Abstract
Study Objectives: To clarify the effects of sleep duration on stroke and stroke subtypes, we adopted a Mendelian randomization (MR) approach to evaluate their causal relationship.Methods: A genome-wide association study including 446,118 participants from UK biobank was used to identify instruments for short sleep, long sleep and sleep duration. Summary-level data for all stroke, ischemic stroke, intracerebral hemorrhage, and their subtypes were obtained from meta-analyses conducted by the MEGASTROKE consortium. MR analyses were performed using the inverse-variance-weighted method, weighted median estimator, MR pleiotropy residual sum and outlier (MR-PRESSO) test, and MR-Egger regression. Sensitivity analyses were further performed using leave-one-out analysis, MR-PRESSO global test and Cochran's Q test to verify the robustness of our findings.Results: By two-sample MR, we didn't find causal associations between sleep duration and risk of stroke. However, in the subgroup analysis, we found weak evidence for short sleep in increasing risk of cardio-embolic stroke (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.11–1.60; P = 0.02) and long sleep in increasing risk of large artery stroke [OR, 1.41; 95% CI, 1.02–1.95; P = 0.04]. But the associations were not significant after Bonferroni correction for multiple comparisons.Conclusions: Our study suggests that sleep duration is not causally associated with risk of stroke and its subtypes.
Highlights
Stroke is the second leading cause of death worldwide, with an age-standardized mortality rate of 86.5 per 100,000 population per year [1]
Genetically determined short sleep was not causally associated with stroke and intracranial hemorrhage (ICH) (OR, 0.55; 95% CI, 0.23–1.29)
There was weak evidence showing that per unit increment in log-odds for short sleep would increase risk for cardioembolic stroke (CES) by 33% (OR, 1.33; 95% CI, 1.11–1.60; P = 0.02)
Summary
Stroke is the second leading cause of death worldwide, with an age-standardized mortality rate of 86.5 per 100,000 population per year [1]. Some studies have found a link between long or short sleep duration and an increased risk of stroke [6,7,8,9], whereas other studies have claimed no significant association [10, 11]. These conflicting findings from observational epidemiological studies may be due to differences in the study population, sample size, sleep duration assessment methods, or covariates adjusted in the statistical models. Whether sleep duration has different influences on different stroke subtypes is unknown
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