep apnea and stroke: links to health disparities. Sleep Health 2015; 1:244-248. [PMID: 29073399 DOI: 10.1016/j.sleh.2015.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 09/16/2015] [Accepted: 09/16/2015] [Indexed: 12/17/2022]
Abstract
Obstructive sleep apnea (OSA) is a novel cardiovascular and cerebrovascular risk factor that presents unique opportunities to understand and reduce seemingly intractable stroke disparity among non-Hispanic blacks and Hispanic/Latinos. Individuals from these 2 groups have up to a 2-fold risk of stroke and greater burden of OSA. Obstructive sleep apnea directly and indirectly increases risk of stroke through a variety of autonomic, chemical, and inflammatory mechanisms and vascular risk factors such as hypertension, obesity, and diabetes mellitus. Untreated OSA exacerbates poststroke prognosis, as it may also influence rehabilitation efforts and functional outcomes such as cognitive function after a stroke. Conversely, treatment of OSA may reduce the risk of stroke and may yield better poststroke prognosis. Unfortunately, in racial/ethnic minority groups, there are limited awareness, knowledge, and screening opportunities for OSA. Increasing awareness and improving screening strategies for OSA in minorities may alleviate stroke risk burden and improve stroke outcomes in these populations. This review article is intended to highlight the epidemiology, clinical characteristics, pathophysiology, diagnosis, and treatment of OSA in relation to stroke risk, with an emphasis on race-ethnic disparities.
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Affiliation(s)
- Alberto R Ramos
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL; Sleep Disorders Program, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL.
| | - Azizi Seixas
- Center for Healthful Behavior Change, Department of Population Health, New York University, School of Medicine, New York, NY
| | - Salim I Dib
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL; Sleep Disorders Program, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL
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Physical activity reduces the risk for hospitalizations in patients with type 2 diabetes. Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-015-0309-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Leng Y, Cappuccio FP, Wainwright NWJ, Surtees PG, Luben R, Brayne C, Khaw KT. Sleep duration and risk of fatal and nonfatal stroke: a prospective study and meta-analysis. Neurology 2015. [PMID: 25716357 DOI: 10.1212/wnl.0000000000001371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To study the association between sleep duration and stroke incidence in a British population and to synthesize our findings with published results through a meta-analysis. METHODS The prospective study included 9,692 stroke-free participants aged 42-81 years from the European Prospective Investigation into Cancer-Norfolk cohort. Participants reported sleep duration in 1998-2000 and 2002-2004, and all stroke cases were recorded until March 31, 2009. For the meta-analysis, we searched Ovid Medline, EMBASE, and the Cochrane Library for prospective studies published until May 2014, and pooled effect estimates using a weighted random-effect model. RESULTS After 9.5 years of follow-up, 346 cases of stroke occurred. Long sleep was significantly associated with an increased risk of stroke (hazard ratio [HR] = 1.46 [95% confidence interval (CI) 1.08, 1.98]) after adjustment for all covariates. The association remained robust among those without preexisting diseases and those who reported sleeping well. The association for short sleep was smaller (and not statistically significant) (HR = 1.18 [95% CI 0.91, 1.53]). There was a higher stroke risk among those who reported persistently long sleep or a substantial increase in sleep duration over time, compared to those reporting persistently average sleep. These were compatible with the pooled HRs from an updated meta-analysis, which were 1.15 (1.07, 1.24) and 1.45 (1.30, 1.62) for short and long sleep duration, respectively. CONCLUSIONS This prospective study and meta-analysis identified prolonged sleep as a potentially useful marker of increased future stroke risk in an apparently healthy aging population.
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Affiliation(s)
- Yue Leng
- From the Department of Public Health and Primary Care (Y.L., N.W.J.W., P.G.S., R.L., C.B., K.-T.K.), University of Cambridge; and the Division of Mental Health & Wellbeing (F.P.C.), University of Warwick, Coventry, UK.
| | - Francesco P Cappuccio
- From the Department of Public Health and Primary Care (Y.L., N.W.J.W., P.G.S., R.L., C.B., K.-T.K.), University of Cambridge; and the Division of Mental Health & Wellbeing (F.P.C.), University of Warwick, Coventry, UK
| | - Nick W J Wainwright
- From the Department of Public Health and Primary Care (Y.L., N.W.J.W., P.G.S., R.L., C.B., K.-T.K.), University of Cambridge; and the Division of Mental Health & Wellbeing (F.P.C.), University of Warwick, Coventry, UK
| | - Paul G Surtees
- From the Department of Public Health and Primary Care (Y.L., N.W.J.W., P.G.S., R.L., C.B., K.-T.K.), University of Cambridge; and the Division of Mental Health & Wellbeing (F.P.C.), University of Warwick, Coventry, UK
| | - Robert Luben
- From the Department of Public Health and Primary Care (Y.L., N.W.J.W., P.G.S., R.L., C.B., K.-T.K.), University of Cambridge; and the Division of Mental Health & Wellbeing (F.P.C.), University of Warwick, Coventry, UK
| | - Carol Brayne
- From the Department of Public Health and Primary Care (Y.L., N.W.J.W., P.G.S., R.L., C.B., K.-T.K.), University of Cambridge; and the Division of Mental Health & Wellbeing (F.P.C.), University of Warwick, Coventry, UK
| | - Kay-Tee Khaw
- From the Department of Public Health and Primary Care (Y.L., N.W.J.W., P.G.S., R.L., C.B., K.-T.K.), University of Cambridge; and the Division of Mental Health & Wellbeing (F.P.C.), University of Warwick, Coventry, UK
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Leng Y, Cappuccio FP, Wainwright NWJ, Surtees PG, Luben R, Brayne C, Khaw KT. Sleep duration and risk of fatal and nonfatal stroke: a prospective study and meta-analysis. Neurology 2015; 84:1072-9. [PMID: 25716357 PMCID: PMC4371404 DOI: 10.1212/wnl.0000000000001371] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To study the association between sleep duration and stroke incidence in a British population and to synthesize our findings with published results through a meta-analysis. Methods: The prospective study included 9,692 stroke-free participants aged 42–81 years from the European Prospective Investigation into Cancer–Norfolk cohort. Participants reported sleep duration in 1998–2000 and 2002–2004, and all stroke cases were recorded until March 31, 2009. For the meta-analysis, we searched Ovid Medline, EMBASE, and the Cochrane Library for prospective studies published until May 2014, and pooled effect estimates using a weighted random-effect model. Results: After 9.5 years of follow-up, 346 cases of stroke occurred. Long sleep was significantly associated with an increased risk of stroke (hazard ratio [HR] = 1.46 [95% confidence interval (CI) 1.08, 1.98]) after adjustment for all covariates. The association remained robust among those without preexisting diseases and those who reported sleeping well. The association for short sleep was smaller (and not statistically significant) (HR = 1.18 [95% CI 0.91, 1.53]). There was a higher stroke risk among those who reported persistently long sleep or a substantial increase in sleep duration over time, compared to those reporting persistently average sleep. These were compatible with the pooled HRs from an updated meta-analysis, which were 1.15 (1.07, 1.24) and 1.45 (1.30, 1.62) for short and long sleep duration, respectively. Conclusions: This prospective study and meta-analysis identified prolonged sleep as a potentially useful marker of increased future stroke risk in an apparently healthy aging population.
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Affiliation(s)
- Yue Leng
- From the Department of Public Health and Primary Care (Y.L., N.W.J.W., P.G.S., R.L., C.B., K.-T.K.), University of Cambridge; and the Division of Mental Health & Wellbeing (F.P.C.), University of Warwick, Coventry, UK.
| | - Francesco P Cappuccio
- From the Department of Public Health and Primary Care (Y.L., N.W.J.W., P.G.S., R.L., C.B., K.-T.K.), University of Cambridge; and the Division of Mental Health & Wellbeing (F.P.C.), University of Warwick, Coventry, UK
| | - Nick W J Wainwright
- From the Department of Public Health and Primary Care (Y.L., N.W.J.W., P.G.S., R.L., C.B., K.-T.K.), University of Cambridge; and the Division of Mental Health & Wellbeing (F.P.C.), University of Warwick, Coventry, UK
| | - Paul G Surtees
- From the Department of Public Health and Primary Care (Y.L., N.W.J.W., P.G.S., R.L., C.B., K.-T.K.), University of Cambridge; and the Division of Mental Health & Wellbeing (F.P.C.), University of Warwick, Coventry, UK
| | - Robert Luben
- From the Department of Public Health and Primary Care (Y.L., N.W.J.W., P.G.S., R.L., C.B., K.-T.K.), University of Cambridge; and the Division of Mental Health & Wellbeing (F.P.C.), University of Warwick, Coventry, UK
| | - Carol Brayne
- From the Department of Public Health and Primary Care (Y.L., N.W.J.W., P.G.S., R.L., C.B., K.-T.K.), University of Cambridge; and the Division of Mental Health & Wellbeing (F.P.C.), University of Warwick, Coventry, UK
| | - Kay-Tee Khaw
- From the Department of Public Health and Primary Care (Y.L., N.W.J.W., P.G.S., R.L., C.B., K.-T.K.), University of Cambridge; and the Division of Mental Health & Wellbeing (F.P.C.), University of Warwick, Coventry, UK
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Léger D, Beck F, Richard JB, Sauvet F, Faraut B. The risks of sleeping "too much". Survey of a National Representative Sample of 24671 adults (INPES health barometer). PLoS One 2014; 9:e106950. [PMID: 25226585 PMCID: PMC4165901 DOI: 10.1371/journal.pone.0106950] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 08/11/2014] [Indexed: 02/02/2023] Open
Abstract
Background A significant U-shaped association between sleep duration and several morbidity (obesity, diabetes or cardiovascular disease) and mortality risks has been regularly reported. However, although the physiological pathways and risks associated with “too short sleep” (<5 hours/day) have been well demonstrated, little is known about “too much sleeping”. Purpose To explore socio-demographic characteristics and comorbidities of “long sleepers” (over 10 hours/day) from a nationally representative sample of adults. Methods A cross-sectional nationally representative sample of 24,671 subjects from 15 to 85-year-old. An estimated total sleep time (TST) on non-leisure days was calculated based on a specifically designed sleep log which allows to distinguish “long sleepers” from “short sleepers” (<5 hours/day). Insomnia was assessed according to the International classification of sleep disorders (ICSD-2). Results The average TST was 7 hours and 13 minutes (+/− 17 minutes). Six hundred and twelve subjects were “long sleepers” (2.7%) and 1969 “short sleepers” (7.5%). Compared to the whole group, “long sleepers” were more often female, younger (15–25 year-old) or older (above 65 year-old), with no academic degree, mostly clerks and blue collar workers. “Long sleepers” were significantly more likely to have psychiatric diseases and a greater body mass index (BMI). However, long sleep was not significantly associated with the presence of any other chronic medical disease assessed. Conversely, short sleep duration was significantly associated with almost all the other chronic diseases assessed. Conclusions In the general population, sleeping too much was associated with psychiatric diseases and higher BMI, but not with other chronic medical diseases.
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Affiliation(s)
- Damien Léger
- Centre du Sommeil et de la Vigilance, Hôtel Dieu, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- VIFASOM, équipe d'accueil Vigilance Fatigue et Sommeil, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- * E-mail:
| | - François Beck
- VIFASOM, équipe d'accueil Vigilance Fatigue et Sommeil, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Equipe Cesames (centre de recherche médecine, sciences, santé, santé mentale, société, Université Paris Descartes/CNRS UMR 8211/Inserm U988/EHESS), Cermes 3, Direction des Affaires Scientifiques INPES, Saint Denis, France
| | - Jean-Baptiste Richard
- VIFASOM, équipe d'accueil Vigilance Fatigue et Sommeil, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Equipe Cesames (centre de recherche médecine, sciences, santé, santé mentale, société, Université Paris Descartes/CNRS UMR 8211/Inserm U988/EHESS), Cermes 3, Direction des Affaires Scientifiques INPES, Saint Denis, France
| | - Fabien Sauvet
- VIFASOM, équipe d'accueil Vigilance Fatigue et Sommeil, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Institut de recherche biomédicale des armées (IRBA), Brétigny-sur-Orge, France
| | - Brice Faraut
- Centre du Sommeil et de la Vigilance, Hôtel Dieu, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- VIFASOM, équipe d'accueil Vigilance Fatigue et Sommeil, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Ramos AR, Dong C, Rundek T, Elkind MSV, Boden-Albala B, Sacco RL, Wright CB. Sleep duration is associated with white matter hyperintensity volume in older adults: the Northern Manhattan Study. J Sleep Res 2014; 23:524-30. [PMID: 25040435 DOI: 10.1111/jsr.12177] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 05/04/2014] [Indexed: 12/18/2022]
Abstract
Self-reports of long or short sleep durations have indicated an association with cardiovascular morbidity and mortality, but there are limited data evaluating their association with white matter hyperintensity volume (WMHV), a marker of cerebral small vessel disease. We conducted a cross-sectional analysis of self-reported sleep duration to test for a correlation with white matter hyperintensities, measured by quantitative magnetic resonance imaging (MRI), in the Northern Manhattan Study. We used multivariable linear regression models to assess associations between both short (<6 h) and long (≥9 h) sleep durations and log-transformed WMHV, adjusting for demographic, behavioural and vascular risk factors. A total of 1244 participants, mean age 70 ± 9 years, 61% women and 68% Hispanics were analysed with magnetic resonance brain imaging and self-reported sleep duration. Short sleep was reported by 23% (n = 293) and long sleep by 10% (n = 121) of the sample. Long sleep (β = 0.178; P = 0.035), but not short sleep (β = -0.053; P = 0.357), was associated with greater log-WMHV in fully adjusted models. We observed an interaction between sleep duration, diabetes mellitus and log-WMHV (P = 0.07). In fully adjusted models, stratified analysis showed that long sleep duration was associated with greater WMHV only in those with diabetes (β = 0.78; P = 0.0314), but not in those without diabetes (β = 0.022; P = 0.2), whereas short sleep was not associated with white matter hyperintensities in those with or without diabetes. In conclusion, long sleep duration was associated with a greater burden of white matter lesions in this stroke-free urban sample. The association was seen mainly among those with diabetes mellitus.
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Affiliation(s)
- Alberto R Ramos
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
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