ABSTRACT Aims This study aimed to explore the relationship between sleep duration and intracranial atherosclerosis and cerebral small vessel disease (CSVD), and pinpoint the potential mediating factors. Methods Data were derived from the cross‐sectional baseline survey of the PRECISE (Poly‐vascular Evaluation for Cognitive Impairment and Vascular Events) study. Participants were divided into short sleep ( 9 h) groups. The associations of sleep duration with intracranial atherosclerotic plaque, intracranial atherosclerotic burden, total CSVD score, and CSVD imaging markers were evaluated. Results We enrolled 3038 participants (53.5% women; mean age: 61.2 ± 6.7 years). A long sleep duration was correlated with a higher risk of intracranial atherosclerotic plaque (long vs. normal: odds ratio OR, 1.40 95% CI, 1.10–1.78), intracranial atherosclerotic burden (long vs. normal: common OR, 1.38 95% CI, 1.09–1.75), enlarged perivascular space in the basal ganglia (BG‐EPVS) (long vs. normal: OR, 1.45 95% CI, 1.07–1.97); a short sleep duration indicated a rise in lacune (short vs. normal: OR, 1.67 95% CI, 1.06–2.63) after adjustment for covariates. The association of a long sleep duration with intracranial atherosclerotic plaque, intracranial atherosclerotic burden, and BG‐EPVS (mediation percentage: 35.4%, 34.0%, 20.3%, respectively) was partially mediated by metabolic factors of blood pressure and fasting plasma glucose. Conclusion Aberrant sleep duration may increase the potential risk for intracranial atherosclerosis and CSVD, which can be partially mediated by blood pressure and fasting plasma glucose. These findings highlight the benefits of clinical management of metabolic factors for those with aberrant sleep duration to prevent intracranial atherosclerosis and CSVD. Trial Registration NCT03178448
Chen et al. (Sun,) studied this question.