The prevalence and associations of stroke history with self-reported sleep disturbances in China: a nationwide cross-sectional study

Sleep is essential for stroke prognosis and recovery. While stroke history has been associated with sleep disturbances, evidence from China remains limited. This study aimed to characterize the prevalence of multiple sleep disturbances and to examine their associations with stroke history based on the China Nutrition and Health Surveillance 2015–2017. 157,135 respondents were included in the current study. Stroke history was defined as being first diagnosed over one year ago. Sleep disturbances were defined as non-optimal sleep duration (< 6 or ≥ 9 h), self-reported sleep-disordered breathing (SDB), and insomnia symptoms. The number of sleep disturbances was further used as an indicator of overall sleep quality. All analyses were weighted to obtain national representativeness. Weighted multivariable Poisson regression and multinomial logistic regression were applied to evaluate the associations between stroke history and sleep disturbances. The prevalence of sleep disturbances was significantly higher among the stroke population than non-stroke population (non-optimal sleep duration: 41.7% vs. 26.3%; self-reported SDB: 42.1% vs. 27.6%; insomnia symptoms: 71.6% vs. 44.7%, all P < 0.01). In addition, the prevalence of having at least one sleep disturbance among the stroke population was higher than in non-stroke population (87.4% vs. 66.4%, P < 0.0001). Positive associations were observed between stroke history and prevalence of non-optimal sleep duration and insomnia symptoms (non-optimal sleep duration: multivariable-adjusted PR = 1.28; insomnia symptoms: PR = 1.12, all P < 0.0001), whereas no association was observed for self-reported SDB (PR = 1.01, P = 0.8045). Moreover, the strength of association between stroke and sleep disturbances increased with the number of co-occurring sleep disturbances (for 1 type: PR = 1.20; 2 types: PR = 1.40; 3 types: PR = 2.13, all P < 0.0001). Stroke history was associated with an increased burden of sleep disturbances across multiple dimensions, particularly non-optimal sleep duration, insomnia symptoms, and sleep disturbance co-occurrence. The current results highlight the multidimensional nature of post-stroke sleep disturbances and the importance of comprehensive sleep assessment and management in post-stroke care.