Physicians' Academy for Cardiovascular Education

Sleep duration-associated CV risk dependent on sex and race

Sleep duration and risk of incident stroke by age, sex, and race The REGARDS study

Literature - Petrov ME, Howard G, Grandner MA, Kleindorfer D et al. - Neurology 2018;00:e1-e8

Introduction and methods

Sleep duration may contribute to risk of stroke [1] and this relationship may be dependent on demographic factors, such as age, sex and race [2]. Previous data suggest that short sleep duration partially modifies the relationship between race (black vs. white adults) and incident stroke symptoms [3], and that short or long sleep duration may be related to excess risk of poor cardiometabolic risk status among black adults [4-9]. However, only few studies assessed race differences on the effect of sleep duration on risk of stroke. This study investigated the sleep duration-stroke relationship and determined whether age, sex, race and combinations of these factors modified this relationship.

The Reasons for Geographic and Racial Differences in Stroke REGARDS (REGARDS) study is a US-population based cohort investigating stroke incidence and mortality among 30,239 black and white participants aged ≥45 years. This subanalysis of the REGARDS study (n=16,733) included subjects that completed an ancillary sleep module and who were free of physician-diagnosed stroke and obstructive sleep apnea at the time of sleep module completion.

Habitual sleep duration was assessed based on questions regarding their habitual sleep duration on weekdays and weekends. Participants were categorized based on a weighted average of the duration on weekdays and weekends: <6 hours (short duration), 6.0 - 6.9, 7.0 - 8.9 (reference group) and ≥9 hours (long duration). Stroke events were identified every 6 months via telephone interview and medical records associated with these events were retrieved and physician-adjudicated.

Main results


Short sleep duration (<6 hours) was associated with decreased risk of incident stroke in black men, whereas long sleep duration (≥9 hours) was associated with increased risk for stroke in white men, suggesting that short and long sleep duration may have differing consequences depending on race and sex. These data underscore the need for mechanistic, longitudinal research of the sleep duration-stroke relationship by demographic subgroups. Furthermore, it may be clinically advisable to assess and monitor middle-aged adult patient with long sleep duration, particularly white men, for CV risk.


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