Restless Sleep and Poor Sleep Patterns Linked to Higher Stroke Risk in Two Large Cohorts

People who reported restless sleep most or all of the time faced a higher risk of stroke in a large Chinese cohort, while adults in the United Kingdom with poor overall sleep patterns showed elevated ischemic stroke risk, according to a new analysis published in BMC Public Health. The study, which combined data from the China Health and Retirement Longitudinal Study (CHARLS) and the UK Biobank, also found that genetic susceptibility to stroke amplified the danger associated with unhealthy sleep.

The research drew on 11,574 CHARLS participants followed through the 2013, 2015 and 2018 survey waves, providing up to roughly seven years of follow-up, during which 707 incident strokes occurred. In the UK Biobank, 485,014 participants were analyzed, with 8,929 incident ischemic strokes recorded in the Cox analysis. The investigators examined nighttime sleep duration, daytime napping and restless sleep in the Chinese cohort, and constructed a five-component sleep score in the UK cohort based on sleep duration, chronotype, insomnia, snoring and daytime sleepiness.

After multivariable adjustment, neither nighttime sleep duration nor daytime napping was significantly associated with incident stroke in CHARLS. Restless sleep, however, told a different story: participants who experienced it most or all of the time had a 22 percent higher stroke risk compared with those who rarely or never reported restless sleep, with a hazard ratio of 1.22 (95 percent confidence interval 1.00 to 1.48). Mediation analyses suggested that hypertension and heart disease might account for part of this association, with an estimated 19.5 percent of the effect mediated through hypertension (95 percent CI 4.0 to 49.0 percent) and 17.0 percent through heart disease (95 percent CI 6.0 to 42.0 percent).

In the UK Biobank, sleep patterns were classified as healthy (scores 0 to 1), moderate (2 to 3) or poor (4 to 5). Each one-point increase in the sleep score, indicating worse sleep, was associated with a 7 percent higher ischemic stroke risk (HR 1.07, 95 percent CI 1.05 to 1.09). Compared with a healthy sleep pattern, moderate sleep was linked to a hazard ratio of 1.10 (95 percent CI 1.05 to 1.14) and poor sleep to 1.29 (95 percent CI 1.16 to 1.44).

The analysis also incorporated a polygenic risk score for stroke, categorized into low, intermediate and high genetic risk by tertiles. In a joint analysis, compared with individuals who had both low genetic risk and healthy sleep, those with high genetic risk combined with moderate or poor sleep patterns faced substantially elevated risk, with hazard ratios of 2.11 (95 percent CI 1.83 to 2.43) and 2.09 (95 percent CI 1.54 to 2.84), respectively.

The authors conclude that stroke risk appeared to vary according to both sleep health and genetic background across the two population-based cohorts. They suggest that multidimensional sleep assessment, particularly when considered alongside cardiometabolic conditions and inherited risk, may help refine population-level stroke prevention strategies. As an observational, prospective analysis, the study identifies associations rather than proven causal effects, and the mediation estimates carry wide confidence intervals that reflect uncertainty in the size of the indirect pathways through hypertension and heart disease.

Subject of Research: Associations between sleep health, cardiometabolic mediation and genetic susceptibility in stroke risk across Chinese and UK cohorts

Article Title: Sleep health and stroke risk: complementary analyses of CHARLS and the UK Biobank, including genetic susceptibility in the UK Biobank

Article References: Tu, Z., Jin, Z., Zhuang, C., Hu, Y., He, J., Xiong, Y., & Zheng, Y. (2026). Sleep health and stroke risk: complementary analyses of CHARLS and the UK Biobank, including genetic susceptibility in the UK Biobank. BMC Public Health. https://doi.org/10.1186/s12889-026-30082-9

Image Credits: AI Generated

DOI: 10.1186/s12889-026-30082-9

Keywords: stroke, sleep health, restless sleep, UK Biobank, CHARLS, polygenic risk score, hypertension, heart disease, ischemic stroke, prospective cohort, Sleep, health