Work

Sleep health and stroke risk: complementary analyses of CHARLS and the UK Biobank, including genetic susceptibility in the UK Biobank

Year: 2026

Type: article

Abstract: Previous prospective studies have linked sleep patterns and genetic susceptibility with cardiovascular disease and stroke risk. However, less is known about how specific sleep dimensions, potential cardiometabolic pathways, and stroke-specific genetic susceptibility complement composite sleep-pattern analyses across distinct populations. We therefore examined these questions using two population-based cohorts from China and the United Kingdom. This prospective analysis included 11,574 participants from the China Health and Retirement Longitudinal Study (CHARLS) and 485,014 participants from the UK Biobank. In CHARLS, nighttime sleep duration, daytime napping, and restless sleep were examined in relation to incident stroke, with hypertension and heart disease evaluated separately as potential mediators. In the UK Biobank, a five-component sleep score was constructed from sleep duration, chronotype, insomnia, snoring, and daytime sleepiness; sleep patterns were classified as healthy (scores 0–1), moderate (2–3), or poor (4–5), and polygenic risk score (PRS) was categorized into low, intermediate, and high genetic risk according to tertiles. CHARLS participants were followed through the 2013, 2015, and 2018 survey waves, providing up to approximately 7 years of follow-up. During follow-up, 707 incident stroke events occurred in CHARLS and 8,929 incident ischemic stroke events occurred in the UK Biobank Cox analysis. Cox proportional hazards models and mediation analyses were performed. In CHARLS, nighttime sleep duration and daytime napping were not significantly associated with incident stroke after multivariable adjustment, whereas restless sleep most or all of the time was associated with higher stroke risk compared with rare or no restless sleep (HR 1.22, 95% CI 1.00–1.48). Mediation analyses suggested potential indirect contributions through hypertension (19.5% mediated, 95% CI 4.0%–49.0%) and heart disease (17.0% mediated, 95% CI 6.0%–42.0%). In the UK Biobank, each 1-point increase in sleep score was associated with higher ischemic stroke risk (HR 1.07, 95% CI 1.05–1.09). Compared with a healthy sleep pattern, moderate and poor sleep patterns were associated with HRs of 1.10 (95% CI 1.05–1.14) and 1.29 (95% CI 1.16–1.44), respectively. In the joint analysis, compared with low genetic risk plus healthy sleep, high genetic risk combined with moderate or poor sleep was associated with HRs of 2.11 (95% CI 1.83–2.43) and 2.09 (95% CI 1.54–2.84), respectively. Across two population-based cohorts, stroke risk appeared to vary according to both sleep health and genetic background. These findings suggest that multidimensional sleep assessment, particularly when considered alongside cardiometabolic conditions and inherited risk, may help refine population-level stroke prevention strategies.

Source: BMC Public Health

DOI: 10.1186/s12889-026-30082-9