Nonlinear association between weekend catch-up sleep and stroke prevalence in U.S. adults

Weekend catch-up sleep (WCS), defined as the difference between weekend and weekday sleep duration, may be a modifiable factor associated with stroke risk. This study examined the association between WCS and stroke prevalence in a nationally representative sample of adults.

Data from 9,096 participants in the 2017-2020 NHANES were analyzed. WCS was categorized as: <0h (deficit), 0-1h (minimal), 1-2h (moderate), and ≥2h (substantial). Stroke was determined by self-reported physician diagnosis. Weighted multivariable logistic regression and restricted cubic spline models were employed, adjusting for demographic, socioeconomic, lifestyle, and clinical covariates.

A nonlinear trend was suggested with an apparent inflection point at 0.5 hours, although the test for nonlinearity did not reach statistical significance. Moderate WCS (1-2 hours) showed a significant inverse association with stroke prevalence (OR = 0.50, 95 % CI: 0.34-0.73, P = 0.0004). Enhanced protective effects were observed among adults ≥60 years (OR = 0.90, P = 0.042), hypertensive individuals (OR = 0.91, P = 0.021), current smokers (OR = 0.89, P = 0.020), and non-Hispanic Black participants (OR = 0.90, P = 0.002).

Moderate weekend catch-up sleep of 1-2 hours was associated with lower stroke prevalence, particularly among high-risk populations. Given the cross-sectional design, these findings should be interpreted as associations rather than evidence of causality, and further longitudinal and interventional studies are warranted to assess potential clinical implications.