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. 2024 Dec 4;24(1):3376.
doi: 10.1186/s12889-024-20892-0.

Insomnia symptoms and the risk of all-cause mortality among stroke survivors

Wendemi Sawadogo  1   2 , Tilahun Adera  3 , Maha Alattar  4 , Robert Perera  5 , James Burch  3
Affiliations

Insomnia symptoms and the risk of all-cause mortality among stroke survivors

Wendemi Sawadogo et al. BMC Public Health. .

Abstract

Background: Insomnia is more frequently reported in stroke survivors but its independent role in mortality in stroke survivors is unknown. The purpose of this study was to investigate the association of insomnia symptoms with all-cause mortality among stroke survivors.

Methods: The Health and Retirement Study, a survey of Americans older than 50 years and their spouses of any age from 2002 to 2018 was used. Only participants with a history of stroke were included. The exposure variable of interest was insomnia symptoms including difficulty initiating sleep, difficulty maintaining sleep, waking up too early, and nonrestorative sleep. The outcome was all-cause mortality. Cox proportional hazards regression models were employed to investigate the association between insomnia symptoms and all-cause mortality.

Results: A total of 3,501 stroke survivors were included of which 55% were females. Over a mean follow-up of 6 years, 1,782 deaths occurred. Difficulty initiating sleep (HR = 1.87, 95% CI: 1.07, 3.25) and difficulty maintaining sleep (1.89, 95% CI: 1.09, 3.29) were associated with all-cause mortality only among male stroke survivors younger than 65 years old while nonrestorative sleep (HR = 1.31, 95% CI: 1.05, 1.62) was associated with all-cause mortality only among male stroke survivors aged 65 years and older. Furthermore, male stroke survivors younger than 65 years of age and older than 65 with insomnia symptom scores ranging from 5 to 8 (mean = 6.2) had a higher but statistically nonsignificant risk of all-cause mortality (HR = 1.56, 95% CI: 0.81, 3.01 and HR = 1.08 95% CI: 0.85, 1.38, respectively) compared to their counterparts without insomnia symptoms. There was no association between insomnia symptoms and all-cause mortality among female stroke survivors.

Conclusion: Insomnia symptoms were associated with an increased risk of death especially in male stroke survivors younger than 65 years of age. Future studies should explore the benefit of insomnia symptom management in stroke survivors.

Keywords: Age difference; All-cause mortality; Insomnia symptoms; Sex difference; Stroke survivors.

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Conflict of interest statement

Declarations. Ethical approval: The Institutional Review Board of the author’s university approved this study (HM20023839). Participant consent was waived for this secondary data analysis. Consent for publication: Not applicable. Competing interests: All authors declare no conflicts of interest or financial interest.

Figures

Fig. 1
Fig. 1
Flowchart of stroke survivors’ inclusion process. a Transient ischemic attack (TIA), unknown stroke status (don’t know, refuse), have never been told that they had a stroke. b New eligible are participants who were not in the initial interview of 2002 or participants who developed a stroke later and became eligible. Baseline characteristics including insomnia symptoms were assessed after stroke diagnosis
See this image and copyright information in PMC

References

    1. Huyett P, Siegel N, Bhattacharyya N. Prevalence of sleep disorders and association with mortality: results from the NHANES 2009–2010. Laryngoscope. 2021;131(3):686–9. 10.1002/lary.28900. - PubMed
    1. Sateia MJ. International classification of sleep disorders. Chest. 2014;146(5):1387–94. 10.1378/chest.14-0970. - PubMed
    1. Jiang B, He D, Guo Z, Mcclure MA, Gao Z. Insomnia disorder increases the risk of mortality: pooled analysis of annual cumulative time-to-event data. Psychiatr Q. 2020;91:1431–7. 10.1007/s11126-020-09768-9. - PubMed
    1. Ge L, Guyatt G, Tian J, Pan B, Chang Y, Chen Y, Li H, Zhang J, Li Y, Ling J, Yang K. Insomnia and risk of mortality from all-cause, cardiovascular disease, and cancer: systematic review and meta-analysis of prospective cohort studies. Sleep Med Rev. 2019;48:101215. 10.1016/j.smrv.2019.101215. - PubMed
    1. Lawson Y, Wilding GE, El-Solh AA. Insomnia and risk of mortality in older adults. J Sleep Res 2024 Apr 29:e14229. 10.1111/jsr.14229 - PubMed

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