A Case-control Study On The Relationship Between Sleep And Primary Ischemic Stroke

Objection:Ischemic stroke?IS?is the most important type of stroke in clinic,which accounts for 60%-80%of all strokes.The Global Burden of Disease 2013 indicated that,globally from 1990 to 2013 there were statistically significant reductions in the incidence,mortality and DALY rates of IS,while the absolute number of people affected by IS in the world over that time period had increased significantly.The tradit ional risk factors include heredity,age,smoking and drinking,diabetes,hypertension and so on.In recent years,many foreign scholars have found that abnormal sleep duration and sleep apnea syndrome may increase the incidence and mortality of stroke.Most of the previous studies have combined ischemic and hemorrhagic stroke,but some researchers suggested that the relationship between sleep and stroke may have subtype difference s.Secondly,the aspect of sleep quality is mostly focused on sleep apnea syndrome,and other sleep disorders are still less reported.Hence,this paper is mainly based on the hospital population with a case-control design.Pittsburgh sleep quality index?PSQI?and insomnia symptoms in the past period of different ages were used to reveal the possible risk factors of ischemic stroke from sleep aspect and to provide the basis for the prevention of ischemic strokeMethods:1.313 primary ischemic stroke patients admitted by the First Affiliated Hospital of C hina Medical University from September 2016 to July 2017 were chosen as controls as cases.313 adults free from cerebrovascular diseases who had undergone physical examination in the 202nd Hospital of PLA at the same period were chosen as controls.2.All subjects signed informed consent and were investigated by a unified survey form.The contents included:basic information,ischemic stroke and other cardiovascular disease history and family history,behavioral factors relating to ischemic stroke,Pittsburgh sleep quality index?PSQI?to assess the sleep quantity and quality in the last 1 months,insomnia symptoms in the past period of different ages??30 years,31-44 years,45-60 years,?60 years old?.The blood pressure,fasting blood glucose,serum total cholesterol and total triglyceride in the two groups were also taken.3.The database is set up by Epidata software and the data is recorded in double entry.SPSS22.0 and SAS 9.3.2 software was used for statistical analysis.Using restricted cubic spline?Restricted cubic spline,RCS?with the Logistic regression model to explore the dose-response relationship between sleep duration,PSQI score and incidence of ischemic stroke.Multi-factor nonconditional logistics regression models were performed to analyze the correlation of recent sleep quantity and quality,and the past insomnia symptoms with ischemic stroke.Results:626 subjects were included in this study,313 cases in case group and 313 cases in control group.1.The restricted cubic spline analysis showed that there was a nonlinear dose-response relationship between sleep duration and risk of ischemic stroke(P_{non-lin-association}=0.019),while a positive linear relationship were found between sleep quality?PSQI score?and the risk of ischemic stroke(P_{non-lin-association}=0.8988).2.In the multi-factor logistics regression models of recent sleep adjusted by other potential risk factors,compared with 7-8 hours,sleeping more than 9 hours may increase the risk of IS,while sleeping less than 6 hours was associated with a decreased risk of IS.Odds ratios and 95%confidence intervals were 2.826?95%CI:1.666-4.794?and0.545?95%CI:0.325-0.916?,respectively.For sleep quality,subjects with good quality has a lower risk of IS than poor sleepers?OR=4.204,95%CI=2.630-6.720?.3.In the multi-factor logistics regression models of past insomnia symptoms,we found that the odds of IS was greater among people who having insomnia symptoms in any stage even after recent sleep adjusted?OR=2.951,95%CI=1.800-4.839?.4.Among people aging45-60,who reporting having sleep disorders after 45 are at higher risk of IS than those without sleep disorders at the same period?OR=3.094,95%CI=1.611-5.942?,but this association disappeared after adjustment of recent sleep.The incidence of IS is associated with recent sleep quality in this group.Among people aging over 60,who reporting having sleep disorders after 60 are at higher risk of IS than those without sleep disorders at the same period?OR=4.673,95%CI=2.600-8.299?,and the risk increased after recent sleep adjusted?O R=7.771,95%CI=3.974-15.196?.What's more,sleeping more than 9h is also risk factors in this group and sleep time less than 6h a protective factor,while sleep quality is not related with IS.Conclusion:1.In the multi-factor logistics regression models of recent sleep,people with sleeping more than 9 hours or poor quality may increase the risk of IS,while sleeping less than 6 hours may reduce the incidence of ischemic stroke.2.There is a significant increase in the risk of future IS in people with insomnia symptoms at any age stage.Among people aging 45-60 now,the risk of IS was only related to the recent poor sleep quality,but not related to insomnia symptoms after 45 years old or recent sleep duration.In people over 60 years old,the risk of IS is positive related with insomnia symptoms after 60 and recent sleep duration.