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Wu J, Liu L, Huang Z, Wang L, Cai F, Li A, Sun Y, Wang B, Li J, Huo Y, Lu Y. Long daytime napping: A silent danger for hypertensive individuals. Eur J Neurol 2024:e16382. [PMID: 38877755 DOI: 10.1111/ene.16382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/14/2024] [Accepted: 05/26/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND AND PURPOSE Hypertension significantly contributes to stroke. Previous research has indicated a connection between daytime napping and stroke. Research on the connection between daytime napping duration and first stroke in hypertensive individuals is lacking nevertheless. METHODS This research, which ran from 24 August 2013 to 31 December 2022, recruited 11,252 individuals with hypertension and without a history of stroke from the China Stroke Primary Prevention Trial. To determine the relationship between daytime napping duration and stroke onset in hypertensive individuals, we conducted analyses for threshold effects, multivariate-adjusted Cox proportional hazard regression models, and Kaplan-Meier survival curves. RESULTS The duration of daytime napping (<75 min) was positively correlated with stroke risk; beyond 75 min, the risk did not increase further. When compared to hypertensive individuals who napped for 1-30 min, daytime napping 31-60 min (hazard ratio [HR] = 1.27, 95% confidence interval [CI] = 1.06-1.53) and >60 min (HR = 1.37, 95% CI = 1.14-1.65) were substantially related with a greater risk of first stroke. Additionally, this correlation was absent in cases of hemorrhagic stroke, but present in cases of ischemic stroke, specifically for hypertensive individuals who napped for 31-60 min or >60 min (p < 0.05). Kaplan-Meier survival curves displayed that hypertensive individuals who extended daytime napping had an elevated incidence of stroke. CONCLUSIONS Hypertensive individuals who take longer daytime naps (>30 min) are at an elevated risk of stroke onset, particularly ischemic stroke, irrespective of other factors.
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Affiliation(s)
- Jinhong Wu
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Lishun Liu
- Clinical Research Center, Shenzhen Evergreen Medical Institute, Shenzhen, China
- Shenzhen International Graduate School, Tsinghua University, Shenzhen, China
| | - Zena Huang
- Clinical Research Center, Shenzhen Evergreen Medical Institute, Shenzhen, China
| | - Li Wang
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Fengjiao Cai
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Aimin Li
- Department of Neurosurgery, First Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang, China
| | - Yong Sun
- Department of Neurosurgery, First Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang, China
| | - Binyan Wang
- Clinical Research Center, Shenzhen Evergreen Medical Institute, Shenzhen, China
| | - Jianping Li
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yan Lu
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, China
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Zawada SJ, Ganjizadeh A, Conte GM, Demaerschalk BM, Erickson BJ. Accelerometer-Measured Behavior Patterns in Incident Cerebrovascular Disease: Insights for Preventative Monitoring From the UK Biobank. J Am Heart Assoc 2024; 13:e032965. [PMID: 38818948 DOI: 10.1161/jaha.123.032965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/03/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND The goal was to compare patterns of physical activity (PA) behaviors (sedentary behavior [SB], light PA, moderate-to-vigorous PA [MVPA], and sleep) measured via accelerometers for 7 days between patients with incident cerebrovascular disease (CeVD) (n=2141) and controls (n=73 938). METHODS AND RESULTS In multivariate models, cases spent 3.7% less time in MVPA (incidence rate ratio [IRR], 0.963 [95% CI, 0.929-0.998]) and 1.0% more time in SB (IRR, 1.010 [95% CI, 1.001-1.018]). Between 12 and 24 months before diagnosis, cases spent more time in SB (IRR, 1.028 [95% CI, 1.001-1.057]). Within the year before diagnosis, cases spent less time in MVPA (IRR, 0.861 [95% CI, 0.771-0.964]). Although SB time was not associated with CeVD risk, MVPA time, both total min/d (hazard ratio [HR], 0.998 [95% CI, 0.997-0.999]) and guideline threshold adherence (≥150 min/wk) (HR, 0.909 [95% CI, 0.827-0.998]), was associated with decreased CeVD risk. Comorbid burden had a significant partial mediation effect on the relationship between MVPA and CeVD. Cases slept more during 12:00 to 17:59 hours (IRR, 1.091 [95% CI, 1.002-1.191]) but less during 0:00 to 5:59 hours (IRR, 0.984 [95% CI, 0.977-0.992]). No between-group differences were significant at subgroup analysis. CONCLUSIONS Daily behavior patterns were significantly different in patients before CeVD. Although SB was not associated with CeVD risk, the association between MVPA and CeVD risk is partially mediated by comorbid burden. This study has implications for understanding observable behavior patterns in cerebrovascular dysfunction and may help in developing remote monitoring strategies to prevent or reduce cerebrovascular decline.
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Affiliation(s)
| | - Ali Ganjizadeh
- Mayo Clinic Artificial Intelligence Laboratory Rochester MN
| | | | - Bart M Demaerschalk
- Mayo Clinic College of Medicine and Science Phoenix AZ
- Mayo Clinic Division of Stroke and Cerebrovascular Diseases Department of Neurology Phoenix AZ
- Mayo Clinic Center for Digital Health Phoenix AZ
| | - Bradley J Erickson
- Mayo Clinic College of Medicine and Science Phoenix AZ
- Mayo Clinic Artificial Intelligence Laboratory Rochester MN
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Guo C, Harshfield EL, Markus HS. Sleep Characteristics and Risk of Stroke and Dementia: An Observational and Mendelian Randomization Study. Neurology 2024; 102:e209141. [PMID: 38350061 PMCID: PMC11067695 DOI: 10.1212/wnl.0000000000209141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/16/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Sleep disturbances are implicated as risk factors of both stroke and dementia. However, whether these associations are causal and whether treatment of sleep disorders could reduce stroke and dementia risk remain uncertain. We aimed to evaluate associations and ascertain causal relationships between sleep characteristics and stroke/dementia risk and MRI markers of small vessel disease (SVD). METHODS We used data sets from a multicenter population-based study and summary statistics from genome-wide association studies (GWASs) of sleep characteristics and outcomes. We analyzed 502,383 UK Biobank participants with self-reported sleep measurements, including sleep duration, insomnia, chronotype, napping, daytime dozing, and snoring. In observational analyses, the primary outcomes were incident stroke, dementia, and their subtypes, alongside SVD markers. Hazard ratios (HRs) and odds ratios (ORs) were adjusted for age, sex, and ethnicity, and additional vascular risk factors. In Mendelian randomization (MR) analyses, ORs or risk ratios are reported for the association of each genetic score with clinical or MRI end points. RESULTS Among 502,383 participants (mean [SD] age, 56.5 [8.1] years; 54.4% female), there were 7,668 cases of all-cause dementia and 10,334 strokes. In longitudinal analyses, after controlling for cardiovascular risk factors, participants with insomnia, daytime napping, and dozing were associated with increased risk of any stroke (HR 1.05, 95% CI 1.01-1.11, p = 8.53 × 10-3; HR 1.09, 95% CI 1.05-1.14, p = 3.20 × 10-5; HR 1.19, 95% CI 1.08-1.32, p = 4.89 × 10-4, respectively). Almost all sleep measures were associated with dementia risk (all p < 0.001, except insomnia). Cross-sectional analyses identified associations between napping, snoring, and MRI markers of SVD (all p < 0.001). MR analyses supported a causal link between genetically predicted insomnia and increased stroke risk (OR 1.31, 95% CI 1.13-1.51, p = 0.00072), but not with dementia or SVD markers. DISCUSSION We found that multiple sleep measures predicted future risk of stroke and dementia, but these associations were attenuated after controlling for cardiovascular risk factors and were absent in MR analyses for Alzheimer disease. This suggests possible confounding or reverse causation, implying caution before proposing sleep disorder modifications for dementia treatment.
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Affiliation(s)
- Chutian Guo
- From the Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom
| | - Eric L Harshfield
- From the Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom
| | - Hugh S Markus
- From the Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom
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Zhang W, Zhou B, Jiang C, Jin Y, Zhu T, Zhu F, Cheng KK, Lam TH, Xu L. Associations of daytime napping and nighttime sleep quality with depressive symptoms in older Chinese: the Guangzhou biobank cohort study. BMC Geriatr 2023; 23:875. [PMID: 38114908 PMCID: PMC10731710 DOI: 10.1186/s12877-023-04579-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/07/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Poor sleep quality has been linked to depression in older adults, but results of the association between daytime napping and depression remains limited and conflicting. Moreover, whether the association of daytime napping with depression varies by nighttime sleep quality is unclear. Hence, we examined the associations of daytime napping and nighttime sleep quality with depressive symptoms in older Chinese. METHODS A total of 16,786 participants aged ≥50 from the Guangzhou Biobank Cohort Study second-round examination (2008-2012) were included in this cross-sectional study. Geriatric Depression Scale (GDS-15), Pittsburgh Sleep Quality Index (PSQI), napping and demographic data were collected by face-to-face interview using a computerized questionnaire. Logistic regression was used to calculate odds ratio (OR) of depressive symptoms for napping and sleep quality. RESULTS The prevalence of depressive symptoms (GDS score > 5) and poor global sleep quality (PSQI score ≥ 6) was 5.3 and 31.9%, respectively. Compared to non-nappers, nappers showed significantly higher odds of depressive symptoms, with OR (95% confidence interval (CI)) being 1.28 (1.11-1.49). The odds of depressive symptoms for daytime napping varied by nighttime sleep quality (P for interaction = 0.04). In good-quality sleepers, compared to non-nappers, nappers had significantly higher odds of depressive symptoms, with OR (95% CI) being 1.57 (1.23-2.01), whereas no association was found in poor-quality sleepers (OR = 1.13, 0.94-1.36). CONCLUSION Napping was associated with higher odds of depressive symptoms in older people, and the association was stronger in good-quality sleepers.
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Affiliation(s)
- Weisen Zhang
- Molecular Epidemiology Research Center, Guangzhou Twelfth People's Hospital, Guangzhou, 510620, Guangdong, China
| | - Baijing Zhou
- Molecular Epidemiology Research Center, Guangzhou Twelfth People's Hospital, Guangzhou, 510620, Guangdong, China
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chaoqiang Jiang
- Molecular Epidemiology Research Center, Guangzhou Twelfth People's Hospital, Guangzhou, 510620, Guangdong, China
| | - Yali Jin
- Molecular Epidemiology Research Center, Guangzhou Twelfth People's Hospital, Guangzhou, 510620, Guangdong, China
| | - Tong Zhu
- Molecular Epidemiology Research Center, Guangzhou Twelfth People's Hospital, Guangzhou, 510620, Guangdong, China
| | - Feng Zhu
- Molecular Epidemiology Research Center, Guangzhou Twelfth People's Hospital, Guangzhou, 510620, Guangdong, China
| | - Kar Keung Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Lin Xu
- School of Public Health, Sun Yat-sen University, Guangzhou, China.
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Yang J, Liu X, Zhai Z, Liao W, He Y, Wu X, Wang C, Sun C, Li Y. The independent and combined association of napping and night sleep duration with stroke in Chinese rural adults. Sleep Breath 2023; 27:265-274. [PMID: 35469369 DOI: 10.1007/s11325-022-02619-w] [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: 11/15/2021] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Inappropriate sleep duration is a potential cause of stroke. But the effect of napping on stroke risk remains controversial and the interaction between night sleep and napping duration remains unclear. The objective of this study was to examine the independent and combined effects of napping and nocturnal sleep duration on stroke. METHODS Subjects were derived from a rural cohort study in Henan. The Pittsburgh Sleep Quality Index (PSQI) was applied to identify nap duration and nocturnal sleep duration. Binary logistic regression was employed to indicate the dose-response relationships between naps, nocturnal sleep, total 24-h sleep duration, and stroke. RESULTS Among the 37,341 participants (14,485 men), 2600 suffered from a stroke. The odds ratios (ORs) and 95% confidence level (CI) for stroke in the fully adjusted model were 1.37 (1.13-1.65) for men nappers compared to non-nappers. Compared to 7-8 h of sleep per day, night sleep durations < 6 h and ≥ 9 h and 24-h sleep duration ≥ 10 h were linked to increased odds of stroke in men. The ORs (95%CI) were 1.34 (1.06-1.69) in nocturnal sleep duration < 6 h, 1.30 (1.06-1.59) in nocturnal sleep duration ≥ 9 h, and 1.40 (1.15-1.71) in 24-h sleep duration ≥ 10 h in men. In addition, long naps and prolonged nocturnal sleep duration have a joint effect on stroke in the fully adjusted model. CONCLUSION The napping duration and nocturnal sleep duration have independently and jointly effects on stroke in rural populations. More research is required to explore the underlying mechanisms for this relationship. CLINICAL TRIAL REGISTRATION The Henan Rural Cohort Study has been registered on the Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699) ( http://www.chictr.org.cn/showproj.aspx?proj=11375 ).
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Affiliation(s)
- Jing Yang
- Department of Clinical Pharmacology, School of Pharmaceutical Science, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.,Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Zhihan Zhai
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Wei Liao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Yaling He
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Xueyan Wu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Chunyang Sun
- Department of Preventive Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - Yuqian Li
- Department of Clinical Pharmacology, School of Pharmaceutical Science, Zhengzhou University, Zhengzhou, Henan, People's Republic of China. .,Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of 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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Fang Y, He Y, Huang Y, Ran L, Song W, Hao J, Yao D, Li R, Pan D, Qin T, Wang M. Sleep duration, daytime napping, and risk of incident stroke: Nuances by metabolic syndrome from the China health and retirement longitudinal study. Front Cardiovasc Med 2022; 9:976537. [PMID: 36119748 PMCID: PMC9478414 DOI: 10.3389/fcvm.2022.976537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background and purposeThe relationship between sleep duration and stroke are inconclusive in China, especially in those individuals with metabolic syndrome. We aimed to investigate the association between sleep duration and incident stroke in participants with metabolic syndrome or its specific components in China.Materials and methodsData were taken from the 2011 and 2015 waves of China Health and Retirement Longitudinal Study (CHARLS). Habitual sleep duration (≤6, 6∼8 [reference], >8 h), daytime napping (0, 1∼60 [reference], and >60 min) were determined by self-reported questionnaires. Metabolic syndrome was defined by blood assessment and biomarkers combined with self-reported doctors’ diagnosis. Incident stroke was determined by reported stroke from 2011 to 2015 wave. Cross-sectional and longitudinal associations between sleep and (incident) stroke at baseline and 4-year follow-up period were tested among the population with metabolic syndrome and its components.ResultsA U-shaped relationship was observed between sleep duration and stroke in cross-sectional analysis. Sleep ≤ 6 h/night had a greater risk of incident stroke (hazard ratio [HR] 1.65; 95% confidence interval [CI] 1.04–2.61) compared with sleep 6∼8 h/night. And the HR of stroke was 1.62 (95%CI, 1.03–2.53) for sleep < 7 h/day compared to 7∼9 h/day. These associations were more evident in the female and individuals aged 45–65 years. Furthermore, the effect of short sleep duration on incident stroke was different in each component of metabolic syndrome, which was more pronounced in participants with elevated blood pressure. And a significant joint effect of sleeping ≤ 6 h/night and no napping on risk of stroke was observed (HR 1.82, 95%CI 1.06–3.12).ConclusionShort sleep duration was an independent risk factor for incident stroke, especially among females, individuals aged 45–65 years, or those with some components of metabolic syndrome, such as hypertension. Napping could buffer the risk of short sleep duration on incident stroke.
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Affiliation(s)
- Yuanyuan Fang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuqin He
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanzhu Huang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lusen Ran
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenhui Song
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiahuan Hao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Di Yao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rong Li
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dengji Pan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tingting Qin
- Department of Biliary-Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Tingting Qin,
| | - Minghuan Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Minghuan Wang,
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Jin X, Chen H, Li Y, Xu W, Chen X, Tian L, Teng W. Association between daytime napping and stroke: A dose-response meta-analysis. J Sleep Res 2021; 30:e13366. [PMID: 33870591 DOI: 10.1111/jsr.13366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 12/15/2022]
Abstract
Daytime napping is common in many regions around the world and has been an important part of people's daily life. Daytime napping has attracted increasing attention in recent years. Thus, we conducted a meta-analysis to evaluate the relationship between daytime napping and stroke, and help reduce the risk of stroke by improving living habits. The Embase, PubMed, Web of Science and PsycINFO databases were searched for cohort studies published before October 2020 and eight eligible studies with 524,408 participants and 5,875 stroke cases were included in the final analysis. The pooled relative risk (RR) of stroke was 1.47 (95% confidence interval [CI]: 1.24-1.74; p < .001) with significant heterogeneity (I2 = 58%, p for heterogeneity = 0.02). However, the heterogeneity decreased when the study in which adjusting for sleep duration and stratifying the results based on sleep duration was not performed was excluded (RR: 1.38; 95% CI: 1.19-1.60, I2 = 44%, p for heterogeneity = 0.10). In dose-response analysis, the linear trend indicated that for every 10-min increase in daytime napping, the risk of stroke increased by 3%. Further well-designed large studies are needed to explore the effects of daytime napping on stroke and the underlying biological mechanisms.
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Affiliation(s)
- Xiaolin Jin
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Hanze Chen
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Yuru Li
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Wenying Xu
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Xinxin Chen
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Li Tian
- Department of Geriatrics, Shengjing Hospital, China Medical University, Shenyang, China
| | - Weiyu Teng
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
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