Sleep duration and long-term mortality after stroke: A nationwide analysis

Sleep duration is a key marker of ideal cardiovascular health in the American Heart Association's new Life's Essential 8 construct, but studies on outcomes in stroke survivors are scarce. We assessed the association between sleep duration and mortality among self-reported stroke survivors in a nationally representative U.S.

Cross-sectional data (2005-2018) from the National Health and Nutrition Examination Surveys database in patients aged ≥18 (n=42,143) with a self-reported history of stroke (n=1,488) were linked to the 2019 National Death Index to determine the association between nightly sleep duration and mortality. Relationships between sleep duration (short: <7 hrs, normal: 7-8 hrs, long: >8 hrs) and demographic characteristics were assessed. Relationships between sleep duration and mortality (all-cause and cardiovascular causes) were evaluated adjusting for demographic and clinical variables, with multivariable Cox regressions.

Among stroke survivors, prevalence of short sleep duration increased with younger age while prevalence of long sleep duration increased with older age (p<0.001). There were no significant sex differences in sleep duration. Long sleep duration was associated with higher all-cause mortality in the unadjusted model (HR 1.82, 1.44-2.31, p<0.0001). After adjustment for co-variates, (HR 1.36, 1.08-1.71, p = 0.01), the association attenuated, but remained significant (HR 1.30, 1.02-1.65, p = 0.03). Sensitivity analysis further verified the reliability of this conclusion. Short sleep duration was not associated with all-cause or cardiovascular mortality after adjusted analyses. There were no significant associations between long sleep duration and cardiovascular mortality.

Long sleep duration is independently associated with higher risk, all-cause mortality after stroke.