Department of Clinical Epidemiology, Institute of Cardiovascular Diseases and Center of Evidence Based Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China; Center of Evidence Based Medicine, Liaoning Province & China Medical University, Shenyang, China.
Department of Clinical Epidemiology, Institute of Cardiovascular Diseases and Center of Evidence Based Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China; Center of Evidence Based Medicine, Liaoning Province & China Medical University, Shenyang, China.
Sleep Med. 2017 Apr;32:66-74. doi: 10.1016/j.sleep.2016.12.012. Epub 2016 Dec 23.
Suboptimal sleep duration has been considered to increase the risk of stroke incidence. Thus we aimed to conduct a dose-response meta-analysis to examine the association between sleep duration and stroke incidence.
We searched PubMed, Web of science and the Cochrane Library to identify all prospective studies evaluating the association of sleep duration and nonfatal and/or fatal stroke incidence. Then, restricted cubic spline functions and piecewise linear functions were used to evaluate the nonlinear and linear dose-response association between them.
We included a total of 16 prospective studies enrolling 528,653 participants with 12,193 stroke events. Nonlinear dose-response meta-analysis showed a J-shaped association between sleep duration and total stroke with the lowest risk observed with sleeping for 7 h. Considering people sleeping for 7 h as reference, long sleepers had a higher predicted risk of total stroke than short sleepers [the pooled risk ratios (95% confidence intervals): 4 h: 1.17 (0.99-1.38); 5 h: 1.17 (1.00-1.37); 6 h: 1.10 (1.00-1.21); 8 h: 1.17 (1.07-1.28); 9 h: 1.45 (1.23-1.70); 10 h: 1.64 (1.4-1.92); p<0.001]. Short sleep durations were only significantly associated with nonfatal stroke and with total stroke in the subgroups of structured interview and non-Asian countries. Additionally, we found a slightly decreased risk of ischemic stroke among short sleepers. For piecewise linear trends, compared to 7 h, every 1-h increment of sleep duration led to an increase of 13% [the pooled risk ratios (95% confidence intervals): 1.13 (1.07-1.20); p < 0.001] in risk of total stroke.
Both in nonlinear and piecewise linear dose-response meta-analyses, long sleep duration significantly increased the risk of stroke incidence.
睡眠时长不理想被认为会增加中风发病率。因此，我们旨在进行一项剂量-反应荟萃分析，以检验睡眠时长与中风发病率之间的关系。
我们检索了 PubMed、Web of Science 和 Cochrane 图书馆，以确定所有评估睡眠时长与非致命性和/或致命性中风发病率之间关系的前瞻性研究。然后，我们使用限制性立方样条函数和分段线性函数来评估它们之间的非线性和线性剂量-反应关系。
我们共纳入了 16 项前瞻性研究，共纳入了 528653 名参与者和 12193 例中风事件。非线性剂量-反应荟萃分析显示，睡眠时长与总中风之间存在“J”型关联，睡眠时间为 7 小时时风险最低。以睡 7 小时的人为参考，长睡眠者总中风的预测风险高于短睡眠者[汇总风险比（95%置信区间）：4 小时：1.17（0.99-1.38）；5 小时：1.17（1.00-1.37）；6 小时：1.10（1.00-1.21）；8 小时：1.17（1.07-1.28）；9 小时：1.45（1.23-1.70）；10 小时：1.64（1.4-1.92）；p<0.001]。短睡眠时长仅与非致命性中风和结构性访谈及非亚洲国家的总中风显著相关。此外，我们发现短睡眠者的缺血性中风风险略有降低。对于分段线性趋势，与 7 小时相比，每增加 1 小时的睡眠时间，总中风风险增加 13%[汇总风险比（95%置信区间）：1.13（1.07-1.20）；p<0.001]。
在非线性和分段线性剂量-反应荟萃分析中，长睡眠时长显著增加了中风发病率的风险。
