scholarly journals Letter by Kawada Regarding Article, “Sleep Duration and Risk of Stroke Mortality Among Chinese Adults: Singapore Chinese Health Study”

Stroke ◽  
2014 ◽  
Vol 45 (7) ◽  
Author(s):  
Tomoyuki Kawada
Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
An Pan ◽  
Jian-Min Yuan ◽  
Woon-Puay Koh

Introduction: Short or long sleep hours are associated with adverse health outcomes, including diabetes, hypertension, coronary heart disease (CHD) and total mortality. However, the prospective relation between sleep duration and stroke risk is less studied, particularly in Asians. Thus, we assessed the hypothesis that short (≤5 hours) and long (≥9 hours) sleep durations were related to increased risk of stroke mortality among Chinese adults residing in Singapore. Methods: The Singapore Chinese Health Study is a population-based cohort that recruited 63,257 Chinese adults aged 45-74 years during 1993 and 1998. Sleep duration was assessed at baseline and categorized to five groups: ≤5, 6, 7, 8 or ≥9 hours. Death information was identified via registry linkage up to December 31, 2011, with ICD-9 codes 430-438 for all stroke deaths, 430-432 for hemorrhagic, and 433-438 for ischaemic or non-specified stroke deaths. Cox proportional hazard models were used to calculate hazard ratios (HRs) with adjustment for socio-demographic, lifestyle and comorbidities. Results: We documented 1,381 total stroke deaths (322 hemorrhagic and 1,059 ischaemic or non-specified strokes) during 926,752 person-years of follow-up. Compared to the reference group of sleeping for 7 hours, the multivariate-adjusted HR (95% confidence interval) for total stroke mortality was 1.25 (1.05-1.50) for ≤5 hours, 1.01 (0.87-1.18) for 6 hours, 1.09 (0.95-1.26) for 8 hours, and 1.54 (1.28-1.85) for ≥9 hours. The increased risk was also observed for ischaemic or non-specified stroke deaths with short (1.37; 1.12-1.68) and long (1.68; 1.36-2.06) sleep durations, but not for hemorrhagic stroke deaths (0.92 [0.62-1.36] and 1.14 [0.76-1.72], respectively). We observed significant interaction with baseline hypertension (P-interaction=0.04): positive association was found for short (1.54; 1.16-2.03) and long (1.95; 1.48-2.57) sleep durations among individuals with baseline hypertension, but not among those without baseline hypertension (1.07 [0.85-1.36] and 1.27 [0.98-1.63], respectively). Furthermore, in participants without baseline CHD/stroke, short and long sleep durations were related to an increased risk (HR 1.30 [1.07-1.57] and 1.43 [1.16-1.76], respectively); while in CHD/stroke patients, only long sleep duration was associated with an increased risk (2.34; 1.53-3.57), but not the short sleep duration (0.96; 0.57-1.62). Conclusions: In this large cohort study of Chinese adults, both short and long sleep durations were significantly associated with increased risks of stroke mortality. The associations were significant and stronger in hypertensive participants, but not in those without hypertension. Further studies are needed to confirm the interaction with hypertension and explore the mechanisms linking sleep quantity and stroke mortality.


Stroke ◽  
2014 ◽  
Vol 45 (6) ◽  
pp. 1620-1625 ◽  
Author(s):  
An Pan ◽  
Deidre Anne De Silva ◽  
Jian-Min Yuan ◽  
Woon-Puay Koh

2020 ◽  
Vol 148 (2) ◽  
pp. 352-362
Author(s):  
Hamed Samavat ◽  
Hung N. Luu ◽  
Kenneth B. Beckman ◽  
Aizhen Jin ◽  
Renwei Wang ◽  
...  

2021 ◽  
Vol 281 ◽  
pp. 125-130
Author(s):  
Jing Wu ◽  
Grand H.-L. Cheng ◽  
Li-Ting Sheng ◽  
Lei Feng ◽  
Jian-Min Yuan ◽  
...  

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Yiwen Jiang ◽  
Liting Sheng ◽  
Jian-Min Yuan ◽  
Woon-Puay Koh ◽  
An Pan

Abstract Objectives We aimed to examine the association between dietary intakes of fat and risk of cognitive impairment in Chinese adults, which has rarely been evaluated. Methods The Singapore Chinese Health Study is an ongoing cohort among Chinese adults living in Singapore. Dietary information was assessed by a validated food-frequency questionnaire at baseline (1993–1998) when the participants were aged 45–74 years old. Cognitive impairment was identified using modified Singapore version of Mini-Mental State Examination at the 3rd follow-up interviews (2014–2016). After a mean follow-up of 19.7 years, 16,948 surviving participants was included in the final analysis. Multivariable logistic regression models were used to calculate odds ratio (OR) and 95% confidence interval (CI) with adjustment for potential confounders. Results Cognitive impairment was presented in 2443 participants. Compared to total carbohydrate, dietary fat intake was inversely related to cognitive impairment (OR comparing extreme quartiles = 0.82; 95% CI 0.69–0.97; P-trend = 0.008). The OR (95% CI) comparing extreme quartiles of specific dietary fats was 1.08 (0.89–1.31) for saturated fatty acids (SFAs; P-trend = 0.50), 0.81 (0.65–1.00) for monounsaturated fatty acids (MUFAs; P-trend = 0.03), 0.83 (0.71–0.97) for polyunsaturated fatty acids (PUFAs; P-trend < 0.001), 0.92 (0.77–1.10) for n-3 PUFAs (P-trend = 0.49), and 0.83 (0.71–0.99) for n-6 PUFAs (P-trend = 0.01). Plant-based fat showed an inverse association with cognitive impairment (OR 0.84; 95% CI 0.72–0.98; P-trend = 0.02), whereas no significant association was found for animal fat (P-trend = 0.97). When compared to SFAs, inverse associations remained similar for MUFAs (P-trend = 0.03) and PUFAs (P-trend < 0.001). Conclusions In this large population-based cohort in Chinese adults, we found that substitution of total carbohydrate or SFAs with MUFAs and PUFAs, mainly n-6 PUFAs, was related to a lower risk of cognitive impairment. Furthermore, plant-based fat intake was associated with a lower risk. Our results indicate the importance of considering the quality of fat intake in preventing cognitive impairment. Funding Sources National Medical Research Council, Singapore; National Institutes of Health; National Key Research and Development Program of China. Supporting Tables, Images and/or Graphs


2019 ◽  
Vol 54 ◽  
pp. 22-27 ◽  
Author(s):  
Ting-Ting Geng ◽  
Tazeen Hasan Jafar ◽  
Jian-Min Yuan ◽  
Woon-Puay Koh

Author(s):  
Yan-Feng Zhou ◽  
Xing-Yue Song ◽  
Xiong-Fei Pan ◽  
Lei Feng ◽  
Nan Luo ◽  
...  

Abstract Background The aim of the study was to examine the relations of individual lifestyle factors and its composite score with healthy ageing among Chinese adults. Method We included 14 159 participants aged 45–74 years at baseline from the Singapore Chinese Health Study, a population-based prospective cohort. A protective lifestyle score (0–5 scale) was calculated at baseline (1993–1998) and updated at the second follow-up visit (2006–2010) on the basis of optimal body mass index (18.5–22.9 kg/m2), healthy diet (upper 40% of the Alternative Healthy Eating Index score), being physically active (≥2 h/wk of moderate activity or ≥0.5 h/wk of strenuous activity), nonsmoking (never smoking), and low-to-moderate alcohol drinking (&gt;0 to ≤14 drinks/wk for men and &gt;0 to ≤7 drinks/wk for women). Healthy ageing was assessed at the third follow-up visit (2014–2016) and was defined as absence of specific chronic diseases, absence of cognitive impairment and limitations in instrumental activities of daily living, good mental and overall self-perceived health, good physical functioning, and no function-limiting pain. Results About 20.0% (2834) of the participants met the criteria of healthy ageing after a median follow-up of 20 years. Each 1-point increase in the protective lifestyle score computed at baseline and second follow-up visits was associated with higher likelihood of healthy ageing by 25% (95% CI: 20%–30%) and 24% (18%–29%), respectively. The population-attributable risk percent of adherence to 4–5 protective lifestyle factors was 34.3% (95% CI: 25.3%–42.3%) at baseline and 31.3% (23.0%–38.7%) at second follow-up visits for healthy ageing. In addition, positive increase in lifestyle scores from baseline to second follow-up visits was also significantly associated with a higher likelihood of healthy ageing with an odds ratio of 1.18 (95% CI: 1.12%–1.24%) for each increment in protective lifestyle score. Conclusions Our findings confirmed that adopting healthy lifestyle factors, even after midlife, was associated with healthy ageing at old age.


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