@article {Lisvn-2017-000136, author = {Li-Jun Li and Yang Yang and Bo-Yuan Guan and Qi Chen and An-Xin Wang and Yong-Jun Wang and Ning Zhang and Chun-Xue Wang}, title = {Insomnia is associated with increased mortality in patients with first-ever stroke: a 6-year follow-up in a Chinese cohort study}, elocation-id = {svn-2017-000136}, year = {2018}, doi = {10.1136/svn-2017-000136}, publisher = {BMJ Specialist Journals}, 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-ever 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.}, issn = {2059-8688}, URL = {https://svn.bmj.com/content/early/2018/03/20/svn-2017-000136}, eprint = {https://svn.bmj.com/content/early/2018/03/20/svn-2017-000136.full.pdf}, journal = {Stroke and Vascular Neurology} }