Chronic insomnia disorder as risk factor for stroke: a systematic review

Abstract

Background Stroke is one of the main causes of mortality worldwide. Nonetheless, there are still risk factors that have not been fully elucidated, such as chronic insomnia disorder.

Objective To evaluate the association between chronic insomnia disorder and the risk of stroke in adults, through a systematic review.

Methods Multiple studies available in the Embase, Lilacs, and Medline platforms were evaluated in English, Spanish, French, and Portuguese. The selection of papers was restricted to those that had investigated the association between chronic insomnia disorder and stroke in adults, regardless of gender or nationality, without a previous history of stroke. The data was extracted with the Cochrane Effective Practice and Organization of Care (EPOC) form. The risk of bias was evaluated by the EPOC Risk of bias tool.

Results A total of 138 articles were identified. After a detailed evaluation with the eligibility criteria, four articles were included in the present systematic review. Three of them recognized the association between chronic insomnia disorder and stroke. The comparative analysis was limited, since the studies used distinct insomnia classifications. Regarding the risk of bias, the analysis displayed an important risk in the selection and allocation of participants, besides the use of own insomnia diagnosis criteria, disrespecting chronology and factors indicated by already established classifications.

Conclusions There is not enough data to determine that chronic insomnia disorder is a risk factor for stroke. The present study points out the existence of a possible relationship between insomnia disorder and stroke, suggesting that further studies adopt standardized criteria and instruments.

RESUMO

Antecedentes O acidente vascular cerebral (AVC) é uma das maiores causas de mortalidade do mundo. Ainda assim, existem fatores de risco não identificados, como o transtorno de insônia crônica.

Objetivo Avaliar a associação entre distúrbio crônico de insônia e o risco de AVC em adultos, por meio de uma revisão sistemática.

Métodos Foram avaliados estudos publicados em inglês, espanhol, francês e português, disponíveis nas plataformas Embase, Lilacs e Medline. Os estudos incluídos foram aqueles que investigaram a associação entre transtorno de insônia crônica e AVC em adultos, sem restrição de gênero ou de nacionalidade, sem história prévia de AVC. Os dados foram extraídos baseados no formulário da Cochrane Effective Practice and Organisation of Care (EPOC, na sigla em inglês). O risco de viés foi avaliado por meio da ferramenta EPOC Risk of bias tool.

Resultados Foram identificados 138 artigos, entre os quais, após avaliação detalhada para os critérios de elegibilidade, 4 foram incluídos na revisão sistemática. Destes, três encontraram associação entre insônia e AVC. Contudo, a análise comparativa apresenta limitações, pois nenhum dos estudos utilizou uma classificação comum de insônia. Quanto à análise do risco de viés, os estudos demonstraram um importante risco de viés na seleção e na alocação de participantes, além de utilizarem critérios diagnósticos de insônia próprios, sem respeitar cronologia e fatores indicados por classificações já estabelecidas.

Conclusões Não existem dados suficientes para determinar que o transtorno crônico de insônia se configura como fator de risco para AVC. A análise aponta para a existência de uma possível relação, sugerindo-se para estudos posteriores o uso de critérios e instrumentos padronizados.

Keywords

Sleep Initiation and Maintenance Disorders - Risk Factors - Stroke - Sleep-Wake Disorders

Palavras-chave

Distúrbios do Início e da Manutenção do Sono - Fatores de Risco - Acidente Vascular Cerebral - Transtornos do Sono-Vigília

Authors' Contributions

LASS and MMA: study concept and design, drafted the manuscript; ALRP, LASS, MMA, VG: data analysis and interpretation; ALRP, VG: critical revision of the manuscript; ALRP: final approval of the manuscript.

Publication History

Received: 16 March 2021

Accepted: 12 October 2021

Article published online:
28 December 2022

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