Association Between Insomnia Symptoms and Trajectory With the Risk of Stroke in the Health and Retirement Study

Sawadogo, Wendemi; Adera, Tilahun; Alattar, Maha; Perera, Robert A.; Burch, James B.

doi:10.1212/wnl.0000000000207449

Cited by 9 publications

(3 citation statements)

References 50 publications

(77 reference statements)

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“…All (Li et al, 2014;Sawadogo et al, 2023); however, its association with dementia remains controversial in the literature and was not associated with dementia onset in the Three-City Study as previously reported (Cavaillès et al, 2022). Moreover, in the present study, the relationship between EDS and dementia mediated via cardiovascular health and stroke events remained consistent after controlling for the presence of loud snoring or the number of insomnia symptoms.…”

Section: Discussionsupporting

confidence: 61%

The role of cardiovascular health and vascular events in the relationship between excessive daytime sleepiness and dementia risk

Cavaillès,

Letellier,

Berr

et al. 2023

Journal of Sleep Research

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SummaryMany studies suggest a relationship between excessive daytime sleepiness (EDS) and dementia incidence, but the underlying mechanisms remain uncertain. The study aimed to investigate the role of cardiovascular burden in the relationship between EDS and dementia incidence over a 12‐year follow‐up in community‐dwelling older adults. We performed analyses on 6171 subjects (aged ≥65 years) free of dementia and vascular disease at baseline. Participants self‐reported EDS at baseline and an expert committee validated both prevalent and incident dementia. We defined cardiovascular burden by a low Cardiovascular Health score, constructed using the American Heart Association metrics, and incident vascular events. To explore the potential role of the cardiovascular burden in the relationship between EDS and dementia, we conducted mediation analyses with inverse odds ratio‐weighted estimation, using multivariable‐adjusted proportional hazard Cox and logistic regression models. Subjects with EDS had a higher risk of all‐cause dementia (hazard ratio [HR] 1.39, 95% confidence interval [CI] 1.13–1.69) and dementia with vascular component (DVC) (HR 2.14, 95% CI 1.30–3.51), but not Alzheimer's disease (HR 1.18, 95% CI 0.93–1.51). Cardiovascular burden explained 5% (95% CI 4.1–5.2) and 11% (95% CI 9.7–11.3) of the relationship between EDS and all‐cause dementia and DVC, respectively. These findings confirm that EDS may be implicated in the development of dementia and indicate a weaker than expected role of cardiovascular burden in the relationship between EDS and DVC.

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Section: Discussionsupporting

confidence: 61%

The role of cardiovascular health and vascular events in the relationship between excessive daytime sleepiness and dementia risk

Cavaillès,

Letellier,

Berr

et al. 2023

Journal of Sleep Research

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“…A population-based study points to a bidirectional causal relationship between GERD and sleep problems ( 34 ). Another recent study showed that insomnia increases the risk of stroke by following 31,126 participants for 9 years ( 35 ). Similarly, one study analysis found a bidirectional association between GERD and depression ( 36 ).…”

Section: Discussionmentioning

confidence: 99%

Association between gastroesophageal reflux disease and stroke: a bidirectional Mendelian randomization study

Meng,

Zhang,

et al. 2024

Front. Neurol.

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ObjectiveSome previous studies have suggested a potential link between stroke and gastroesophageal reflux disease (GERD). We used a two-sample bidirectional Mendelian randomization (MR) method to explore the causal relationship between stroke and GERD.DesignSummary-level data derived from the published genome-wide association studies (GWAS) were employed for analyses. Single-nucleotide polymorphisms (SNPs) as instrumental variables (IVs) for stroke (n = 446,696) and its common subtypes ischemic stroke (IS) (n = 440,328), large vessel stroke (LVS) (n = 410,484), small vessel stroke (SVS) (n = 198,048), and cardioembolic stroke (CES) (n = 413,304) were obtained from the MEGASTROKE consortium. The data on intracerebral hemorrhage (ICH) (n = 721,135) come from the UK Biobank. Instrumental variables (IVs) for lacunar stroke (LS) (n = 474,348) and GERD (n = 602,604) were screened from publicly available genetic summary data. The inverse variance weighted (IVW) method was used as the main MR method. Pleiotropy was detected by the MR-Egger intercept test, MR pleiotropy residual sum and outlier, and leave-one-out analysis. Cochran Q statistics were used as supplements to detect pleiotropy.ResultsWe found that GERD can causally increase the risk of stroke [IVW odds ratio (OR): 1.22, 95% confidence interval (CI): 1.13–1.32, p = 1.16 × 10−6] and its common subtypes IS (OR: 1.19, 95% CI: 1.10–1.30, p = 3.22 × 10−5), LVS (OR: 1.49, 95% CI: 1.21–1.84, p = 1.47 × 10−4), and LS (OR: 1.20, 95% CI: 1.001–1.44, p = 0.048). Several important risk factors for stroke have also been implicated in the above causal relationship, including type 2 diabetes, sleep apnea syndrome, high body mass index, high waist-to-hip ratio, and elevated serum triglyceride levels. In reverse MR analysis, we found that overall stroke (OR: 1.09, 95% CI: 1.004–1.19, p = 0.039) and IS (OR: 1.10, 95% CI: 1.03–1.17, p = 0.007) have the causal potential to enhance GERD risk.ConclusionThis MR study provides evidence supporting a causal relationship between GERD and stroke and some of its common subtypes. We need to further explore the interconnected mechanisms between these two common diseases to better prevent and treat them.

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“…OSA, if not treated, heightens the risk of serious health issues such as hypertension, stroke, depression, and increased mortality [ 11 ]. Similarly, untreated insomnia is moderately linked to acute myocardial risk and a higher likelihood of stroke [ 13 , 14 ], and individuals with insomnia are twice as likely to develop depression compared to those without sleep issues [ 15 ]. REM sleep behavior disorder (RBD), marked by aggressive dreams and physical actions like kicking and vocal outbursts, is essential for the early detection of neurological disorders such as Parkinson’s disease due to its association with alpha-synucleinopathies.…”

Section: Introductionmentioning

confidence: 99%

Artificial Intelligence Models for the Automation of Standard Diagnostics in Sleep Medicine—A Systematic Review

Alattar,

Govind,

Mainali

2024

Bioengineering

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Sleep disorders, prevalent in the general population, present significant health challenges. The current diagnostic approach, based on a manual analysis of overnight polysomnograms (PSGs), is costly and time-consuming. Artificial intelligence has emerged as a promising tool in this context, offering a more accessible and personalized approach to diagnosis, particularly beneficial for under-served populations. This is a systematic review of AI-based models for sleep disorder diagnostics that were trained, validated, and tested on diverse clinical datasets. An extensive search of PubMed and IEEE databases yielded 2114 articles, but only 18 met our stringent selection criteria, underscoring the scarcity of thoroughly validated AI models in sleep medicine. The findings emphasize the necessity of a rigorous validation of AI models on multimodal clinical data, a step crucial for their integration into clinical practice. This would be in line with the American Academy of Sleep Medicine’s support of AI research.

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Association Between Insomnia Symptoms and Trajectory With the Risk of Stroke in the Health and Retirement Study

Cited by 9 publications

References 50 publications

The role of cardiovascular health and vascular events in the relationship between excessive daytime sleepiness and dementia risk

The role of cardiovascular health and vascular events in the relationship between excessive daytime sleepiness and dementia risk

Association between gastroesophageal reflux disease and stroke: a bidirectional Mendelian randomization study

Artificial Intelligence Models for the Automation of Standard Diagnostics in Sleep Medicine—A Systematic Review

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