OP32 Strong associations between a range of sleep criteria and stroke: a nationally representative cross-sectional analysis of UK adults -conference paper abstract-

Publication type

Journal Article

Published in

Journal of Epidemiology and Community Health


G.R. Law, E.M. Scott and G.T.H. Ellison

Publication date


Strong observational evidence exists, from small- and medium-scale
studies, linking short, disturbed and poor quality sleep
with metabolic and cardiovascular
disorders. However, the extent to which such evidence might be
generalisable to the general
population remains unclear, and
to-date there have been no large-scale nationally representative
analyses of these associations.

Methods To
establish the contemporary relevance of sleep as a correlate of stroke
among adults in the UK, we examined the relationship
between seven self-reported sleep
measures (duration; latency; wakefulness; coughing/snoring; perceived
quality; medication;
and daytime sleepiness) and
self-reported stroke in the first wave of a large (n = 50,994)
nationally representative cohort
study (Understanding Society). The
association between self-reported sleep measures and self-reported
stroke was examined
before and after adjusting for: age;
sex; body mass index; educational attainment; employment status;
ethnicity; household
income; and General Health
Questionnaire (GHQ) caseness – all of which had been identified as
potential confounders using
a directed acyclic graph.

There were strong, graded and statistically significant associations
between all seven self-reported sleep measures and stroke
before adjustment for potential
confounders. All of these associations were attenuated following
adjustment, yet all but one
(sleep duration) remained
statistically significant. For these six self-reported sleep variables,
respondents reporting ‘very
bad’ sleep quality had more than
three times the odds of stroke than those reporting ‘very good’ sleep
quality (OR: 3.31;
95% CI:2.25, 4.86); whilst those who
reported that on ‘most nights’ they: could not ‘get to sleep within 30
min’; ‘wake in
the middle of the night’; and ‘cough
or snore loudly’ had 2.68 (95% CI: 2.01, 3.58), 1.17 (95% CI: 0.85,
1.62) and 1.70 (95%
CI: 1.26, 2.28) the odds of stroke,
respectively, than those who reported that these had ‘not [occurred] in
the past month’.
Likewise, respondents reporting
frequent (‘≥3x a month’) use of ‘medication to sleep’ and ‘trouble
staying awake’ had 1.70
(95% CI: 1.05, 1.07) and 2.12 (95%
CI: 1.21, 3.71) the odds of stroke, respectively, compared to those not
using medication
or struggling to stay awake ‘in the
past month’

These findings confirm that a wide range of sleep-related
characteristics are associated with stroke and, in particular,
that perceived sleep quality (a
likely indicator of satisfaction with sleep) and trouble sleeping due to
breathing problems
(a likely indicator of sleep apnoea)
had the strongest associations with stroke. It remains to be seen
whether these cross-sectional
associations reflect a causal
relationship between sleep and stroke and, if so, the relative
importance of sleep as a determinant
of stroke and vice versa.








Medicine and Health


Society for Social Medicine 58th Annual Scientific Meeting Hosted by the Nuffield Department of Population Health, University of Oxford Keble College, Oxford 10–12 September 2014; Albert Sloman Library Periodicals *hard copy*; Online in Albert Sloman Library, except current 36 months