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Cai C, Atanasov S. Long Sleep Duration and Stroke-Highly Linked, Poorly Understood. Neurol Int 2023; 15:764-777. [PMID: 37489354 PMCID: PMC10366725 DOI: 10.3390/neurolint15030048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/26/2023] Open
Abstract
Stroke is one of the leading causes of disability and mortality. Both short and long sleep durations are associated with adverse health outcomes. Cross-sectional studies have shown an increased prevalence of stroke in long sleepers. Long sleep duration increases stroke incidence and mortality in prospective epidemiological studies. Accumulating evidence suggests that the magnitude of the association between sleep and stroke appears to be stronger for longer sleep than shorter sleep, yielding a J-shaped curve. Potential links between long sleep duration and stroke include increased incidence of diabetes and atrial fibrillation, elevated levels of inflammation, arterial stiffness, and blood pressure variability. Long sleep duration is a strong marker and a plausible risk factor for stroke and should be considered in future scoring for risk stratification and stroke prevention.
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Affiliation(s)
- Chumeng Cai
- Department of Neuroscience, College of Natural Sciences, The University of Texas at Austin, Austin, TX 78712-0805, USA
| | - Strahil Atanasov
- Division of Pulmonary Critical Care & Sleep Medicine, University of Texas Medical Branch, Galveston, TX 77555-0561, USA
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Luo W, Kong L, Chen H, Wang X, Du Q, Shi Z, Zhou H. Visual disability in neuromyelitis optica spectrum disorders: prognostic prediction models. Front Immunol 2023; 14:1209323. [PMID: 37350969 PMCID: PMC10282746 DOI: 10.3389/fimmu.2023.1209323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/25/2023] [Indexed: 06/24/2023] Open
Abstract
Background and objectives Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune inflammatory disease of the central nervous system characterized by simultaneous or consecutive episodes of acute optic neuritis and transverse myelitis. Attacks of NMOSD can result in the accrual of severe visual disability over time. This study aimed to develop and validate prognostic models for visual disability risk within 1, 3, and 5 years. Methods Medical records of NMOSD patients were retrospectively analyzed. The least absolute shrinkage and selection operator (LASSO) regression algorithm and univariate and multivariate Cox regression analyses were performed to select predictors of visual disability. Two models predicting the probability of visual disability in 1, 3, and 5 years were developed based on different selections and displayed as nomograms. Risk scores were calculated for every patient, and a cut-off point was obtained to recognize patients at high risk. Results In total, 161 (25.2%) patients developed visual disabilities during the follow-up period. Four visual disability-related factors were selected using LASSO regression: optic neuritis (ON) onset, higher annual relapse rate (ARR) before maintenance therapy, no maintenance immune suppression therapy (IST), and initial severe attack. Three additional predictors were determined using multivariate Cox regression: male sex, age at first onset, and positive AQP4-IgG serology. Discrimination and calibration were satisfied, with concordance indexes (C-index) close to 0.9 in both models. Decision curve analysis showed good clinical usefulness in both models, and Kaplan-Meier curves showed satisfactory discrimination between patients with high risk and low risk by the cut-off points. Conclusion This study reported predictors of visual disability and generated nomograms. High-risk patients need more active treatment and management to avoid unfavorable outcomes.
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Affiliation(s)
| | | | | | | | | | - Ziyan Shi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hongyu Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Chen J, Chen J, Zhu T, Fu Y, Cheongi IH, Yi K, Wang H, Li X. Causal relationships of excessive daytime napping with atherosclerosis and cardiovascular diseases: a Mendelian randomization study. Sleep 2023; 46:6775966. [PMID: 36302037 DOI: 10.1093/sleep/zsac257] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/17/2022] [Indexed: 11/27/2022] Open
Abstract
STUDY OBJECTIVES Previous observational studies have found conflicting evidence on the relationship between daytime napping and incident cardiovascular diseases (CVDs), but it remains unclear whether these associations present causality. This study aims to verify whether and why there is a causal relationship between these parameters, and whether there is an etiological basis. METHODS A two-sample Mendelian randomization analysis was performed using 79 single nucleotide polymorphisms associated with daytime napping. Summary-level data for coronary atherosclerosis, peripheral atherosclerosis, total CVD, and five CVD outcomes were obtained from the FinnGen study. Meta-analyses were aimed at investigating the relationships of excessive daytime napping with total CVD, coronary heart disease, myocardial infarction (MI), and stroke incidence. Subgroup, network meta-analysis (NMA) and trial sequential analysis (TSA) were also performed in this study. RESULTS The inverse-variance weighted method demonstrated that a genetic predisposition to more frequent daytime napping was significantly associated with higher odds of coronary atherosclerosis (odds ratio [OR] = 1.55, 95% confidence interval [CI]: 1.11 to 2.17), MI (OR = 1.63, 95% CI: 1.06 to 2.50), and heart failure (OR = 1.80, 95%CI: 1.28 to 2.52). In NMA, an increased risk of developing CVD in people who napped for more than 60 min a day than those who did not nap was demonstrated and then supported by TSA results (summary relative risk = 1.98, 95% CI: 1.39 to 2.82). CONCLUSION Habitual daytime napping is causally associated with an increased risk of incident CVD primarily via the development of coronary atherosclerosis. An average napping duration of more than 60 min is associated with an elevated risk of CVD in all participants.
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Affiliation(s)
- Jiayun Chen
- State Key Laboratory of Oncogenes and Related Genes, Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Chen
- State Key Laboratory of Oncogenes and Related Genes, Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianren Zhu
- State Key Laboratory of Oncogenes and Related Genes, Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuanyuan Fu
- State Key Laboratory of Oncogenes and Related Genes, Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Io Hong Cheongi
- State Key Laboratory of Oncogenes and Related Genes, Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kexin Yi
- State Key Laboratory of Oncogenes and Related Genes, Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Wang
- State Key Laboratory of Oncogenes and Related Genes, Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xue Li
- State Key Laboratory of Oncogenes and Related Genes, Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Zhou B, Jiang C, Zhang W, Jin Y, Zhu T, Zhu F, Xu L. Association of sleep duration and napping with stroke mortality in older Chinese: A 14-year prospective cohort study of the Guangzhou Biobank Cohort study. Sleep Med 2023; 101:384-391. [PMID: 36512889 DOI: 10.1016/j.sleep.2022.11.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/13/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
Abstract
STUDY OBJECTIVE Evidence regarding the association of short sleep duration and napping with stroke remains limited and controversial. We examined the association of sleep duration and napping with risk of stroke mortality in an older Chinese cohort. METHODS Sleep duration and daytime napping were assessed by face-to-face interview during 2003-2008. Information of causes of death until April 30, 2021 was collected via record linkage with the Death Registry. Cox regression was used to calculate the hazard ratio (HR) and 95% confidence interval (CI). RESULTS Of 27,254 participants aged average 62.0 (standard deviation = 7.1) years, 818 stroke deaths occurred within 388,798 person-years (mean = 14.3 years) of follow-up. A U-shaped relation between sleep duration and risk of stroke mortality was observed. Participants with short (≤5 h/day) or long sleep duration (≥9 h/day) showed higher risks of total stroke mortality, with adjusted HRs (95% CIs) being 1.27 (1.01-1.59) and 1.37 (1.07-1.75), respectively. However, non-significant association of short or long sleep duration with hemorrhagic or ischemic stroke mortality was found. The associations of short and long sleep duration with total stroke mortality were more pronounced in those with hypertension (P for interaction with hypertension = 0.01), with HRs (95% CIs) being 1.37 (1.04-1.82) and 1.77 (1.33-2.36), respectively. No association between napping and risk of stroke mortality was found. CONCLUSIONS Both short and long sleep duration, but not daytime napping, were associated with higher risk of stroke mortality. Public health messages to encourage good sleep hygiene may be important, especially for people with hypertension.
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Affiliation(s)
- Baijing Zhou
- School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Chaoqiang Jiang
- Molecular Epidemiology Research Center, Guangzhou Twelfth People's Hospital, Guangzhou, 510620, China
| | - Weisen Zhang
- Molecular Epidemiology Research Center, Guangzhou Twelfth People's Hospital, Guangzhou, 510620, China.
| | - Yali Jin
- Molecular Epidemiology Research Center, Guangzhou Twelfth People's Hospital, Guangzhou, 510620, China
| | - Tong Zhu
- Molecular Epidemiology Research Center, Guangzhou Twelfth People's Hospital, Guangzhou, 510620, China
| | - Feng Zhu
- Molecular Epidemiology Research Center, Guangzhou Twelfth People's Hospital, Guangzhou, 510620, China
| | - Lin Xu
- School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
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Sun J, Ma C, Zhao M, Magnussen CG, Xi B. Daytime napping and cardiovascular risk factors, cardiovascular disease, and mortality: A systematic review. Sleep Med Rev 2022; 65:101682. [PMID: 36027794 DOI: 10.1016/j.smrv.2022.101682] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 10/15/2022]
Abstract
Associations between night sleep duration and cardiovascular risk factors in adults have been well documented. However, the associations for daytime napping remain unclear. In this review, six databases were searched for eligible publications to April 8, 2022. A total of 11 articles were identified for umbrella review on the association of daytime napping with diabetes, metabolic syndrome (MetS), cardiovascular disease (CVD), and mortality in adults, 97 for systematic review on the association with CVD and several CVD risk factors. Our umbrella review showed that the associations of daytime napping with diabetes, MetS, CVD, and mortality in most meta-analyses were mainly supported by weak or suggestive evidence. Our systematic review showed that long daytime napping (≥1 h/d) was associated with higher odds of several CVD risk factors, CVD, and mortality, but no significant association was found between short daytime napping and most of the abovementioned outcomes. Our dose-response meta-analyses showed that daytime napping <30 min/d was not significantly associated with higher odds of most CVD risk factors and CVD among young and middle-aged adults. However, among older adults aged >60 years, we observed significant dose-response associations of daytime napping with higher odds of diabetes, dyslipidemia, MetS, and mortality starting from 0 min/d.
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Affiliation(s)
- Jiahong Sun
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chuanwei Ma
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Min Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Costan G Magnussen
- Baker Heart and Diabetes Institute, Melbourne, Australia; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Bo Xi
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
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Pre-stroke habitual prolonged sleep as a predictor for post-stroke sleep quality, stroke-related quality of life, and lifestyle values. J Clin Neurosci 2021; 90:26-31. [PMID: 34275560 DOI: 10.1016/j.jocn.2021.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 04/11/2021] [Accepted: 05/02/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Prolonged sleep is a higher stroke risk, but post-stroke prolonged sleep facilitates stroke recovery. No study has explored the relationship between pre- and post-stroke prolonged sleep and their involvement in stroke-related quality of life (QOL).This study aimed to clarify the role of pre- and post-stroke prolonged sleep in QOL and sleep quality during hospitalization. METHODS Fifty-one subacute stroke inpatients were enrolled. QOL was assessed by the Stroke and Aphasia QOL Scale-39-J. Sleep quality and lifestyle values were assessed by original questionnaires. RESULTS Patients in pre-stroke prolonged sleep > 8 h had a higher incidence of post-stroke poor sleep quality than those belonging to the normal or shorter hours (OR 5.33, 95% CI 1.30-21.84, p = 0.047). In addition, pre-stroke prolonged sleep was associated with lower scores of psychosocial QOL and lifestyle values of "accepting disability; caring about what other people think of what you do". In contrast, post-stroke prolonged sleep was associated with the lower risk of post-stroke poor sleep quality (OR 0.27, 95% CI 0.08-0.86, p = 0.045). Post-stroke high sleep quality had higher (better) scores of physical and energy QOL, and lifestyle values of "caring about what other people think of what you do; having some places to go out after discharge" compared with post-stroke poor sleep quality. Post-stroke prolonged sleep was derived from pre-stroke not prolonged sleep rather than pre-stroke prolonged sleep (p = 0.039, Chi-square test). CONCLUSIONS Pre-stroke prolonged sleep is associated with a higher incidence of post-stroke poor sleep quality and lower scores of QOL and lifestyle values after stroke.
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Bai J, He B, Wang N, Chen Y, Liu J, Wang H, Liu D. Snoring Is Associated With Increased Risk of Stroke: A Cumulative Meta-Analysis. Front Neurol 2021; 12:574649. [PMID: 33868139 PMCID: PMC8047148 DOI: 10.3389/fneur.2021.574649] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 03/08/2021] [Indexed: 01/21/2023] Open
Abstract
Background: Several studies have suggested that snoring is associated with an increased risk of stroke; however, the results are inconsistent. We aim to conduct a systematic review and meta-analysis of observational studies assessing the association between snoring and the risk of stroke in adults. Methods: We searched PubMed for relevant studies. A random-effect model was adopted to summary relative risks (RRs), and forest plots from a cumulative meta-analysis method were used for a better presentation of how the pooled RRs changed as updated evidence accumulated. Results: The literature search yielded 16 articles that met our inclusion criteria, and a total of 3,598 stroke patients and 145,901 participants were finally included in our analysis. A consistent trend toward association was found after the initial discovery, and the summary analysis indicated that snoring is associated with a 46% (RR, 1.46; 95%CI, 1.29–1.63; p < 0.001) increased risk of stroke. Conclusions: Snoring is associated with a significantly increased risk for stroke, up to 46%. The importance of the current study lies in that we provide an imputes to take a more active approach against the increased risk of stroke in snorers.
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Affiliation(s)
- Jing Bai
- Cardiovascular Institute of Luohe, Luohe Central Hospital, Luohe Medical College, Luohe, China
| | - Bing He
- Cardiovascular Institute of Luohe, Luohe Central Hospital, Luohe Medical College, Luohe, China
| | - Nan Wang
- Cardiovascular Institute of Luohe, Luohe Central Hospital, Luohe Medical College, Luohe, China
| | - Yifei Chen
- Cardiovascular Institute of Luohe, Luohe Central Hospital, Luohe Medical College, Luohe, China.,Department of Clinical Medicine, Henan University of Science and Technology, Luohe, China
| | - Junxiang Liu
- Cardiovascular Institute of Luohe, Luohe Central Hospital, Luohe Medical College, Luohe, China
| | - Haoran Wang
- Cardiovascular Institute of Luohe, Luohe Central Hospital, Luohe Medical College, Luohe, China
| | - Dongliang Liu
- Cardiovascular Institute of Luohe, Luohe Central Hospital, Luohe Medical College, Luohe, China
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Wang H, Chen L, Shen D, Cao Y, Zhang X, Xie K, Wang C, Zhu S, Guo Y, Fiona B, Yu M, Chen Z, Li L. Association of daytime napping in relation to risk of diabetes: evidence from a prospective study in Zhejiang, China. Nutr Metab (Lond) 2021; 18:18. [PMID: 33557863 PMCID: PMC7869458 DOI: 10.1186/s12986-021-00545-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/15/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Diabetes was a major risk factor for numerous chronic diseases. However, the associations between daytime napping and diabetes in the existing literature is still inconsistent. METHODS The analysis included 53,916 participants aged 30-79 years of the China Kadoorie Biobank prospective study from Tongxiang. Incident diabetes were identified through linkage with incident diabetes surveillance systems, health insurance system, and death registries. Cox regressions were used to estimate the associations of daytime napping with diabetes. RESULTS 5.11% of participants reported habitual daytime napping. During 488,233 person-years (median 9.4 years) of follow-up, 3333 incident diabetes, including 1249 males and 2084 females, were documented. After adjusting for socio-demographic status, behavioral lifestyle, BMI, waist circumference and snoring, as comparison with those without daytime napping, the hazard ratios for risk of diabetes were 1.39 (95% CI 1.21-1.59). The corresponding figures for males and females were 1.45 (95% CI 1.20-1.74) and 1.30 (95% CI 1.05-1.59), respectively. The corresponding figures for postmenopausal and premenopausal females were 1.41 (95% CI 1.08-1.80) and 1.13 (95% CI 0.78-1.59), respectively. CONCLUSIONS Habitual daytime napping is positively associated with risk of diabetes in adults, except premenopausal females.
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Affiliation(s)
- Hao Wang
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Diseases Control and Prevention, #3399 Binsheng Road, Binjiang District, Hangzhou, Zhejiang Province China
| | - Lingli Chen
- Department of NCDS Control and Prevention, Tongxiang City Center for Disease Control and Prevention, Tongxiang, China
| | - Dun Shen
- Department of NCDS Control and Prevention, Tongxiang City Center for Disease Control and Prevention, Tongxiang, China
| | - Yuan Cao
- Department of NCDS Control and Prevention, Tongxiang City Center for Disease Control and Prevention, Tongxiang, China
| | - Xiaoyi Zhang
- Department of NCDS Control and Prevention, Tongxiang City Center for Disease Control and Prevention, Tongxiang, China
| | - Kaixu Xie
- Department of NCDS Control and Prevention, Tongxiang City Center for Disease Control and Prevention, Tongxiang, China
| | - Chunmei Wang
- Department of NCDS Control and Prevention, Tongxiang City Center for Disease Control and Prevention, Tongxiang, China
| | - Shuiqing Zhu
- Department of NCDS Control and Prevention, Tongxiang City Center for Disease Control and Prevention, Tongxiang, China
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Bragg Fiona
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Min Yu
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Diseases Control and Prevention, #3399 Binsheng Road, Binjiang District, Hangzhou, Zhejiang Province China
| | - Zhengming Chen
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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Li W, Kondracki A, Gautam P, Rahman A, Kiplagat S, Liu H, Sun W. The association between sleep duration, napping, and stroke stratified by self-health status among Chinese people over 65 years old from the China health and retirement longitudinal study. Sleep Breath 2020; 25:1239-1246. [DOI: 10.1007/s11325-020-02214-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 12/12/2022]
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Li W, Taskin T, Gautam P, Gamber M, Sun W. Is there an association among sleep duration, nap, and stroke? Findings from the China Health and Retirement Longitudinal Study. Sleep Breath 2020; 25:315-323. [PMID: 32562171 DOI: 10.1007/s11325-020-02118-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/18/2020] [Accepted: 05/27/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE The objective of this study was to assess the association among nighttime sleep, daytime napping, total sleep duration (nighttime sleep plus daytime napping), and stroke in an elderly Chinese population. METHODS Data were derived from the 2011 China Health and Retirement Longitudinal Study (CHARLS) with 4785 Chinese respondents over 65 years old. Four binary logistic regression models were used to estimate odds ratios and 95% confidence intervals of the association among total sleep duration, nighttime sleep, daytime napping, and stroke, adjusting for confounders. RESULTS After controlling for sociodemographic characteristics, lifestyle, health status, and comorbidity, there was no association between abnormal nighttime sleep and stroke (P values > 0.05). Compared to individuals with normal total sleep duration (7-8 h per day), short sleep duration (< 7 h per day) was approximately two times more likely to increase the risk of stroke (AOR = 1.81, 95%CI 1.10-2.97). Individuals who reported vision impairment, disability, hypertension, dyslipidemia, and mental health issues were at higher risk of stroke. In addition, physical activities with different levels were associated with a lower risk of stroke. Taking naps was not associated with stroke incidence (AOR = 1.12, 95%CI 0.77-1.64). CONCLUSION In this elderly Chinese population, short total sleep duration per 24 h, not merely daytime napping or nighttime sleep, was significantly associated with an increased risk of stroke. Preventive measures for stroke may require a focus on elderly, sedentary individuals who report other health problems.
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Affiliation(s)
- Wei Li
- Robert Stempel College of Public Health, Florida International University, Miami, FL, 33165, USA
| | - Tanjila Taskin
- Robert Stempel College of Public Health, Florida International University, Miami, FL, 33165, USA
| | - Prem Gautam
- Robert Stempel College of Public Health, Florida International University, Miami, FL, 33165, USA
| | - Michelle Gamber
- School of Health Professions, Shenandoah University, Winchester, VA, USA
| | - Wenjie Sun
- Robert Stempel College of Public Health, Florida International University, Miami, FL, 33165, USA.
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U-Shaped Association between Sleep Duration, C-Reactive Protein, and Uric Acid in Korean Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082657. [PMID: 32294936 PMCID: PMC7216061 DOI: 10.3390/ijerph17082657] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/10/2020] [Accepted: 04/11/2020] [Indexed: 11/17/2022]
Abstract
Serum high-sensitivity C-reactive protein (hsCRP) and serum uric acid (SUA) are biomarkers that predict chronic inflammation and cardiovascular dysfunction. Therefore, we aimed to investigate the association between sleep duration, hsCRP, and SUA in Korean women. Cross-sectional data from the Seventh Korea National Health and Nutrition Examination Survey was analyzed. The odds ratio (OR) and 95% confidence intervals (CIs) for an association between higher hsCRP (>2.0 mg/L) or higher SUA (>5.6 mg/dL) and sleep duration were calculated using multiple logistic regression analyses after adjusting for potential confounders. In total, 6151 women were included in the analysis. There was a U-shaped relationship between continuous sleep duration, hsCRP, and SUA. Compared to those who slept for 7-8 h, the ORs (95% CIs) for higher hsCRP were 1.43 (0.95-2.16) in short sleepers and 1.64 (1.09-2.48) in long sleepers after adjusting for confounders. Compared with those who slept for 7-8 h, the ORs (95% CIs) for higher SUA were 1.54 (1.04-2.26) in short sleepers and 1.94 (1.27-2.96) in long sleepers after adjusting for confounders. We found a U-shaped association between sleep duration, hsCRP, and SUA in Korean women. 7-8 h sleep was associated with lower level of hsCRP and SUA in Korean women.
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12
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Yan B, Jin X, Li R, Gao Y, Zhang J, Li J, Wang G. Association of daytime napping with incident stroke in middle-aged and older adults: a large community-based study. Eur J Neurol 2020; 27:1028-1034. [PMID: 32129913 DOI: 10.1111/ene.14197] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/28/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE There are conflicting reports on the association between daytime napping and incident stroke. This study was designed to investigate the relationship between daytime napping and stroke within a community-based cohort. METHODS The present prospective study was based on the Sleep Heart Health Study. Napping habits were assessed with a self-reported Sleep Habits Questionnaire. Participants with napping habits of different durations and frequencies were followed up until the first stroke occurred or the final censoring date. Cox proportional hazards models were used to estimate the relationship between napping habits and stroke. RESULTS A total of 4757 participants (2219 men, mean age 63.6 ± 11.1 years) were enrolled in this study. Compared with those taking no naps, multivariate proportional hazards models analysis indicated that individuals taking naps with a duration of >60 min [hazard ratio (HR), 2.460; 95% confidence interval (CI), 1.538-3.934] had a higher risk of stroke. There was also an increased risk of stroke among participants taking naps daily (HR, 1.563; 95% CI, 1.059-2.307) or five to six times/week (HR, 1.548; 95% CI, 1.026-2.335). After combining napping durations and frequencies, regular long naps (HR, 1.903; 95% CI, 1.182-3.065) and regular short naps (HR, 1.451; 95% CI, 1.010-2.084) were independent risk factors for incident stroke. CONCLUSION Daytime napping with a long duration (>30 min) or a high frequency (≥5 times/week) may increase the risk of stroke.
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Affiliation(s)
- B Yan
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - X Jin
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - R Li
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Y Gao
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - J Zhang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - J Li
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - G Wang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Hu L, Huang X, Zhou W, You C, Li J, Li P, Wu Y, Wu Q, Wang Z, Gao R, Bao H, Cheng X. Effect of hypertension status on the association between sleep duration and stroke among middle-aged and elderly population. J Clin Hypertens (Greenwich) 2019; 22:65-73. [PMID: 31816157 DOI: 10.1111/jch.13756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/16/2019] [Accepted: 10/23/2019] [Indexed: 12/13/2022]
Abstract
We aimed to examine whether hypertension status modified the association between sleep duration and stroke among middle-aged and elderly population. This cross-sectional study included 10 516 participants aged ≥45 years from the China Hypertension Survey study. Sleep duration and history of stroke were assessed by questionnaires. Multivariate logistic regression analyses, a generalized additive model (GAM) and smooth curve fitting (penalized spline method) and a two-piecewise logistic regression models were performed to evaluate the association between sleep duration and stroke in different status of hypertension. 95% confidence interval (CI) for turning point was obtained by bootstrapping. Multiple logistic analyses showed that per 1 hour increase in sleep duration was associated with a 37% increased prevalence of stroke among participants without hypertension and associated with a 8% increased prevalence of stroke among hypertensive participants (without hypertension: odds ratio [OR] = 1.37, 95% CI 1.09-1.71; with hypertension: OR = 1.08, 95% CI 0.95-1.21; PInteraction = .029). The fully adjusted smooth curves presented a linear association between sleep duration and stroke among participants without hypertension, but a threshold, nonlinear association among hypertensive participants. The turning point for the curve was found at a sleep duration of 8 (95% CI 5-9) h among hypertensive patients. The ORs (95% CIs) for stroke were 0.92 (0.79, 1.06) and 1.60 (1.23, 2.08) to the left and right of the turning point, respectively. In conclusion, we found a linear association between sleep duration and stroke among middle-aged and elderly participants without hypertension, but a threshold, nonlinear association among hypertensive participants.
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Affiliation(s)
- Lihua Hu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiao Huang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Zhou
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chunjiao You
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Juxiang Li
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ping Li
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yanqing Wu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qinghua Wu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zengwu Wang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Fuwai Hospital, Beijing, China
| | - Runlin Gao
- Peking Union Medical College & Chinese Academy of Medical Sciences, Fuwai Hospital, Beijing, China
| | - Huihui Bao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaoshu Cheng
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Regularized logistic regression for obstructive sleep apnea screening during wakefulness using daytime tracheal breathing sounds and anthropometric information. Med Biol Eng Comput 2019; 57:2641-2655. [PMID: 31696438 DOI: 10.1007/s11517-019-02052-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 09/27/2019] [Indexed: 12/23/2022]
Abstract
Obstructive sleep apnea (OSA) is a prevalent health problem. Developing a technology for quick OSA screening is momentous. In this study, we used regularized logistic regression to predict the OSA severity level of 199 individuals (116 males) with apnea/hypopnea index (AHI) ≥ 15 (moderate/severe OSA) and AHI < 5 (non-OSA) using their tracheal breathing sounds (TBS) recorded during daytime, while they were awake. The participants were guided to breathe through their nose, and then through their mouth at their deep breathing rate. The least absolute shrinkage and selection operator (LASSO) feature selection approach was used to select the discriminative features from the power spectra of the TBS and the anthropometric information. Using a five-fold cross-validation procedure, five different training sets and their corresponding blind-testing sets were formed. The average blind-testing classification accuracy over the five different folds was found to be 79.3% ± 6.1 with the sensitivity (specificity) of 82.2% ± 7.2% (75.8% ± 9.9%). The accuracy for the entire dataset was found to be 81.1% with sensitivity (specificity) of 84.4% (77.0%). The feature selection and classification procedures were intelligible and fast. The selected features were physiologically meaningful. Overall, the results show that TBS analysis can be used as a quick and reliable prediction of the presence and severity of OSA during wakefulness without a sleep study. Graphical abstract Wakefulness screening of obstructive sleep apnea using tracheal breathing sounds and anthropometric information by means of regularized logistic regression with the least absolute shrinkage and selection operator approach for feature selection and classification.
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Gottlieb E, Landau E, Baxter H, Werden E, Howard ME, Brodtmann A. The bidirectional impact of sleep and circadian rhythm dysfunction in human ischaemic stroke: A systematic review. Sleep Med Rev 2019; 45:54-69. [DOI: 10.1016/j.smrv.2019.03.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 03/08/2019] [Accepted: 03/12/2019] [Indexed: 01/11/2023]
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Chen Y, Kartsonaki C, Clarke R, Guo Y, Yu C, Bian Z, Jiang Q, Li S, Chen J, Li L, Chen Z. Characteristics and correlates of sleep duration, daytime napping, snoring and insomnia symptoms among 0.5 million Chinese men and women. Sleep Med 2017. [PMID: 29530372 PMCID: PMC5869948 DOI: 10.1016/j.sleep.2017.11.1131] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Background Inadequate sleep duration and insomnia can affect both physical and mental health. There is limited evidence, however, on characteristics and correlates of sleep patterns and insomnia in urban and rural China. Methods This cross-sectional study, involving 512,891 adults aged 30–79 years from ten (five urban and five rural) diverse areas in China, recorded detailed information, using interviewer-administered laptop-based questionnaires, on sleep patterns (duration, daytime napping and snoring) and insomnia symptoms. Logistic regression was used to examine the associations of sleep patterns and insomnia symptoms with a range of socio-economic, lifestyle, behaviour and health-related factors. Results Overall, the mean (SD) sleep duration was 7.38 (1.37) h, with 23% reporting short (≤6 h) and 16% reporting long (≥9 h) sleep duration, 21% taking daytime naps and 22% having frequent snoring. Overall, 17% reported having insomnia symptoms, with a higher proportion in women than in men (19% vs 13%), in rural than in urban residents (19% vs 15%), and in individuals who were living alone (23%). The adjusted odds ratios (ORs) of having insomnia symptoms were significantly higher among people with major depressive episodes (6.10, 95% CI: 5.69–6.55), generalised anxiety disorders (7.46, 6.65–8.37) and any chronic diseases (1.46; 1.44–1.49). In contrast, the ORs of insomnia symptoms were significantly lower among those reporting napping (0.77, 0.75–0.78) and frequent snoring (0.86, 0.84–0.87). Conclusions Among Chinese adults, sleep patterns varied greatly by socio-economic, lifestyle and health-related factors. The risk of insomnia symptoms was associated with both poor mental and physical health status. Men, older people, and rural residents in China had longer mean sleep duration than their counter parts. Low socio-economic status and living alone were associated with short sleep duration, and low BMI were associated with insomnia symptoms. Mental disorders such as depression and anxiety were associated with much greater risk of insomnia symptoms than physical illnesses.
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Affiliation(s)
- Yiping Chen
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Christiana Kartsonaki
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Robert Clarke
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yu Guo
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing 100730, China
| | - Canqing Yu
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing 100730, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing 100730, China
| | - Qilian Jiang
- NCDs Prevention and Control Department, Liuzhou CDC, Liuzhou 545007, China
| | - Shanpeng Li
- Qingdao CDC, 175 Shandong Road, Qingdao, Shandong 266033, China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Chaoyang District, Beijing 100021, China
| | - Liming Li
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing 100730, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Noninvasive scoring system for significant inflammation related to chronic hepatitis B. Sci Rep 2017; 7:43752. [PMID: 28281521 PMCID: PMC5345042 DOI: 10.1038/srep43752] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 01/26/2017] [Indexed: 01/10/2023] Open
Abstract
Although a liver stiffness measurement-based model can precisely predict significant intrahepatic inflammation, transient elastography is not commonly available in a primary care center. Additionally, high body mass index and bilirubinemia have notable effects on the accuracy of transient elastography. The present study aimed to create a noninvasive scoring system for the prediction of intrahepatic inflammatory activity related to chronic hepatitis B, without the aid of transient elastography. A total of 396 patients with chronic hepatitis B were enrolled in the present study. Liver biopsies were performed, liver histology was scored using the Scheuer scoring system, and serum markers and liver function were investigated. Inflammatory activity scoring models were constructed for both hepatitis B envelope antigen (+) and hepatitis B envelope antigen (-) patients. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve were 86.00%, 84.80%, 62.32%, 95.39%, and 0.9219, respectively, in the hepatitis B envelope antigen (+) group and 91.89%, 89.86%, 70.83%, 97.64%, and 0.9691, respectively, in the hepatitis B envelope antigen (-) group. Significant inflammation related to chronic hepatitis B can be predicted with satisfactory accuracy by using our logistic regression-based scoring system.
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