Sleep Patterns and the Risk of Acute Stroke

Authors: Christine E. Mc Carthy, Salim Yusuf, Conor Judge, Alberto Alvarez‐Iglesias, Graeme J. Hankey, Shahram Oveisgharan, Albertino Damasceno, Helle K. Iversen, Annika Rosengren, Álvaro Avezum, Patricio López‐Jaramillo, Denis Xavier, Xingyu Wang, Sumathy Rangarajan, Martin O’Donnell, for INTERSTROKE, for INTERSTROKE, Rafael Díaz, George Varigos, George Varigos, Lisheng Liu, Hongye Zhang, Zvonko Rumboldt, Eenesto Peñaherrera, Hans-Christoper Diener, Prem Pais, Osamah Albaker, Khalid Yusoff, Okechukwu S. Ogah, Adesola Ogunniyi, Romaina Iqbal, Germán Málaga, Antonio Dans, Anna Członkowska, Danuta Ryglewicz, Nana Pogosova, Fawaz Alhussein, L. Devilliers, Amhed Elsayed, Yongchai Nilanont, Aytekin Oğuz, Charles Mondo, Alfzalhussein Yusufali, Peter Langhorne - Neurology 2023 cited by 63

Background and Objectives: Symptoms of sleep disturbance are common, and may represent important modifiable risk factors for stroke. We evaluated the association between a spectrum of sleep disturbance symptoms and risk of acute stroke in an international setting. Methods: INTERSTROKE is an international case-control study of patients presenting with first acute stroke and controls matched by age (+/- 5 years) and sex. Sleep symptoms in the previous month were assessed via a questionnaire. Conditional logistic regression estimated the association between sleep disturbance symptoms and acute stroke, expressed as odds ratios and 95% confidence intervals. The primary model adjusted for age, occupation, marital status and modified-Rankin Scale at baseline, with subsequent models adjusting for potential mediators (behavioural/disease risk factors). Results: Overall, 4,496 matched participants were included, with 1,799 of participants having experienced an ischemic stroke and 439 an intracerebral haemorrhage. Short sleep (<5hrs: 3.15, 2.09-4.76), long sleep (>9hr: 2.67, 1.89-3.78), impaired quality (1.52, 1.32-1.75), difficulty getting to sleep (1.32, 1.13-1.55) or maintaining sleep (1.33, 1.15-1.53), unplanned napping (1.59, 1.31-1.92), prolonged napping (>1hr: 1.88, 1.49-2.38), snoring (1.91, 1.62-2.24), snorting (2.64, 2.17-3.20) and breathing cessation (2.87, 2.28-2.60) were all significantly associated with increased odds of acute stroke in the primary model. A derived Obstructive Sleep Apnoea (OSA) score of 2-3 (2.67, 2.25-3.15) and cumulative sleep symptoms (>5: 5.06, 3.67-6.97) were also associated with a significantly increased odds of acute stroke, with the latter showing a graded association. Following extensive adjustment, significance was maintained for the majority of symptoms (not difficulty getting to/maintaining sleep and unplanned napping), with similar findings for stroke subtypes. Discussion: We found that sleep disturbance symptoms were common, and associated with a graded increased risk of stroke. These symptoms may be a marker of increased individual risk, or represent independent risk factors. Future clinical trials are warranted to determine the efficacy of sleep interventions in stroke prevention.