From the Department of Obstetrics and Gynecology (M.-P.W.), Department of Medical Research (M.-P.W., S.-F.W., C.-H.H., J.-J.W., Y.-W.H.), and Department of Neurology (H.-J.L.), Chi-Mei Medical Center, Tainan, Taiwan; and Center of General Education (M.-P.W.), Department of Cosmetic Science (H.-J.L.), and Department of Hospital and Health Care Administration (S.-F.W., C.-H.H., Y.-W.H.), Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
Stroke. 2014 May;45(5):1349-54. doi: 10.1161/STROKEAHA.113.003675. Epub 2014 Apr 3.
The studies assessing the impact of insomnia on stroke are still lacking. We aim to investigate insomnia in relation to subsequent stroke during the 4-year follow-up.
Data from the Taiwan National Health Insurance Research Database were used. Enrollees with International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for insomnia were compared with randomly selected, age- and sex-matched noninsomnia enrollees with subsequent hospitalization for stroke during the 4-year follow-up. All enrollees, insomniacs and noninsomniacs, did not have previous diagnosis of stroke, sleep apnea, and insomnia. Individuals with insomnia were further categorized into different subgroups based on their insomnia patterns to explore whether the risk of stroke varies by subtype. The risk of outcomes was assessed with Kaplan-Meier curves and the impact of insomnia was estimated using Poisson regression analysis and Cox proportional hazards models.
The study included 21,438 (mean age, 52±16 years) insomniacs and 64,314 matched noninsomniacs (mean age, 51±16 years). Compared with noninsomniacs, insomniacs had 54% higher risk of developing stroke (adjusted hazard ratio, 1.54; 95% confidence interval, 1.38-1.72). When breaking down into insomnia subgroups, the persistent insomniacs had a higher 3-year cumulative incidence rate of stroke than those in the remission group (P=0.024). The insomniacs-to-noninsomniacs incidence rate ratio for stroke was highest among those aged 18 to 34 years (incidence rate ratio, 8.06).
Insomnia predisposes individuals to increased risk of stroke and this association is profound among young adults. Our results underscore the clinical importance of identifying and treating insomnia. A novel behavioral intervention targeting insomnia that may prevent stroke should be explored.
目前评估失眠对中风影响的研究仍然较少。本研究旨在调查 4 年随访期间失眠与随后中风之间的关系。
使用台湾全民健康保险研究数据库的数据。将国际疾病分类，第 9 版，临床修正诊断代码为失眠的患者与在 4 年随访期间因中风住院的年龄和性别匹配的随机选择的非失眠患者进行比较。所有患者，失眠症患者和非失眠症患者均无先前的中风、睡眠呼吸暂停和失眠症诊断。根据失眠模式将失眠症患者进一步分为不同亚组，以探讨不同亚型中风的风险是否存在差异。采用 Kaplan-Meier 曲线评估结局风险，采用泊松回归分析和 Cox 比例风险模型评估失眠的影响。
本研究共纳入 21438 名（平均年龄 52±16 岁）失眠症患者和 64314 名匹配的非失眠症患者（平均年龄 51±16 岁）。与非失眠症患者相比，失眠症患者发生中风的风险增加了 54%（调整后的危险比 1.54；95%置信区间 1.38-1.72）。将失眠症患者细分为不同亚组时，持续失眠症患者的中风 3 年累积发生率高于缓解组（P=0.024）。18-34 岁年龄组的失眠症患者与非失眠症患者中风发病率比最高（发病率比 8.06）。
失眠使个体中风的风险增加，这种关联在年轻成年人中更为显著。我们的研究结果强调了识别和治疗失眠的重要性。应探索针对失眠的新型行为干预措施，以预防中风。
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