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Sleep Duration and Risk of Fatal and Nonfatal Stroke: A Prospective Study and Meta
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Sleep Duration and Risk of Fatal and Nonfatal Stroke: A Prospective Study and Meta-analysis
Leng Y, Cappuccio FP, Wainwright NW, et al
Sleep characteristics, particularly short and long sleep duration, may help predict stroke and other cardiovascular events. The goal of this prospective study was to examine the association between sleep duration and stroke incidence in a British population and to pool these data with published data using a meta-analysis.
In the European Prospective Investigation into Cancer-Norfolk study, 9692 participants aged 42-81 years and without stroke at baseline reported sleep duration in 1998-2000 and 2002-2004. Stroke cases were recorded through March 31, 2009. Search of Ovid Medline, EMBASE, and the Cochrane Library identified prospective studies published until May 2014. The meta-analysis used a weighted random-effects model for pooled effect estimates.
More than two thirds (69%) of participants reported sleeping for 6-8 hours per day, and 10% reported sleeping for longer than 8 hours. Those who slept for less than 6 hours or more than 8 hours were older and more likely to be women, be less active, have major depressive disorder, and take antihypertensive drugs.
There were 346 cases of stroke during 9.5 years of follow-up. After adjustment for all covariates, long sleep was significantly associated with a 46% increased risk for stroke (hazard ratio [HR], 1.46; 95% confidence interval [CI], 1.08-1.98]). Long sleep duration was also significantly associated with increased stroke risk among persons without preexisting diseases and among those who reported sleeping well. Findings from this study were similar to those in the updated meta-analysis.
There w best mobile porn as a smaller association (18%) for short sleep duration, but this was not statistically significant overall. Among younger people with short sleep, however, there was an 87% increase in stroke risk (HR, 1.87; 95% CI, 0.97-3.60).
Compared with persons report gay cartoon porn ing persistently average sleep duration, those who reported persistently long sleep or a marked increase in sleep duration over time had a higher stroke risk (doubled risk or nearly fourfold increase in risk, respectively). The association was stronger between short sleep and ischemic stroke and between long sleep and hemorrhagic stroke.
Strengths of the prospective study include the ability to assess longitudinal change in sleep duration and to explore whether the association differed by comorbidities, general sleep quality, and stroke subtypes. Strengths of the meta-analysis include the large sample of more than 8000 stroke cases. Limitations include participants who were younger and had higher social class and educational level compared with the baseline population; sleep duration reported with a single question; and possible residual confounding.
Nonetheless, as seen in previous studies, long sleep is robustly associated with increased stroke risk. Prolonged sleep appears to be potentially useful to predict heightened risk for future stroke among apparently healthy middle-aged to older persons. The mechanisms underlying this association are still unclear but may involve inflammation. The question of whether long sleep is a cause, result, or early marker of poor health also merits additional targeted research.
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