Sleep mediates the association between stroke and all cause mortality in the NHANES cohort

This study examines the associations among stroke, sleep, and all-cause mortality and explores the mediating role of sleep using data from the National Health and Nutrition Examination Survey (NHANES). This cohort study used NHANES data from 2005 to 2018. The primary endpoint was all-cause mortality. Multivariate Logistic regression was used to analyze the association between stroke and sleep, while Cox regression and subgroup analyses were employed to examine associations between stroke/sleep and all-cause mortality. Mediation analysis assessed the role of sleep in the stroke-mortality relationship. Statistical analyses were performed using R software. Among the 27,302 participants included with a mean follow-up of 111.05 months, 1046 experienced a stroke, 4666 had poor sleep patterns, and 3807 deaths occurred. In the multivariable-adjusted model, stroke was significantly associated with all-cause mortality (HR = 6.08, 95% CI = 5.37-6.87, P < 0.001); compared with poor sleep patterns, both moderate and healthy sleep patterns were significantly associated with a lower risk of stroke (Moderate: HR = 0.97, 95% CI = 0.97-0.98, P < 0.001; Healthy: HR = 0.97, 95% CI = 0.96-0.97, P < 0.001) and all-cause mortality (Moderate vs. Poor: HR = 0.64, 95% CI = 0.57-0.72, P < 0.001; Healthy vs. Poor: HR = 0.60, 95% CI = 0.54-0.67, P < 0.001). Mediation analysis showed that sleep mediated 1.4% of the stroke-mortality association. This study demonstrates that sleep significantly mediate the association between stroke and all-cause mortality, highlighting the importance of addressing sleep issues in stroke populations.