Article
Sleep Characteristics and the Incidence of Stroke: Results of the Heinz Nixdorf Recall Study
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Authors
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Nils Kuklik
- Zentrum für Klinische Epidemiologie; Institut für Medizinische Informatik, Biometrie und Epidemiologie; Universitätsklinikum Essen; Universität Duisburg-Essen, Essen, Germany
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Bernd Kowall
- Zentrum für Klinische Epidemiologie, Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
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Anna-Therese Lehnich
- Zentrum für Klinische Epidemiologie, Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
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Christian Weimar
- Klinik für Neurologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
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Raimund Erbel
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
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Karl-Heinz Jöckel
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
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Andreas Stang
- Zentrum für Klinische Epidemiologie, Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
| Published: | September 6, 2019 |
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Outline
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Background: Midday naps and nocturnal sleep disturbances have several effects on cardiovascular and humoral factors, such as blood pressure, heart rate, platelet aggregability and blood viscosity. Previous studies that described the association between sleep duration and the incidence of stroke suffered from limitations regarding specification of sleep habits and the assessment of confounders. Based on the Heinz Nixdorf Recall Study, a population-based prospective cohort study, our aim is to examine the association between sleep-related characteristics such as regularity and duration of midday napping and nocturnal sleep disturbances (difficulties falling asleep, difficulties maintaining sleep, early morning arousal) and the occurrence of strokes, accounting for several cardiovascular confounders.
Methods: We used data from 4,636 participants aged 45-76 years and examined the association between self-reported sleep characteristics and stroke using Cox proportional hazards regression. Participants with a history of stroke were excluded. The baseline examinations included standardized interviews, physical examinations, and laboratory tests. We adjusted for several potential confounders at baseline including age, gender, nocturnal sleep duration, BMI, waist circumference, CRP, smoking, alcohol and coffee use, depression, marital and employment status, and education based on causal diagram analysis. The outcome variable included ischemic and hemorrhagic strokes.
Results: Overall, 175 of 4,636 participants (3.8 %) suffered from stroke during a median follow-up time of 13.4 years. Regular long midday nap (5-7 naps per week > 60 min) was associated with an increased adjusted hazard ratio for strokes (HR 3.20, 95% CI: 1.92-5.32), but no association was observed for regular short nap (HR 1.09, 95% CI: 0.73-1.63) compared to irregular or no nap, respectively. Regular (nearly every night) difficulties falling asleep showed an association with stroke (HR 1.64, 95% CI: 1.05-2.56), but no association was observed for regular difficulties maintaining sleep (HR 0.91, 95% CI: 0.66-1.25) and regular early morning arousal (HR 0.92, 95% CI: 0.54-1.56).
Conclusions: Regular long midday naps and regular difficulties falling asleep are positively associated with the incidence of stroke, which should be adequately addressed in future research on sleep hygiene recommendations.
The authors declare that they have no competing interests.
The authors declare that a positive ethics committee vote has been obtained.
