Sleep duration and all-cause mortality among stroke survivors

Wendemi Sawadogo; Tilahun Adera; James B Burch; Maha Alattar; Robert Perera; Virginia J Howard

doi:10.1016/j.jstrokecerebrovasdis.2024.107615

Sleep duration and all-cause mortality among stroke survivors

J Stroke Cerebrovasc Dis. 2024 Apr;33(4):107615. doi: 10.1016/j.jstrokecerebrovasdis.2024.107615. Epub 2024 Feb 1.

Authors

Wendemi Sawadogo¹, Tilahun Adera², James B Burch², Maha Alattar³, Robert Perera⁴, Virginia J Howard⁵

Affiliations

¹ Department of Public Health, College of Human and Health Services, Southern Connecticut State University, New Haven, CT, United States; Department of Epidemiology, School of Population Health, Virginia Commonwealth University, Richmond, VA, United States. Electronic address: sawadogow1@southernct.edu.
² Department of Epidemiology, School of Population Health, Virginia Commonwealth University, Richmond, VA, United States.
³ Division of Adult Neurology, Sleep Medicine, Vascular Neurology, Department of Neurology, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States.
⁴ Department of Biostatistics, School of Population Health, Virginia Commonwealth University, Richmond, VA, United States.
⁵ Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States.

PMID: 38307468
DOI: 10.1016/j.jstrokecerebrovasdis.2024.107615

Abstract

Background: Post stroke sleep duration could increase the risk of death. This study tested the hypothesis that inadequate sleep duration is associated with increased mortality among stroke survivors.

Methods: The REasons for Geographic And Racial Differences in Stroke (REGARDS), a national population-based longitudinal study, was the data source. Sleep duration was ascertained between 2013 and 2016 among stroke survivors who were subsequently followed up until death or censored on December 31, 2022. Sleep duration was estimated as the difference between wake-up time and bedtime to which was subtracted the time spent in bed without sleep. Cox proportional hazards regression models were employed to investigate the association between sleep duration and all-cause mortality adjusting for demographic factors, socioeconomic factors, behavioral factors, and co-morbidities.

Results: A total of 468 non-Hispanic Black and White stroke survivors were included in this analysis. The mean age was 76.3 years, 52.6% were females and 56.0% were non-Hispanic White individuals. The distribution of short (≤6 h), adequate (7.0-8.9 h), and long sleep (≥9 h) was 30.3%, 44.7%, and 25%, respectively. Over a mean follow-up of 5.0 years, 190 (40.6%) deaths occurred. Compared to stroke survivors with adequate sleep (7.0-8.9 h), stroke survivors with long sleep (≥9 h) were at increased risk of all-cause mortality (HR=1.46, 95% CI=1.01, 2.12). However, short sleep (≤6 h) was not significantly associated with an increased risk of all-cause mortality (HR=1.31, 95% CI=0.90, 1.91). Subgroup analyses indicated higher risk in the age <75 years, females, non-Hispanic Black individuals, and those living in the Stroke Belt region, but those differences were not statistically significant.

Conclusion: In this study of stroke survivors, 9 hours or more of sleep per day was associated with an increased risk of all-cause mortality. This finding suggests that excessive sleep duration may be a warning sign of poor life expectancy in stroke survivors.

Keywords: All-cause mortality; Cohort study; Sleep duration; Stroke survivors.

MeSH terms

Aged
Female
Humans
Longitudinal Studies
Male
Risk Factors
Sleep
Sleep Deprivation / complications
Sleep Duration*
Stroke* / etiology
Survivors