Associations of sleep duration, physical activity, and longitudinal changes with the risk of fatal stroke occurrence in middle-aged to older individuals

Sleep and physical activity (PA) are associated with the risk of stroke, but the relationships between longitudinal changes in sleep and PA habits and between their combination index and fatal stroke are unclear. In this prospective cohort study on the risks of stroke and sleep and physical activity (PA), 26,672 participants with 951 stroke deaths in the Guangzhou Biobank Cohort Study (GBCS) and 7218 participants with 49 stroke deaths in the National Health and Nutrition Examination Survey (NHANES) were enrolled after mean follow-up times of 15.4 (SD = 3.57) and 6.71 (SD = 3.43) years, respectively. Compared with stable participants, GBCS participants with sleep durations ≤ 5 and ≥ 9 h were at greater risk for fatal all-stroke (aHR = 1.35, 95% CI: 1.10–1.66, P = 0.004; aHR = 1.47, 95% CI: 1.16–1.87, P = 0.001) and fatal ischemic stroke (aHR = 1.52, 95% CI: 1.14–2.03, P = 0.004; aHR = 1.63, 95% CI: 1.18–2.27, P = 0.003); longitudinally increased sleep duration was associated with greater risks for fatal all-stroke (aHR = 1.34, 95% CI: 1.04–1.72, P = 0.02) and fatal ischemic stroke (aHR = 1.51, 95% CI: 1.08–2.12, P = 0.02), and greater risks for fatal ischemic stroke were presented in moderate–inactive PA (aHR = 3.24, 95% CI: 1.49–7.05, P = 0.003). The NHANES substandard PA had a greater risk for fatal all-stroke (aHR = 2.86, 95% CI: 1.54–5.30, P < 0.001) than did standard PA; a greater risk of fatal all-stroke was associated with short sleep + substandard PA (aHR = 7.11, 95% CI: 2.46–20.54, P < 0.001) and normal sleep + substandard PA (aHR = 2.46, 95% CI: 1.16–5.24, P = 0.02) than with normal sleep + standard PA. Abnormal sleep and longitudinal changes in sleep and substandard PA are associated with an increased risk of fatal stroke occurrence; these findings may be potential indicators of future fatal stroke occurrence in relatively healthy middle-aged to older individuals.