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Insomnia is more frequently reported in stroke survivors but its independent role in mortality in stroke survivors is unknown. The purpose of this study was to investigate the association of insomnia symptoms with all-cause mortality among stroke survivors.
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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.
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Objective: To determine the association of sleep duration and disturbances with physical and mental health-related quality of life (HRQoL) in stroke survivors. Design: Cross-sectional analysis of the REasons for Geographic And Racial Differences in Stroke second in-home visit (May 2013-Dec 2016). Setting: Population-based national study in US. Participants: Individuals with adjudicated incident stroke (N=368). Interventions: Not applicable. Main Outcome Measures: Physical and mental HRQoL based on the 12-item Short Form. Sleep measures included sleep duration, difficulty initiating sleep, difficulty maintaining sleep, nonrestorative sleep, and a combined measure based on the latent class model. Logistic regression models were used to investigate the association between sleep variables and HRQoL, adjusting for demographic factors, socioeconomic factors, behavioral factors, and comorbidities. Results: This study included 368 non-Hispanic Black and White stroke survivors. The mean age was 76.0 years (SD=7.9), and 52.7% were men. Stroke survivors with short sleep duration were more likely to have poor physical HRQoL (OR, 2.87; 95% CI, 1.46-5.62) compared with stroke survivors with adequate sleep duration after adjusting for confounding. Similarly, stroke survivors with nonrestorative sleep were 3 times more likely to have poor physical HRQoL (OR, 3.11; 95% CI, 1.28-7.55) compared with stroke survivors with restorative sleep. Conclusions: Non-optimal sleep duration and nonrestorative sleep were associated with higher odds of poor physical HRQoL in stroke survivors. These findings highlight the importance of considering sleep health in post-stroke care. © 2025 American Congress of Rehabilitation Medicine
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- English (1)