Zhu Yike, Lu Chuansen
Department of Pulmonary and Critical Care Medicine, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China.
Department of Neurology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, No.19, Xiuhua Road, Xiuying District, Haikou City, 570311, Hainan Province, China.
Sci Rep. 2025 Aug 2;15(1):28280. doi: 10.1038/s41598-025-13842-2.
This study examines the associations among stroke, sleep, and all-cause mortality and explores the mediating role of sleep using data from the National Health and Nutrition Examination Survey (NHANES). This cohort study used NHANES data from 2005 to 2018. The primary endpoint was all-cause mortality. Multivariate Logistic regression was used to analyze the association between stroke and sleep, while Cox regression and subgroup analyses were employed to examine associations between stroke/sleep and all-cause mortality. Mediation analysis assessed the role of sleep in the stroke-mortality relationship. Statistical analyses were performed using R software. Among the 27,302 participants included with a mean follow-up of 111.05 months, 1046 experienced a stroke, 4666 had poor sleep patterns, and 3807 deaths occurred. In the multivariable-adjusted model, stroke was significantly associated with all-cause mortality (HR = 6.08, 95% CI = 5.37-6.87, P < 0.001); compared with poor sleep patterns, both moderate and healthy sleep patterns were significantly associated with a lower risk of stroke (Moderate: HR = 0.97, 95% CI = 0.97-0.98, P < 0.001; Healthy: HR = 0.97, 95% CI = 0.96-0.97, P < 0.001) and all-cause mortality (Moderate vs. Poor: HR = 0.64, 95% CI = 0.57-0.72, P < 0.001; Healthy vs. Poor: HR = 0.60, 95% CI = 0.54-0.67, P < 0.001). Mediation analysis showed that sleep mediated 1.4% of the stroke-mortality association. This study demonstrates that sleep significantly mediate the association between stroke and all-cause mortality, highlighting the importance of addressing sleep issues in stroke populations.
本研究利用美国国家健康与营养检查调查（NHANES）的数据，考察了中风、睡眠与全因死亡率之间的关联，并探讨了睡眠的中介作用。这项队列研究使用了2005年至2018年的NHANES数据。主要终点是全因死亡率。采用多变量逻辑回归分析中风与睡眠之间的关联，同时采用Cox回归和亚组分析来检验中风/睡眠与全因死亡率之间的关联。中介分析评估了睡眠在中风-死亡率关系中的作用。使用R软件进行统计分析。在纳入的27302名参与者中，平均随访111.05个月，1046人发生中风，4666人睡眠模式不佳，3807人死亡。在多变量调整模型中，中风与全因死亡率显著相关（HR = 6.08，95%CI = 5.37 - 6.87，P < 0.001）；与睡眠模式不佳相比，适度和健康的睡眠模式均与较低的中风风险显著相关（适度：HR = 0.97，95%CI = 0.97 - 0.98，P < 0.001；健康：HR = 0.97，95%CI = 0.96 - 0.97，P < 0.001）以及全因死亡率（适度与不佳相比：HR = 0.64，95%CI = 0.57 - 0.72，P < 0.001；健康与不佳相比：HR = 0.60，95%CI = 0.54 - 0.67，P < 0.001）。中介分析表明，睡眠介导了中风-死亡率关联的1.4%。本研究表明，睡眠显著介导了中风与全因死亡率之间的关联，凸显了解决中风人群睡眠问题的重要性。
