Probable REM sleep behavior disorder and risk of stroke: A prospective study

Objective: To examine whether probable REM sleep behavior disorder (pRBD) was associated with increased risk of developing stroke in a community-based cohort. Methods: The study included 12,003 participants (mean age 54.0 years) of the Kailuan Study, free of stroke, cancer, Parkinson disease, dementia, and head injury at baseline (2012). We determined pRBD using a validated REM sleep behavior disorder (RBD) questionnaire in 2012. Incident stroke cases were confirmed by review of medical records. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of stroke according to pRBD status, adjusting for several sleep measures (i.e., insomnia, daytime sleepiness, sleep duration, snoring, and use of hypnotics) and other potential confounders. Results: During 3 years of follow-up, we documented 159 incident stroke cases. Relative to participants without pRBD at the baseline, those with pRBD had a 157% higher risk (95% CI 59%-313%) of developing stroke. Presence of pRBD was associated with increased risk of both stroke types - the adjusted HR was 1.93 (95% CI 1.07-3.46) for ischemic stroke and 6.61 (95% CI 2.27-19.27) for hemorrhagic stroke. Conclusions: Presence of pRBD was associated with a higher risk of developing stroke, including both ischemic and hemorrhagic types. Future studies with clinically confirmed RBD and a longer follow-up would be appropriate to further investigate this association.