Li Chunhua, Zeng Kaimin, Mo Dingsheng, Yu Xiang, Peng Jingjing, Zhao Zhihong
Department of Neurology, The First Affiliated Hospital (People's Hospital of Hunan Province), Hunan Normal University, No. 61 West Jiefang Road, Changsha, 410006, Hunan Province, China.
Department of Respiratory Medicine, Hunan Aerospace Hospital, Changsha City, 410000, Hunan Province, China.
Hormones (Athens). 2025 Sep 1. doi: 10.1007/s42000-025-00711-w.
BACKGROUND: Sleep disorders are closely linked to stroke, while the role of gut microbiota in human health and disease is increasingly recognized. However, the causal relationships between sleep disorders, gut microbiota, and stroke remain unclear. OBJECTIVE: This study aimed to investigate the causal relationships between sleep disorders, gut microbiota, and stroke (including its subtypes), as well as the potential mediating role of gut microbiota in the association between sleep disorders and stroke. METHODS: Using a two-sample Mendelian randomization approach, we analyzed causal relationships among various sleep disorders, gut microbiota, and stroke. The inverse variance weighted method served as the primary analysis, supplemented by multiple sensitivity analyses to ensure robustness. Mediation effects of gut microbiota in the sleep disorder-stroke relationship were assessed using the coefficient product method. RESULTS: Insomnia was causally associated with transient ischemic attacks (OR = 1.592, 95% CI: 1.116-2.270), excessive daytime sleepiness with ischemic stroke (IS) (OR = 1.887, 95% CI: 1.041-3.420), and sleep apnea with overall stroke risk (OR = 1.247, 95% CI: 1.015-1.532). Several gut microbiota taxa showed causal associations with stroke and its subtypes, with Ruminococcus E sp900314705 increasing the risk of overall stroke, IS, and transient ischemic attacks. Ezakiellaceae partially mediated the causal relationship between daytime sleepiness and IS, accounting for 15.9% of the effect. CONCLUSION: The current study established and elucidated causal relationships between sleep disorders and stroke, identified specific gut microbiota associated with stroke risk, and highlighted the mediating role of Ezakiellaceae in the causal relationship between daytime sleepiness and IS. These findings underscore the potential importance of improving sleep quality and modulating gut microbiota for stroke prevention and management.
背景:睡眠障碍与中风密切相关,而肠道微生物群在人类健康和疾病中的作用日益受到认可。然而,睡眠障碍、肠道微生物群和中风之间的因果关系仍不清楚。 目的:本研究旨在探讨睡眠障碍、肠道微生物群和中风(包括其亚型)之间的因果关系,以及肠道微生物群在睡眠障碍与中风关联中的潜在中介作用。 方法:采用两样本孟德尔随机化方法,分析各种睡眠障碍、肠道微生物群和中风之间的因果关系。逆方差加权法作为主要分析方法,并辅以多种敏感性分析以确保结果的稳健性。使用系数乘积法评估肠道微生物群在睡眠障碍-中风关系中的中介作用。 结果:失眠与短暂性脑缺血发作存在因果关系(比值比[OR]=1.592,95%置信区间[CI]:1.116-2.270),日间过度嗜睡与缺血性中风(IS)存在因果关系(OR=1.887,95%CI:1.041-3.420),睡眠呼吸暂停与总体中风风险存在因果关系(OR=1.247,95%CI:1.015-1.532)。几种肠道微生物分类群与中风及其亚型存在因果关系,其中瘤胃球菌E sp900314705增加了总体中风、IS和短暂性脑缺血发作的风险。埃扎基菌科部分介导了日间嗜睡与IS之间的因果关系,占该效应的15.9%。 结论:本研究建立并阐明了睡眠障碍与中风之间的因果关系,确定了与中风风险相关的特定肠道微生物群,并强调了埃扎基菌科在日间嗜睡与IS因果关系中的中介作用。这些发现强调了改善睡眠质量和调节肠道微生物群对中风预防和管理的潜在重要性。
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