Self‐Reported Sleep Duration and Quality and Cardiovascular Disease and Mortality: A Dose‐Response Meta‐Analysis

Kwok, Chun Shing; Kontopantelis, Evangelos; Kuligowski, George; Gray, Matthew P.; Muhyaldeen, Alan; Gale, Chris P; Peat, George; Cleator, Jacqueline; Chew‐Graham, Carolyn; Loke, Yoon K.; Mamas, Mamas A.

doi:10.1161/jaha.118.008552

Cited by 290 publications

(253 citation statements)

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“…Systematic reviews: Two systematic reviews were found. One systematic review included 15 prospective studies (cohort, sub-cohort and population-based studies) [87,88]. The original studies included in the systematic review by HE et al [87] were of class I quality.…”

Section: Results Of Literature Searchmentioning

confidence: 99%

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EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

et al. 2020

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@ERSpublicationsEvidence suggests a bidirectional relationship between sleep and stroke. However, the pathophysiological base of the associations and the possibilities of improving prevention and outcome through sleep-related interventions require further evaluation.ABSTRACT Sleep disorders are highly prevalent in the general population and may be linked in a bidirectional fashion to stroke, which is one of the leading causes of morbidity and mortality.Four major scientific societies established a task force of experts in neurology, stroke, respiratory medicine, sleep medicine and methodology, to critically evaluate the evidence regarding potential links and the impact of therapy. 13 research questions were evaluated in a systematic literature search using a stepwise hierarchical approach: first, systematic reviews and meta-analyses; second, primary studies postdating the systematic reviews/meta-analyses. A total of 445 studies were evaluated and 88 included. Statements were generated regarding current evidence and clinical practice.Severe obstructive sleep apnoea (OSA) doubles the risk for incident stroke, especially in young to middle-aged patients. Continuous positive airway pressure (CPAP) may reduce stroke risk, especially in treatment-compliant patients. The prevalence of OSA is high in stroke patients and can be assessed by polygraphy. Severe OSA is a risk factor for recurrence of stroke and may be associated with stroke mortality, while CPAP may improve stroke outcome. It is not clear if insomnia increases stroke risk, while pharmacotherapy of insomnia may increase it. Periodic limb movements in sleep (PLMS), but not restless limb syndrome (RLS), may be associated with an increased risk of stroke. Preliminary data suggest a high frequency of post-stroke insomnia and RLS and their association with a less favourable stroke outcome, while treatment data are scarce.Overall, the evidence base is best for OSA relationship with stroke and supports active diagnosis and therapy. Research gaps remain especially regarding insomnia and RLS/PLMS relationships with stroke. This article has an editorial commentary: https://doi.

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Section: Results Of Literature Searchmentioning

confidence: 99%

“…The systematic review by KWOK et al [88] did not find an association between poor sleep quality and stroke outcome (table e6).…”

Section: Overview Of the Evidencementioning

confidence: 96%

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

et al. 2020

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“…While sleep length may provide some neuroprotective effect through promoting clearance of amyloid, a very recent meta‐analysis of 74 studies has revealed that too much sleep (>8 hr) also can have adverse health implications, particularly in relation to cardiovascular events (Kwok et al, ). These studies support the recommendations of the US National Sleep Foundation that 7–8 hr of sleep is optimal for those 65 years and over.…”

Section: Sleep Amyloid Clearance and Neurodegenerationmentioning

confidence: 99%

Targeting amyloid clearance in Alzheimer's disease as a therapeutic strategy

Nalivaeva

Turner

2019

British J Pharmacology

130

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Targeting the amyloid‐β (Aβ) peptide cascade has been at the heart of therapeutic developments in Alzheimer's disease (AD) research for more than 25 years, yet no successful drugs have reached the marketplace based on this hypothesis. Nevertheless, the genetic and other evidence remains strong, if not overwhelming, that Aβ is central to the disease process. Most attention has focused on the biosynthesis of Aβ from its precursor protein through the successive actions of the β‐ and γ‐secretases leading to the development of inhibitors of these membrane proteases. However, the levels of Aβ are maintained through a balance of its biosynthesis and clearance, which occurs both through further proteolysis by a family of amyloid‐degrading enzymes (ADEs) and by a variety of transport processes. The development of late‐onset AD appears to arise from a failure of these clearance mechanisms rather than by overproduction of the peptide. This review focuses on the nature of these clearance mechanisms, particularly the various proteases known to be involved, and their regulation and potential as therapeutic targets in AD drug development. The majority of the ADEs are zinc metalloproteases [e.g., the neprilysin (NEP) family, insulin‐degrading enzyme, and angiotensin converting enzymes (ACE)]. Strategies for up‐regulating the expression and activity of these enzymes, such as genetic, epigenetic, stem cell technology, and other pharmacological approaches, will be highlighted. Modifiable physiological mechanisms affecting the efficiency of Aβ clearance, including brain perfusion, obesity, diabetes, and sleep, will also be outlined. These new insights provide optimism for future therapeutic developments in AD research. Linked Articles This article is part of a themed section on Therapeutics for Dementia and Alzheimer's Disease: New Directions for Precision Medicine. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.18/issuetoc

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“…Mounting evidence suggests that sleep plays an important role in human mental and physical health [1,2]. Inappropriate sleep duration and poor sleep quality are closely related to common chronic diseases, including diabetes [3], cardiovascular diseases [4] and cancer [5], as well as increased all-cause and cause-specific mortality rates [6]. In addition, sleep deprivation and excessive sleep duration have adverse effects on hormone levels, metabolism and immune function [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Relationship between Sleep Duration and All-Cause Mortality in the Older People: An Updated and Dose-Response Meta-Analysis

Niu

Deng

et al. 2020

Preprint

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Background Short or long sleep duration is recognized as a potential risk factor for all-cause mortality in the older people, yet the results are not often reproducible. ObjectivesWe aimed to investigate whether sleep duration was associated with an increased risk of all-cause mortality in the older people through a comprehensive meta-analysis. Methods Literature retrieval, research selection and data extraction were done independently and in duplicate. Effect-size estimates are expressed as odds ratio (OR) and 95% confidence interval (CI). ResultsSummary data from 35 articles, involving 11746 older people, were meta-analyzed. Overall analyses revealed a significant association between long sleep duration and all-cause mortality in the older people (OR=1.27, 95% CI: 1.19-1.35, P <.001), and short sleep duration was marginally related to the all-cause mortality in the older people (OR=1.05; 95% CI: 1.00-1.09; P =.045). The Egger's test indicated no publication bias between sleep duration and all-cause mortality in the older people. In subgroup analyses, the association with all-cause mortality was reinforced in older people women with long sleep duration (OR=1.48, 95% CI: 1.18-1.85, P =.002) relative to older people men with long sleep duration (OR=1.3, 95% CI: 1.10-1.50, P =.001). Further dose-response analyses showed a Jshaped relationship between sleep duration and all-cause mortality in the older people. ConclusionsOur meta-analytical findings demonstrated a J-shaped relationship between sleep duration and allcause mortality in the older people. For long sleep duration, older people women had a higher mortality rate than older people men.

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Self‐Reported Sleep Duration and Quality and Cardiovascular Disease and Mortality: A Dose‐Response Meta‐Analysis

Cited by 290 publications

References 98 publications

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

Targeting amyloid clearance in Alzheimer's disease as a therapeutic strategy

Relationship between Sleep Duration and All-Cause Mortality in the Older People: An Updated and Dose-Response Meta-Analysis

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