title: Probable REM sleep behavior disorder and risk of stroke: A prospective study.
abstract: OBJECTIVE
  To examine whether probable REM sleep behavior disorder (pRBD) was associated with increased risk of developing stroke in a community-based cohort.
  
  
  METHODS
  The study included 12,003 participants (mean age 54.0 years) of the Kailuan Study, free of stroke, cancer, Parkinson disease, dementia, and head injury at baseline (2012). We determined pRBD using a validated REM sleep behavior disorder (RBD) questionnaire in 2012. Incident stroke cases were confirmed by review of medical records. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of stroke according to pRBD status, adjusting for several sleep measures (i.e., insomnia, daytime sleepiness, sleep duration, snoring, and use of hypnotics) and other potential confounders.
  
  
  RESULTS
  During 3 years of follow-up, we documented 159 incident stroke cases. Relative to participants without pRBD at the baseline, those with pRBD had a 157% higher risk (95% CI 59%-313%) of developing stroke. Presence of pRBD was associated with increased risk of both stroke types-the adjusted HR was 1.93 (95% CI 1.07-3.46) for ischemic stroke and 6.61 (95% CI 2.27-19.27) for hemorrhagic stroke.
  
  
  CONCLUSIONS
  Presence of pRBD was associated with a higher risk of developing stroke, including both ischemic and hemorrhagic types. Future studies with clinically confirmed RBD and a longer follow-up would be appropriate to further investigate this association.
authors.affiliation: From the Department of Nutritional Sciences (C.M., X.G.), The Pennsylvania State University, University Park; Department of Neurology (M.P.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Departments of Neurology (Yesong Liu, Ying Liu, C.H.) and Cardiology (S.W.), Kailuan General Hospital, Tangshan, China.
authors.forename: Chaoran
authors.initials: C
authors.lastname: Ma
authors.affiliation: From the Department of Nutritional Sciences (C.M., X.G.), The Pennsylvania State University, University Park; Department of Neurology (M.P.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Departments of Neurology (Yesong Liu, Ying Liu, C.H.) and Cardiology (S.W.), Kailuan General Hospital, Tangshan, China.
authors.forename: Milena
authors.initials: M
authors.lastname: Pavlova
authors.affiliation: From the Department of Nutritional Sciences (C.M., X.G.), The Pennsylvania State University, University Park; Department of Neurology (M.P.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Departments of Neurology (Yesong Liu, Ying Liu, C.H.) and Cardiology (S.W.), Kailuan General Hospital, Tangshan, China.
authors.forename: Yesong
authors.initials: Y
authors.lastname: Liu
authors.affiliation: From the Department of Nutritional Sciences (C.M., X.G.), The Pennsylvania State University, University Park; Department of Neurology (M.P.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Departments of Neurology (Yesong Liu, Ying Liu, C.H.) and Cardiology (S.W.), Kailuan General Hospital, Tangshan, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Liu
authors.affiliation: From the Department of Nutritional Sciences (C.M., X.G.), The Pennsylvania State University, University Park; Department of Neurology (M.P.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Departments of Neurology (Yesong Liu, Ying Liu, C.H.) and Cardiology (S.W.), Kailuan General Hospital, Tangshan, China.
authors.forename: Chunmei
authors.initials: C
authors.lastname: Huangfu
authors.affiliation: From the Department of Nutritional Sciences (C.M., X.G.), The Pennsylvania State University, University Park; Department of Neurology (M.P.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Departments of Neurology (Yesong Liu, Ying Liu, C.H.) and Cardiology (S.W.), Kailuan General Hospital, Tangshan, China.
authors.forename: Shouling
authors.initials: S
authors.lastname: Wu
authors.affiliation: From the Department of Nutritional Sciences (C.M., X.G.), The Pennsylvania State University, University Park; Department of Neurology (M.P.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Departments of Neurology (Yesong Liu, Ying Liu, C.H.) and Cardiology (S.W.), Kailuan General Hospital, Tangshan, China. xxg14@psu.edu drwusl@163.com.
authors.forename: Xiang
authors.initials: X
authors.lastname: Gao
mesh_terms: D002545:Brain Ischemia / Q000150:complications / Q000453:epidemiology; D002543:Cerebral Hemorrhage / Q000150:complications / Q000453:epidemiology; D002681:China; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D020187:REM Sleep Behavior Disorder / Q000150:complications / Q000453:epidemiology*; D012306:Risk; D012680:Sensitivity and Specificity; D020521:Stroke / Q000150:complications / Q000453:epidemiology*; D011795:Surveys and Questionnaires