Sleep Duration and Risk of Ischemic Stroke in Postmenopausal Women

Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill, NC 27599-7435, USA.
Stroke (Impact Factor: 5.72). 12/2008; 39(12):3185-92. DOI: 10.1161/STROKEAHA.108.521773
Source: PubMed


Many studies have shown a U-shape association between sleep duration and mortality, but epidemiological evidence linking cardiovascular diseases with habitual sleep patterns is limited and mixed.
We conducted a prospective study on 93 175 older women (aged 50 to 79 years) in the Women's Health Initiative Observational study cohort to examine the risk of ischemic stroke in relation to self-reported sleep duration. Cox models were used to investigate the putative associations, adjusting for multiple sociodemographic and lifestyle factors, depression, snoring, sleepiness symptoms, and other cardiovascular disease-related clinical characteristics.
At baseline, 8.3% of subjects had reported their sleep duration as <or=5 hours per night and 4.6% reported long duration of sleep (>or=9 hours/night). After an average of 7.5 years of follow-up, 1166 cases of ischemic stroke had occurred. Multivariable-adjusted relative risk (RR) and 95% CI for ischemic stroke (using a sleep time of 7 hours/night as the reference) were 1.14 (0.97, 1.33), 1.24 (1.04, 1.47), and 1.70 (1.32, 2.21) for women reporting <or=6, 8, and >or=9 hours of sleep. A modestly stronger association with sleep duration <or=6 hours per night (RR, 1.22; 1.03, 1.44) was noted among women without prevalent cardiovascular disease at baseline. Our analyses also reveal that the adverse effect of long sleep is likely independent of the increased risk for ischemic stroke associated with frequent snoring and sleepiness (RR, 1.31; 1.00, 1.72).
Habitual sleep patterns are important neurobehavioral determinants of risk for ischemic stroke in postmenopausal women. The underlying neurobiology and mechanistic mediators for the putative adverse effect of long sleep (>or=9 hours/night) need further elucidation.

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Available from: Sylvia Wassertheil-Smoller, Oct 05, 2015
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    • "being apparent across several days of monitoring with sleep diaries. The National Sleep Foundation recommends 7—9 h of sleep in healthy adults; less than 6 hours is not recommended (Hirshkowitz et al., 2015) and is associated with increased risk for poor health outcomes including stroke and diabetes (Chen et al., 2008; Holliday et al., 2013; Irwin, 2015). Insomnia also is an independent risk factor for poor health (Irwin, 2015) and the most dramatic consequences arise when insomnia and short sleep duration coexist. "
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    ABSTRACT: The menopausal transition is marked by increased prevalence in disturbed sleep and insomnia, present in 40-60% of women, but evidence for a physiological basis for their sleep complaints is lacking. We aimed to quantify sleep disturbance and the underlying contribution of objective hot flashes in 72 women (age range: 43-57 years) who had (38 women), compared to those who had not (34 women), developed clinical insomnia in association with the menopausal transition. Sleep quality was assessed with two weeks of sleep diaries and one laboratory polysomnographic (PSG) recording. In multiple regression models controlling for menopausal transition stage, menstrual cycle phase, depression symptoms, and presence of objective hot flashes, a diagnosis of insomnia predicted PSG-measured total sleep time (p<0.01), sleep efficiency (p=0.01) and wakefulness after sleep onset (WASO) (p=0.01). Women with insomnia had, on average, 43.5min less PSG-measured sleep time (p<0.001). There was little evidence of cortical EEG hyperarousal in insomniacs apart from elevated beta EEG power during REM sleep. Estradiol and follicle stimulating hormone levels were unrelated to beta EEG power but were associated with the frequency of hot flashes. Insomniacs were more likely to have physiological hot flashes, and the presence of hot flashes predicted the number of PSG-awakenings per hour of sleep (p=0.03). From diaries, women with insomnia reported more WASO (p=0.002), more night-to-night variability in WASO (p<0.002) and more hot flashes (p=0.012) compared with controls. Women who develop insomnia in the approach to menopause have a measurable sleep deficit, with almost 50% of the sample having less than 6h of sleep. Compromised sleep that develops in the context of the menopausal transition should be addressed, taking into account unique aspects of menopause like hot flashes, to avoid the known negative health consequences associated with insufficient sleep and insomnia in midlife women.
    Psychoneuroendocrinology 06/2015; 60. DOI:10.1016/j.psyneuen.2015.06.005 · 4.94 Impact Factor
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    • "Although studies in sleep-deprived animals [40] and humans [41] have shown a strong physiological association between sleep and hypertension, more clinical trials need to be performed to delineate the underlying pathophysiology. Previous research has shown that long sleep is associated with hypertension [42], obesity [43], and stroke [44], and long sleep may actually be more detrimental to health than short sleep. Underlying mechanisms that could be responsible for the effect of long sleep, as suggested in previous analyses, include sleep fragmentation and photoperiodic abnormalities, which could all lead to increased blood pressure levels [45]. "
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    ABSTRACT: Background. Evidence suggests that insufficient sleep duration is associated with an increased likelihood for hypertension. Both short (<6 hours) and long (>8 hour) sleep durations as well as hypertension are more prevalent among blacks than among whites. This study examined associations between sleep duration and hypertension, considering differential effects of race and ethnicity among black and white Americans. Methods. Data came from a cross-sectional household interview with 25,352 Americans (age range: 18-85 years). Results. Both white and black short sleepers had a greater likelihood of reporting hypertension than those who reported sleeping 6 to 8 hours. Unadjusted logistic regression analysis exploring the race/ethnicity interactions between insufficient sleep and hypertension indicated that black short (<6 hours) and long (>8 hours) sleepers were more likely to report hypertension than their white counterparts (OR = 1.34 and 1.37, resp.; P < 0.01). Significant interactions of insufficient sleep with race/ethnicity were observed even after adjusting to effects of age, sex, income, education, body mass index, alcohol use, smoking, emotional distress, diabetes, coronary heart disease, and stroke. Conclusion. Results suggest that the race/ethnicity interaction is a significant mediator in the relationship between insufficient sleep and likelihood of having a diagnosis of hypertension.
    International Journal of Hypertension 04/2013; 2013:436502. DOI:10.1155/2013/436502
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    • "Previous studies have observed an association between sleep duration and risk of CVD, finding an increased risk of CHD or stroke with habitual sleeping duration of less than 6 hours per night [24-27] and long sleep duration (sleep duration >9 hours/night) [24,25]. The potential mechanisms between decreased sleep duration and risk of CHD are not fully understood but likely include sympathetic overactivity, increases in blood pressure, and decreased glucose tolerance [25]. "
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    BMC Public Health 02/2013; 13(1):122. DOI:10.1186/1471-2458-13-122 · 2.26 Impact Factor
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