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January 28, 2020; 94 (4) Article

Sleep duration, midday napping, and sleep quality and incident stroke

The Dongfeng-Tongji cohort

Lue Zhou, Kuai Yu, Liangle Yang, Hao Wang, Yang Xiao, View ORCID ProfileGaokun Qiu, Xuezhen Liu, Yu Yuan, Yansen Bai, Xiulou Li, Handong Yang, Meian He, Chongjian Wang, Tangchun Wu, Xiaomin Zhang
First published December 11, 2019, DOI: https://doi.org/10.1212/WNL.0000000000008739
Lue Zhou
From the Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating) (L.Z., K.Y., L.Y., H.W., Y.X., G.Q., X.L., Y.Y., Y.B., M.H., T.W., X.Z.), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Department of Cardiovascular Diseases (X.L., H.Y.), Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan; and Department of Epidemiology and Biostatistics (C.W.), College of Public Health, Zhengzhou University, China.
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Kuai Yu
From the Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating) (L.Z., K.Y., L.Y., H.W., Y.X., G.Q., X.L., Y.Y., Y.B., M.H., T.W., X.Z.), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Department of Cardiovascular Diseases (X.L., H.Y.), Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan; and Department of Epidemiology and Biostatistics (C.W.), College of Public Health, Zhengzhou University, China.
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Liangle Yang
From the Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating) (L.Z., K.Y., L.Y., H.W., Y.X., G.Q., X.L., Y.Y., Y.B., M.H., T.W., X.Z.), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Department of Cardiovascular Diseases (X.L., H.Y.), Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan; and Department of Epidemiology and Biostatistics (C.W.), College of Public Health, Zhengzhou University, China.
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Hao Wang
From the Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating) (L.Z., K.Y., L.Y., H.W., Y.X., G.Q., X.L., Y.Y., Y.B., M.H., T.W., X.Z.), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Department of Cardiovascular Diseases (X.L., H.Y.), Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan; and Department of Epidemiology and Biostatistics (C.W.), College of Public Health, Zhengzhou University, China.
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Yang Xiao
From the Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating) (L.Z., K.Y., L.Y., H.W., Y.X., G.Q., X.L., Y.Y., Y.B., M.H., T.W., X.Z.), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Department of Cardiovascular Diseases (X.L., H.Y.), Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan; and Department of Epidemiology and Biostatistics (C.W.), College of Public Health, Zhengzhou University, China.
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Gaokun Qiu
From the Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating) (L.Z., K.Y., L.Y., H.W., Y.X., G.Q., X.L., Y.Y., Y.B., M.H., T.W., X.Z.), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Department of Cardiovascular Diseases (X.L., H.Y.), Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan; and Department of Epidemiology and Biostatistics (C.W.), College of Public Health, Zhengzhou University, China.
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  • ORCID record for Gaokun Qiu
Xuezhen Liu
From the Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating) (L.Z., K.Y., L.Y., H.W., Y.X., G.Q., X.L., Y.Y., Y.B., M.H., T.W., X.Z.), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Department of Cardiovascular Diseases (X.L., H.Y.), Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan; and Department of Epidemiology and Biostatistics (C.W.), College of Public Health, Zhengzhou University, China.
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Yu Yuan
From the Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating) (L.Z., K.Y., L.Y., H.W., Y.X., G.Q., X.L., Y.Y., Y.B., M.H., T.W., X.Z.), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Department of Cardiovascular Diseases (X.L., H.Y.), Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan; and Department of Epidemiology and Biostatistics (C.W.), College of Public Health, Zhengzhou University, China.
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Yansen Bai
From the Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating) (L.Z., K.Y., L.Y., H.W., Y.X., G.Q., X.L., Y.Y., Y.B., M.H., T.W., X.Z.), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Department of Cardiovascular Diseases (X.L., H.Y.), Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan; and Department of Epidemiology and Biostatistics (C.W.), College of Public Health, Zhengzhou University, China.
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Xiulou Li
From the Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating) (L.Z., K.Y., L.Y., H.W., Y.X., G.Q., X.L., Y.Y., Y.B., M.H., T.W., X.Z.), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Department of Cardiovascular Diseases (X.L., H.Y.), Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan; and Department of Epidemiology and Biostatistics (C.W.), College of Public Health, Zhengzhou University, China.
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Handong Yang
From the Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating) (L.Z., K.Y., L.Y., H.W., Y.X., G.Q., X.L., Y.Y., Y.B., M.H., T.W., X.Z.), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Department of Cardiovascular Diseases (X.L., H.Y.), Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan; and Department of Epidemiology and Biostatistics (C.W.), College of Public Health, Zhengzhou University, China.
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Meian He
From the Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating) (L.Z., K.Y., L.Y., H.W., Y.X., G.Q., X.L., Y.Y., Y.B., M.H., T.W., X.Z.), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Department of Cardiovascular Diseases (X.L., H.Y.), Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan; and Department of Epidemiology and Biostatistics (C.W.), College of Public Health, Zhengzhou University, China.
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Chongjian Wang
From the Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating) (L.Z., K.Y., L.Y., H.W., Y.X., G.Q., X.L., Y.Y., Y.B., M.H., T.W., X.Z.), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Department of Cardiovascular Diseases (X.L., H.Y.), Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan; and Department of Epidemiology and Biostatistics (C.W.), College of Public Health, Zhengzhou University, China.
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Tangchun Wu
From the Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating) (L.Z., K.Y., L.Y., H.W., Y.X., G.Q., X.L., Y.Y., Y.B., M.H., T.W., X.Z.), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Department of Cardiovascular Diseases (X.L., H.Y.), Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan; and Department of Epidemiology and Biostatistics (C.W.), College of Public Health, Zhengzhou University, China.
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Xiaomin Zhang
From the Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating) (L.Z., K.Y., L.Y., H.W., Y.X., G.Q., X.L., Y.Y., Y.B., M.H., T.W., X.Z.), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Department of Cardiovascular Diseases (X.L., H.Y.), Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan; and Department of Epidemiology and Biostatistics (C.W.), College of Public Health, Zhengzhou University, China.
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Citation
Sleep duration, midday napping, and sleep quality and incident stroke
The Dongfeng-Tongji cohort
Lue Zhou, Kuai Yu, Liangle Yang, Hao Wang, Yang Xiao, Gaokun Qiu, Xuezhen Liu, Yu Yuan, Yansen Bai, Xiulou Li, Handong Yang, Meian He, Chongjian Wang, Tangchun Wu, Xiaomin Zhang
Neurology Jan 2020, 94 (4) e345-e356; DOI: 10.1212/WNL.0000000000008739

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Abstract

Objective To investigate the associations of sleep duration, midday napping, sleep quality, and change in sleep duration with risk of incident stroke and stroke subtypes.

Methods Among 31,750 participants aged 61.7 years on average at baseline from the Dongfeng-Tongji cohort, we used Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident stroke.

Results Compared with sleeping 7 to <8 hours/night, those reporting longer sleep duration (≥9 hours/night) had a greater risk of total stroke (hazard ratio [HR] 1.23; 95% confidence interval [CI] 1.07–1.41), while shorter sleep (<6 hours/night) had no significant effect on stroke risk. The HR (95% CI) of total stroke was 1.25 (1.03–1.53) for midday napping >90 minutes vs 1–30 minutes. The results were similar for ischemic stroke. Compared with good sleep quality, those with poor sleep quality showed a 29%, 28%, and 56% higher risk of total, ischemic, and hemorrhagic stroke, respectively. Moreover, we observed significant joint effects of sleeping ≥9 hours/night and midday napping >90 minutes (HR 1.85; 95% CI 1.28–2.66), and sleeping ≥9 hours/night and poor sleep quality (HR 1.82; 95% CI 1.33–2.48) on risk of total stroke. Furthermore, compared with persistently sleeping 7–9 hours/night, those who persistently slept ≥9 hours/night or switched from 7 to 9 hours to ≥9 hours/night had a higher risk of total stroke.

Conclusions Long sleep duration, long midday napping, and poor sleep quality were independently and jointly associated with higher risks of incident stroke. Persistently long sleep duration or switch from average to long sleep duration increased the risk of stroke.

Glossary

BMI=
body mass index;
CHD=
coronary heart disease;
CI=
confidence interval;
DBP=
diastolic blood pressure;
DMC=
Dongfeng Motor Corporation;
HR=
hazard ratio;
ICD-10=
International Classification of Diseases, 10th Revision;
ICH=
intracerebral hemorrhage;
SAH=
subarachnoid hemorrhage;
SBP=
systolic blood pressure;
WHI=
Women's Health Initiative

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received January 21, 2019.
  • Accepted in final form July 19, 2019.
  • © 2019 American Academy of Neurology
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Letters: Rapid online correspondence

  • Reader response: Sleep duration, midday napping, and sleep quality and incident stroke: The Dongfeng-Tongji cohort
    • Ricardo Lutzky Saute, Neurologist, Department of Neurosciences and Behavioral Sciences, Faculty of Medicine of Ribeirão Preto, University of São Paulo
    Submitted January 14, 2020
  • Reader response: Sleep duration, midday napping, and sleep quality and incident stroke: The Dongfeng-Tongji cohort
    • Murli Mishra, Ph.D., St. George's University School of Medicine (Grenada); Jackson Memorial Hospital (Miami, FL)
    Submitted December 22, 2019
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