Routinely sleeping less than six hours a night significantly increases the risk of stroke or having stroke symptoms in middle-aged adults who are not overweight and have a low risk of sleep-disordered breathing, a new study suggests . “Health providers and their patients should increase their awareness of the impact of sleep on the development of stroke,” Dr Megan Ruiter (University of Alabama, Birmingham) said in an interview. “It may be important for healthcare providers to ask their patients about their sleep, particularly the patients who have few traditional risk factors for stroke such as obesity or obstructive sleep apnea,” she added. Ruiter presented her findings here at SLEEP 2012, the annual meeting of the Associated Professional Sleep Societies. The findings are based on 5666 working adults aged 45 and older enrolled in the well-known Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. All were free of stroke, transient ischemic attack, stroke symptoms, or sleep-disordered breathing at baseline.
“Our study was different from previous studies on the association between sleep and stroke because we examined only participants who did not have a high risk for obstructive sleep apnea,” Ruiter commented. “Obstructive sleep apnea is known to be associated with stroke events; therefore, in previous studies, the presence of obstructive sleep apnea may have actually explained the association between extremes in sleep duration and stroke,” she said. In a fully adjusted model including adults with normal body-mass index, a nightly sleep duration of less than six hours was strongly associated with a greater incidence of stroke symptoms (HR 4.54, 95% CI 1.75-11.83; p=0.002).
It’s estimated that 30% of working adults get less than six hours of sleep each night. “We speculate that short sleep duration is a precursor to other traditional stroke risk factors, and once these traditional stroke risk factors are present, then perhaps they become stronger risk factors than sleep duration alone,” Ruiter said in a statement from the conference. “Sleep and sleep-related behaviors,” she added, “are highly modifiable with cognitive-behavioral therapy approaches and/or pharmaceutical interventions. These results may serve as a preliminary basis for using sleep treatments to prevent the development of stroke.”
Commenting in an interview, session moderator Dr Daniel Cohen (Eastern Virginia Medical School, Norfolk), said, “It’s unclear, I think, whether treating insomnia lowers the risk of stroke.” Cohen said that in his own practice he “usually applies this sort of information by telling patients if they are undercutting their sleep requirements and they are capable of more sleep, there are emerging data to suggest that that may be a risk factor for cardiovascular [problems] like stroke.”