June 13, 2012 (Boston, Massachusetts) — Routinely sleeping less than 6 hours a night significantly increases the risk for stroke symptoms in middle-aged adults who are not overweight and have a low risk for 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," Megan Ruiter, PhD, from the University of Alabama, Birmingham, told Medscape Medical News.
"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.
Dr. Ruiter presented her findings here at SLEEP 2012: Associated Professional Sleep Societies 26th Annual Meeting.
The findings are based on 5666 working adults aged 45 years 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, and sleep-disordered breathing at baseline.
"Our study was different than previous studies on the association between sleep and stroke because we only examined participants who did not have a high risk for obstructive sleep apnea," Dr. 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 that included adults with normal body mass index, a nightly sleep duration less than 6 hours was strongly associated with a greater incidence of stroke symptoms. The hazard ratio was 4.54 (95% confidence interval, 1.75 - 11.83; P = .002).
"Surprisingly," said Dr. Ruiter, there was no significant association among overweight and obese participants.
It's estimated that 30% of working adults get less than 6 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," Dr. 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."
In an interview with Medscape Medical News, session moderator Daniel Cohen, MD, said, "It's unclear, I think, whether treating insomnia lowers the risk of stroke."
Dr. Cohen, from Sentara Neurology Specialists and Eastern Virginia Medical School in Norfolk, said in his own practice he "usually applies this sort of information by telling patients if they are under cutting their sleep requirements and they are capable of more sleep, there is emerging data to suggest that that may be a risk factor for cardiovascular (problems) like stroke."
The REGARDS study is funded by the National Institutes of Health, National Institute of Neurological Disorders and Stroke. The authors and Dr. Cohen have disclosed no relevant financial relationships.
SLEEP 2012: Associated Professional Sleep Societies 26th Annual Meeting. Abstract #0829. Presented June 11, 2012.
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