Zhu Yanhan, Chen Bo, Qin Minghui, Yang Jing, Hu Mei, Zeng Jingjing, Fan Menglin, Wang Ke, Chang Liying, Xu Shaoyong
Department of Neurology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China.
Center for Clinical Evidence-Based and Translational Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China.
BMC Public Health. 2025 Apr 23;25(1):1502. doi: 10.1186/s12889-025-22588-5.
Stroke survivors exhibit a higher prevalence of sleep disturbances and physical activity (PA) deficiencies. The joint effects of the two behaviors on mortality risk among stroke survivors remains unclear. This study aimed to explore the joint association of PA and sleep quality with the all-cause and cardiovascular disease ( CVD ) mortality risk in stroke survivors.
A total of 5,507 stroke survivors from the UK Biobank were included to assess the independent or joint associations of sleep score and PA with mortality. PA levels were categorized as meeting recommended moderate-to-vigorous physical activity (MVPA) and not meeting recommended MVPA. Sleep quality was classified as healthy, poor/intermediate based on a novel sleep score, leading to the identification of four distinct PA-sleep combinations. Cox proportional hazard models were employed to estimate hazard ratio (HR) for all-cause and cardiovascular disease (CVD) mortality, with data ascertained through October 2021. The dose-response relationship between PA or sleep duration and mortality risk were explored by plotting restricted cubic splines. Sensitivity analyses were conducted to examine the robustness of the results.
After an average follow-up of 12.55 years, healthy sleep score group were associated with an decreased all-cause mortality risk compared to poor/intermediate sleep score group (HR: 0.873; 95% CI: 0.767-0.995). Compared to individuals who did not meet the recommended MVPA levels, those who did achieve the recommended MVPA levels was exhibited a significantly lower risk of all-cause mortality (HR, 0.729; 95% CI, 0.640-0.831) and CVD mortality (HR, 0.786; 95% CI, 0.627-0.986). PA levels exhibit an L-shaped association with mortality(cut off value = 2,000 MET-minutes per week). Participants meeting MVPA recommendations and/or reporting healthy sleep scores reduced 28.5-35.9% risk of all-cause mortality.
Poor sleep quality is associated with a elevated risk of all-cause mortality. Stroke survivors meeting recommended MVPA levels exhibit lower mortality risk, even among those with poor sleep quality. Future intervention studies are needed to establish whether increasing PA to recommended levels among stroke survivors directly reduces mortality risk linked to poor sleep quality.
中风幸存者睡眠障碍和身体活动（PA）不足的患病率较高。这两种行为对中风幸存者死亡风险的联合影响尚不清楚。本研究旨在探讨PA和睡眠质量与中风幸存者全因死亡率和心血管疾病（CVD）死亡风险的联合关联。
纳入英国生物银行的5507名中风幸存者，以评估睡眠评分和PA与死亡率的独立或联合关联。PA水平分为达到推荐的中等至剧烈身体活动（MVPA）和未达到推荐的MVPA。根据新的睡眠评分将睡眠质量分为健康、差/中等，从而确定四种不同的PA-睡眠组合。采用Cox比例风险模型估计全因死亡率和心血管疾病（CVD）死亡率的风险比（HR），数据截至2021年10月。通过绘制受限立方样条探索PA或睡眠时间与死亡风险之间的剂量反应关系。进行敏感性分析以检验结果的稳健性。
平均随访12.55年后，与睡眠评分差/中等的组相比，健康睡眠评分组的全因死亡风险降低（HR：0.873；95%CI：0.767-0.995）。与未达到推荐MVPA水平的个体相比，达到推荐MVPA水平的个体全因死亡率风险显著降低（HR，0.729；95%CI，0.640-0.831），心血管疾病死亡率风险也显著降低（HR，0.786；95%CI，0.627-0.986）。PA水平与死亡率呈L形关联（临界值=每周2000代谢当量分钟）。达到MVPA建议和/或报告健康睡眠评分的参与者全因死亡风险降低28.5-35.9%。
睡眠质量差与全因死亡风险升高有关。达到推荐MVPA水平的中风幸存者死亡风险较低，即使在睡眠质量差的人群中也是如此。未来需要进行干预研究来确定将中风幸存者的PA增加到推荐水平是否能直接降低与睡眠质量差相关的死亡风险。
