Sleep duration and long-term mortality after stroke: A nationwide analysis

Abstract

Background: Sleep duration is a key marker of ideal cardiovascular health in the American Heart Association's new Life's Essential 8 construct, but studies on outcomes in stroke survivors are scarce. We assessed the association between sleep duration and mortality among self-reported stroke survivors in a nationally representative U.S.

Methods: Cross-sectional data (2005-2018) from the National Health and Nutrition Examination Surveys database in patients aged ≥18 (n=42,143) with a self-reported history of stroke (n=1,488) were linked to the 2019 National Death Index to determine the association between nightly sleep duration and mortality. Relationships between sleep duration (short: <7 hrs, normal: 7-8 hrs, long: >8 hrs) and demographic characteristics were assessed. Relationships between sleep duration and mortality (all-cause and cardiovascular causes) were evaluated adjusting for demographic and clinical variables, with multivariable Cox regressions.

Results: Among stroke survivors, prevalence of short sleep duration increased with younger age while prevalence of long sleep duration increased with older age (p<0.001). There were no significant sex differences in sleep duration. Long sleep duration was associated with higher all-cause mortality in the unadjusted model (HR 1.82, 1.44-2.31, p<0.0001). After adjustment for co-variates, (HR 1.36, 1.08-1.71, p = 0.01), the association attenuated, but remained significant (HR 1.30, 1.02-1.65, p = 0.03). Sensitivity analysis further verified the reliability of this conclusion. Short sleep duration was not associated with all-cause or cardiovascular mortality after adjusted analyses. There were no significant associations between long sleep duration and cardiovascular mortality.

Conclusion: Long sleep duration is independently associated with higher risk, all-cause mortality after stroke.

Keywords: Mortality; Sleep duration; Stroke.