A study presented at the annual meeting of the Associated Professional Sleep Societies (APSS) shows that persistent sleep deprivation not only leads to fatigue but also increases the risk of stroke. In this study, Megan Ruiter, PhD, of the University of Alabama at Birmingham, and colleagues used data from the nationwide population-based REGARDS study to examine whether sleep duration predicted stroke risk in patients at low risk for sleep apnea or hypoventilation. Over 30,000 volunteers aged 45 years and older for stroke risk and cognitive health follow-up. Based on self-reported stroke symptoms collected at 6-month intervals, Dr. Ruiter et al. identified 5,666 subjects with no history of stroke, transient ischemic attacks, stroke symptoms, and low risk of sleep-disordered breathing (as assessed by the Berlin Sleep Questionnaire). Subsequently, the investigators estimated hazard ratios (HRs) predicting the time from measurement of sleep duration (less than 6 h, 6 to 6.9 h, 7 to 7.9 h, 8 to 8.9 h, and more than 9 h) to first stroke symptoms by developing interval-censored parametric survival models and exponential distributions. Data were corrected for demographic data, cholesterol levels, hypertension, body mass index (BMI), sleep-disordered breathing, depressive symptoms, and anxiety. Among low-risk subjects with obstructive sleep apnea whose BMI was in the optimal range (18.5 to 24.99 kg/m2), those who slept less than 6 h per night had four times the risk of developing stroke symptoms than those who slept 7 to 8 h per night. Specifically, the HR for stroke symptoms was 2.93 in subjects with normal BMI who slept less than 6 h per night compared to controls, and a similar association between short sleep loss and stroke symptoms was not observed in overweight and obese subjects. After correcting for other known stroke risk factors, a significant association between short sleep duration and stroke symptoms, including sudden physical weakness, numbness, or visual impairment, was observed. In another analysis, the researchers also found that blacks tended to sleep for shorter periods of time and were more likely to have stroke symptoms. This study suggests that short sleep duration is an independent predictor of stroke risk in middle-aged adults. A limitation is that it relied primarily on subjects’ self-reported stroke symptom information, so there is a potential for inaccurate recall. Future studies are needed to further clarify the specific sleep characteristics associated with stroke symptoms. For example, whether it is not sleep duration per se that is truly associated with stroke risk, but rather sleep fragmentation or factors related to individual sleep perception and sleep quality. It is also important to explore whether sleep duration is associated with a true stroke event. All of these factors can be intervened with behavioral therapy.