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Original article
Insomnia is associated with increased mortality in patients with first-ever stroke: a 6-year follow-up in a Chinese cohort study
  1. Li-Jun Li1,2,3,4,5,
  2. Yang Yang1,2,3,4,5,
  3. Bo-Yuan Guan1,2,3,4,5,
  4. Qi Chen1,2,3,4,5,
  5. An-Xin Wang2,3,4,5,
  6. Yong-Jun Wang2,3,4,5,
  7. Ning Zhang1,2,3,4,5,
  8. Chun-Xue Wang1,2,3,4,5
  1. 1 Department of Neuropsychiatry, Behavioral Neurology and Sleep Center, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
  2. 2 Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
  3. 3 China National Clinical Research Center for Neurological Diseases, Beijing, China
  4. 4 Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
  5. 5 Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
  1. Correspondence to Dr Ning Zhang; yi1020{at}263.net and Dr Chun-Xue Wang; snowsen{at}126.com

Abstract

Objective Insomnia is a highly prevalent disorder among patients suffering from stroke. The association between insomnia and stroke mortality is less studied, particularly using the latest diagnostic criteria. The current study examined the relationship between insomnia and mortality among patients with first-evonal hazard models were used to calculate HRs for stroke er stroke in China.

Methods Patients with acute cerebrovascular diseases (stroke) were recruited from 56 hospitals in mainland China. Insomnia was defined as difficulty falling asleep, or difficulty staying asleep or waking up early, for at least two consecutive visits. Demographic data, medical history and clinical data were collected. Four follow-up visits occurred within the first year after stroke, and the last follow-up call was conducted 6 years later. Cox proportional hazard models were used to calculate HRs for stroke mortality.

Results Insomnia was reported by 38.4% (489/1273) of patients at baseline. During the 6 years of follow-up, after adjusting for all confounders, insomnia was found to be associated with increased mortality (HR=1.66, 95% CI 1.10 to 2.48). Old age (HR=1.08, 95% CI 1.06 to 1.10), stroke recurrence in the first year of follow-up (HR=2.53, 95% CI 1.48 to 4.31) and stroke survivors with hypertension (HR=1.62, 95% CI 1.04 to 2.53) had substantially higher risk of mortality.

Conclusions Besides old age, stroke recurrence in the first year of follow-up and hypertension, insomnia is associated with increased risk of mortality in patients with first-ever stroke in China. More studies about prompt and efficient interventions for insomnia are expected in the future.

Trial registration number rctn62169508.

  • insomnia
  • risk factor
  • mortality
  • first-ever stroke

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/svn-2017-000136

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    Footnotes

    • Contributors All the listed authors have participated actively in the study and approved the submitted manuscript. C-XW, NZ and Y-JW: responsible for conception or design of the work, and approved the final version of the manuscript to be published. YY, QC and A-XW: acquisition, analysis or interpretation of data for the work. C-XW and B-YG: revising the paper critically for important intellectual content. L-JL: conducted the experimental studies and drafted the manuscript.

    • Funding This study was funded by National Key Research & Development Program of China (2016YFC1307200), Beijing excellent talents training Program, the Ministry of Science and Technology and the Ministry of Health of the People’s Republic of China. Individual grants include the National 11th & 12th Five-year S & T Major Project (2006BAI01A11, 2011BAI08B01, 2011BAI08B02, 2015BAI13B03), the National Key Technology Research and Development Program of the Ministry of Science and Technology of China (2013BAI09B03), the Ministry of Science and Technology of the People’s Republic of China Beijing Institute for Brain Disorders (BIBD-PXM2013_014226_07_000084), the Beijing Biobank of Cerebral Vascular Disease (D131100005313003), the Basic Clinical Research Cooperation Program of Capital Medical University (16JL(TTZX)03), Beijing Brain Research (Z161100000216131) and the Beijing Municipal Science & Technology Commission (Z151100004015127 and Z151100003915117).

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval The study was approved by the medical ethics committee (IRB) of Beijing Tiantan Hospital, which is affiliated with Capital Medical University.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.