Is there an association among sleep duration, nap, and stroke? Findings from the China Health and Retirement Longitudinal Study

Abstract

Purpose

The objective of this study was to assess the association among nighttime sleep, daytime napping, total sleep duration (nighttime sleep plus daytime napping), and stroke in an elderly Chinese population.

Methods

Data were derived from the 2011 China Health and Retirement Longitudinal Study (CHARLS) with 4785 Chinese respondents over 65 years old. Four binary logistic regression models were used to estimate odds ratios and 95% confidence intervals of the association among total sleep duration, nighttime sleep, daytime napping, and stroke, adjusting for confounders.

Results

After controlling for sociodemographic characteristics, lifestyle, health status, and comorbidity, there was no association between abnormal nighttime sleep and stroke (P values > 0.05). Compared to individuals with normal total sleep duration (7–8 h per day), short sleep duration (< 7 h per day) was approximately two times more likely to increase the risk of stroke (AOR = 1.81, 95%CI 1.10–2.97). Individuals who reported vision impairment, disability, hypertension, dyslipidemia, and mental health issues were at higher risk of stroke. In addition, physical activities with different levels were associated with a lower risk of stroke. Taking naps was not associated with stroke incidence (AOR = 1.12, 95%CI 0.77–1.64).

Conclusion

In this elderly Chinese population, short total sleep duration per 24 h, not merely daytime napping or nighttime sleep, was significantly associated with an increased risk of stroke. Preventive measures for stroke may require a focus on elderly, sedentary individuals who report other health problems.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    World Health Organization (2011) Global Health and Aging. World Health Organization Report. https://www.who.int/ageing/publications/global_health.pdf. Accessed March 20, 2020.

  2. 2.

    Lozano R, Naghavi M, Foreman K et al (2012) Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2095–2128. https://doi.org/10.1016/S0140-6736(12)61728-0

    Article  PubMed  Google Scholar 

  3. 3.

    Zhou M, Wang H, Zeng X et al (2019) Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 394(10204):1145–1158. https://doi.org/10.1016/S0140-6736(19)30427-1

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Wang J, Wen X, Li W, Li X, Wang Y, Lu W (2017) Risk factors for stroke in the Chinese population: a systematic review and meta-analysis. J Stroke Cerebrovasc Dis 26(3):509–517. https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.12.002

    Article  PubMed  Google Scholar 

  5. 5.

    Howard G, Cushman M, Kissela BM et al (2011) Traditional risk factors as the underlying cause of racial disparities in stroke: lessons from the half-full (empty?) glass. Stroke 42(12):3369–3375. https://doi.org/10.1161/STROKEAHA.111.625277

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Mims KN, Kirsch D (2016) Sleep and stroke. Sleep Med Clin 11(1):39–51. https://doi.org/10.1016/j.jsmc.2015.10.009

    Article  PubMed  Google Scholar 

  7. 7.

    Petrov ME, Howard G, Grandner MA, Kleindorfer D, Molano JR, Howard VJ (2018) Sleep duration and risk of incident stroke by age, sex, and race: the REGARDS study. Neurology 91(18):e1702–e1709. https://doi.org/10.1212/WNL.0000000000006424

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Wallace DM, Ramos AR, Rundek T (2012) Sleep disorders and stroke. Int J Stroke 7(3):231–242. https://doi.org/10.1111/j.1747-4949.2011.00760.x

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    National Sleep Foundation (2015) National Sleep Foundation Recommends New Sleep Times. The Journal of the National Sleep Foundation. https://www.sleepfoundation.org/press-release/national-sleep-foundation-recommends-new-sleep-times. Accessed March 20, 2020.

  10. 10.

    Leng Y, Cappuccio FP, Wainwright NWJ et al (2015) Sleep duration and risk of fatal and nonfatal stroke: a prospective study and meta-analysis. Neurology 84(11):1072–1079. https://doi.org/10.1212/WNL.0000000000001371

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Li JX, Cacchione PZ, Hodgson N et al (2017) Afternoon napping and cognition in Chinese older adults: findings from the China Health and Retirement Longitudinal Study Baseline Assessment. J Am Geriatr Soc 65(2):373–380. https://doi.org/10.1111/jgs.14368

    Article  PubMed  Google Scholar 

  12. 12.

    Yamada T, Hara K, Shojima N, Yamauchi T, Kadowaki T (2015) Daytime napping and the risk of cardiovascular disease and all-cause mortality: a prospective study and dose-response meta-analysis. Sleep 38(12):1945–1953. https://doi.org/10.5665/sleep.5246

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Zhao Y, Hu Y, Smith JP, Strauss J, Yang G (2012) Cohort profile: the China Health and Retirement Longitudinal Study (CHARLS). Int J Epidemiol 43(1):61–68. https://doi.org/10.1093/ije/dys203

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Wen Y, Liu C, Liao J, Yin Y, Wu D (2019) Incidence and risk factors of depressive symptoms in 4 years of follow-up among mid-aged and elderly community-dwelling Chinese adults: findings from the China Health and Retirement Longitudinal Study. BMJ Open 9(9):e029529. https://doi.org/10.1136/bmjopen-2019-029529

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    You Y, Wang J, Teng W, Ma G, Liu P (2018) Blood pressure and noncommunicable diseases in middle-aged and older adults in China. PLoS One 13(11):e0206635. https://doi.org/10.1371/journal.pone.0206635

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Essien SK, Feng CX, Sun W, Farag M, Li L, Gao Y (2018) Sleep duration and sleep disturbances in association with falls among the middle-aged and older adults in China: a population-based nationwide study. BMC Geriatr 18(1):196. https://doi.org/10.1186/s12877-018-0889-x

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Skelly AC, Dettori JR, Brodt ED (2012) Assessing bias: the importance of considering confounding. Evid Based Spine Care J 3(1):9–12. https://doi.org/10.1055/s-0031-1298595

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    von Ruesten A, Weikert C, Fietze I, Boeing H (2012) Association of sleep duration with chronic diseases in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study. PLoS One 7(1):e30972. https://doi.org/10.1371/journal.pone.0030972

    CAS  Article  Google Scholar 

  19. 19.

    Koo DL, Nam H, Thomas RJ, Yun CH (2018) Sleep disturbances as a risk factor for stroke. J Stroke 20(1):12–32. https://doi.org/10.5853/jos.2017.02887

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Wen Y, Pi FH, Guo P et al (2016) Sleep duration, daytime napping, markers of obstructive sleep apnea and stroke in a population of southern China. Sci Rep-Uk 6:34689. https://doi.org/10.1038/srep34689

    CAS  Article  Google Scholar 

  21. 21.

    Li M, Hou WS, Zhang XW, Tang ZY (2014) Obstructive sleep apnea and risk of stroke: a meta-analysis of prospective studies. Int J Cardiol 172(2):466–469. https://doi.org/10.1016/j.ijcard.2013.12.230

    Article  PubMed  Google Scholar 

  22. 22.

    Catalan-Serra P, Campos-Rodriguez F, Reyes-Nuñez N, Selma-Ferrer MJ, Navarro-Soriano C, Ballester-Canelles M, Soler-Cataluña JJ, Roman-Sanchez P, Almeida-Gonzalez CV, Martinez-Garcia MA (2019) Increased incidence of stroke, but not coronary heart disease, in elderly patients with sleep apnea. Stroke 50(2):491–494. https://doi.org/10.1161/STROKEAHA.118.023353

    Article  PubMed  Google Scholar 

  23. 23.

    Al Lawati NM, Patel SR, Ayas NT (2009) Epidemiology, risk factors, and consequences of obstructive sleep apnea and short sleep duration. Prog Cardiovasc Dis 51(4):285–293. https://doi.org/10.1016/j.pcad.2008.08.001

    Article  PubMed  Google Scholar 

  24. 24.

    American Academy of Sleep Medicine (2008) Decreased total sleep time associated with increased REM sleep during subsequent naps. www.sciencedaily.com/releases/2008/06/080610071936.htm. Accessed March 20, 2020.

  25. 25.

    Li X, Pang X, Liu Z et al (2018) Joint effect of less than one hour of daytime napping and seven to eight hours of night sleep on the risk of stroke. Sleep Med 52:180–187. https://doi.org/10.1016/j.sleep.2018.05.011

    Article  PubMed  Google Scholar 

  26. 26.

    Pace M, Camilo MR, Seiler A et al (2018) Rapid eye movements sleep as a predictor of functional outcome after stroke: a translational study. Sleep 41(10):1–11. https://doi.org/10.1093/sleep/zsy138

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Wenjie Sun.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval for collecting data on human subjects was received at Peking University by their institutional review board (IRB). All participants gave their explicit written informed consent before recruitment into the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Li, W., Taskin, T., Gautam, P. et al. Is there an association among sleep duration, nap, and stroke? Findings from the China Health and Retirement Longitudinal Study. Sleep Breath (2020). https://doi.org/10.1007/s11325-020-02118-w

Download citation

Keywords

  • Aging
  • Sleep
  • Nap
  • Stroke