Longer Sleep Duration Linked to Intracerebral Hemorrhage Risk

Sleep duration has previously been linked to hypertension and stroke risk.

Longer sleep duration may increase the risk for intracerebral hemorrhage (ICH), according to results from a case-control study conducted in Korea.

It has previously been established that abnormal sleep duration affects risk for hypertension, and in turn stroke, however data on specific stroke subtypes such as ICH is lacking.

“Abnormal sleep duration, especially long sleep duration, could be associated with poor health condition, less social support, and irregular lifestyle in patients,” Byung-Woo Yoon, MD, PhD, FAHA, of the Department of Neurology at Seoul National University Hospital in Seoul, told Neurology Advisor.“These factors are positively correlated with risk of stroke, so it is important that physicians pay attention to the sleep habits of patients with cardiovascular disease.”

To evaluate possible associations between sleep duration and ICH risk, investigators conducted a multicenter case-control study assessing sleep, lifestyle, and medical history of 490 patients with ICH and 980 sex- and age-matched controls. Participants with ICH were 58.2% male with a mean age of 57 years. They were more likely to have hypertension (P<.001) and drink alcohol (P<.001) compared to controls.

A greater proportion of participants in the ICH group (30.4%) were more likely to have longer sleep duration (>8 hours) (P=.002) and snoring (P=.001) compared to those in the control group (22.6%). Participants with longer sleep duration were more likely to be hypertensive, older, have blue-collar jobs, lower education level, and less working hours compared to those with 7 hours of sleep duration.  Shorter sleep duration was associated with higher levels of stress and sleep fragmentation (P=.007 and P<.001).

After adjustment for confounders, longer sleep duration was associated with a greater risk of ICH (8 h, OR 1.57, 95% CI 1.00–2.47; ≥9 h, OR 5.00, 95% CI 2.18–11.47).

Limitations of the study included self-reported sleep duration that was assessed after the participant developed ICH, which may have led to recall bias. Further, participants with fatal or severe ICH were excluded from the study.

While further research is needed to determine the underlying mechanisms of this relationship, the data suggests that “sleep duration is a valuable marker for increased ICH risk,” the authors wrote. Noting that treatment of ICH is not well-established, Dr Yoon added that prevention is the best way to address incidence of ICH, and to do so, “it is important to identify risk factors for ICH.”


Kim TJ, Kim CK, Kim Y, et al. Prolonged sleep increases the risk of intracerebral haemorrhage: a nationwide case-control study. Eur J Neurol. 2016; doi:10.1111/ene.12978.