ArticleNeurology2023
Sleep Patterns and the Risk of Acute Stroke: Results From the INTERSTROKE International Case-Control Study.
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Article in Neurology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 2 of them syntheses that pooled it.
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35citing papers in PubMed, 2 pooled it
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
35 citing papers in PubMed, 2 syntheses or guidelines pooled it, 60 citations in OpenAlex.
- Sleep disorders increase the risk of dementia, Alzheimer's disease, and cognitive decline: a meta-analysis.GeroScience · 2025Pooled it
- Inadequate sleep increases stroke risk: evidence from a comprehensive meta-analysis of incidence and mortality.GeroScience · 2025Pooled it
- Construction and verification of a nomogram model for predicting the risk of post-stroke spasticity: a retrospective study.Annals of medicine · 2026Article
- Pre-stroke sleep symptoms and neurological outcomes after stroke: an exploratory secondary analysis of two prospective cohorts.Sleep & breathing = Schlaf & Atmung · 2026Article
- Sleep status among adults.Sleep & breathing = Schlaf & Atmung · 2026Article
- Predisposing Factors, Pathologies, and Precipitating Factors Causing Intracerebral Hemorrhage.Stroke · 2026Review
- Predictive Modeling of Preoperative Sleep Disorder Risk in Older Adults by Using Data From Wearable Monitoring Devices: Prospective Cohort Study.JMIR formative research · 2026Article
- Factors associated with sleep duration in a Chinese middle-aged and elderly diabetic population: a cross-sectional study.Acta diabetologica · 2025Article
- Sleep and Stroke-An Overlooked Bidirectional Influence: Why Should Sleep and Vascular Neurologists Work Closer?Journal of clinical medicine · 2025Article
- Chronic Insomnia and Stroke Risk-A Real Bidirectional Issue.Life (Basel, Switzerland) · 2025Review
- Article
- Comparative analysis of sleep duration and stroke prevalence in China and the U.S. before and during COVID-19.Journal of cardiothoracic surgery · 2025Article
- A Multimodal Sleep Foundation Model Developed with 500K Hours of Sleep Recordings for Disease Predictions.medRxiv : the preprint server for health sciences · 2025Article
- The link between sleep bruxism and oxidative stress based on a polysomnographic study.Scientific reports · 2025Article
- Continuous positive airway pressure in acute ischemic stroke patients with obstructive sleep apnea: analysis of the National Inpatient Sample database.Frontiers in neurology · 2025Article
- Heart rate variability in chronic ischemic stroke: analysis during the sleep-wake cycle.Arquivos de neuro-psiquiatria · 2024Article
- Interactions of Obstructive Sleep Apnea With the Pathophysiology of Cardiovascular Disease, Part 1: JACC State-of-the-Art Review.Journal of the American College of Cardiology · 2024Review
- Causal Associations of Sleep Apnea With Alzheimer Disease and Cardiovascular Disease: A Bidirectional Mendelian Randomization Analysis.Journal of the American Heart Association · 2024Article
- Lifestyle deterioration linked to elevated inflammatory cytokines over a two-month follow-up.Scientific reports · 2024Article
- Article
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Authors and funding
16 authors at 1 institution in 1 country.
Christine Eileen Mc CarthyFrom the Department of Medicine (C.E.M.C., C.J., A.A.-I., M.O.D.), University of Galway, Ireland; Department of Medicine (S.Y., S.R.), Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), Faculty of Health and Medical Sciences, University of Western Australia, Perth; Department of Medicine (S.O.), Rush Alzheimer Disease Research Center in Chicago, IL; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen, Denmark; Department of Molecular and Clinical Medicine (A.R.), University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Medicine (A.A.), International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; Department of Medicine (P.L.-J.), Instituto de Investigaciones MASIRA, Universidad de Santander, Bucaramanga, Colombia; Department of Medicine (D.X.), St John's Medical College and Research Institute, Bangalore, India; and Department of Medicine (X.W.), Beijing Hypertension League Institute, China. christine.mccrth@gmail.com.ORCID 0000-0002-8703-0661
Salim YusufFrom the Department of Medicine (C.E.M.C., C.J., A.A.-I., M.O.D.), University of Galway, Ireland; Department of Medicine (S.Y., S.R.), Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), Faculty of Health and Medical Sciences, University of Western Australia, Perth; Department of Medicine (S.O.), Rush Alzheimer Disease Research Center in Chicago, IL; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen, Denmark; Department of Molecular and Clinical Medicine (A.R.), University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Medicine (A.A.), International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; Department of Medicine (P.L.-J.), Instituto de Investigaciones MASIRA, Universidad de Santander, Bucaramanga, Colombia; Department of Medicine (D.X.), St John's Medical College and Research Institute, Bangalore, India; and Department of Medicine (X.W.), Beijing Hypertension League Institute, China.
Conor JudgeFrom the Department of Medicine (C.E.M.C., C.J., A.A.-I., M.O.D.), University of Galway, Ireland; Department of Medicine (S.Y., S.R.), Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), Faculty of Health and Medical Sciences, University of Western Australia, Perth; Department of Medicine (S.O.), Rush Alzheimer Disease Research Center in Chicago, IL; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen, Denmark; Department of Molecular and Clinical Medicine (A.R.), University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Medicine (A.A.), International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; Department of Medicine (P.L.-J.), Instituto de Investigaciones MASIRA, Universidad de Santander, Bucaramanga, Colombia; Department of Medicine (D.X.), St John's Medical College and Research Institute, Bangalore, India; and Department of Medicine (X.W.), Beijing Hypertension League Institute, China.ORCID 0000-0001-9473-2920
Alberto Alvarez-IglesiasFrom the Department of Medicine (C.E.M.C., C.J., A.A.-I., M.O.D.), University of Galway, Ireland; Department of Medicine (S.Y., S.R.), Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), Faculty of Health and Medical Sciences, University of Western Australia, Perth; Department of Medicine (S.O.), Rush Alzheimer Disease Research Center in Chicago, IL; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen, Denmark; Department of Molecular and Clinical Medicine (A.R.), University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Medicine (A.A.), International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; Department of Medicine (P.L.-J.), Instituto de Investigaciones MASIRA, Universidad de Santander, Bucaramanga, Colombia; Department of Medicine (D.X.), St John's Medical College and Research Institute, Bangalore, India; and Department of Medicine (X.W.), Beijing Hypertension League Institute, China.
Graeme J HankeyFrom the Department of Medicine (C.E.M.C., C.J., A.A.-I., M.O.D.), University of Galway, Ireland; Department of Medicine (S.Y., S.R.), Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), Faculty of Health and Medical Sciences, University of Western Australia, Perth; Department of Medicine (S.O.), Rush Alzheimer Disease Research Center in Chicago, IL; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen, Denmark; Department of Molecular and Clinical Medicine (A.R.), University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Medicine (A.A.), International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; Department of Medicine (P.L.-J.), Instituto de Investigaciones MASIRA, Universidad de Santander, Bucaramanga, Colombia; Department of Medicine (D.X.), St John's Medical College and Research Institute, Bangalore, India; and Department of Medicine (X.W.), Beijing Hypertension League Institute, China.ORCID 0000-0002-6044-7328
Shahram OveisgharanFrom the Department of Medicine (C.E.M.C., C.J., A.A.-I., M.O.D.), University of Galway, Ireland; Department of Medicine (S.Y., S.R.), Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), Faculty of Health and Medical Sciences, University of Western Australia, Perth; Department of Medicine (S.O.), Rush Alzheimer Disease Research Center in Chicago, IL; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen, Denmark; Department of Molecular and Clinical Medicine (A.R.), University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Medicine (A.A.), International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; Department of Medicine (P.L.-J.), Instituto de Investigaciones MASIRA, Universidad de Santander, Bucaramanga, Colombia; Department of Medicine (D.X.), St John's Medical College and Research Institute, Bangalore, India; and Department of Medicine (X.W.), Beijing Hypertension League Institute, China.
Albertino DamascenoFrom the Department of Medicine (C.E.M.C., C.J., A.A.-I., M.O.D.), University of Galway, Ireland; Department of Medicine (S.Y., S.R.), Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), Faculty of Health and Medical Sciences, University of Western Australia, Perth; Department of Medicine (S.O.), Rush Alzheimer Disease Research Center in Chicago, IL; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen, Denmark; Department of Molecular and Clinical Medicine (A.R.), University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Medicine (A.A.), International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; Department of Medicine (P.L.-J.), Instituto de Investigaciones MASIRA, Universidad de Santander, Bucaramanga, Colombia; Department of Medicine (D.X.), St John's Medical College and Research Institute, Bangalore, India; and Department of Medicine (X.W.), Beijing Hypertension League Institute, China.ORCID 0000-0003-0925-494X
Helle Klingenberg IversenFrom the Department of Medicine (C.E.M.C., C.J., A.A.-I., M.O.D.), University of Galway, Ireland; Department of Medicine (S.Y., S.R.), Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), Faculty of Health and Medical Sciences, University of Western Australia, Perth; Department of Medicine (S.O.), Rush Alzheimer Disease Research Center in Chicago, IL; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen, Denmark; Department of Molecular and Clinical Medicine (A.R.), University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Medicine (A.A.), International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; Department of Medicine (P.L.-J.), Instituto de Investigaciones MASIRA, Universidad de Santander, Bucaramanga, Colombia; Department of Medicine (D.X.), St John's Medical College and Research Institute, Bangalore, India; and Department of Medicine (X.W.), Beijing Hypertension League Institute, China.
Annika RosengrenFrom the Department of Medicine (C.E.M.C., C.J., A.A.-I., M.O.D.), University of Galway, Ireland; Department of Medicine (S.Y., S.R.), Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), Faculty of Health and Medical Sciences, University of Western Australia, Perth; Department of Medicine (S.O.), Rush Alzheimer Disease Research Center in Chicago, IL; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen, Denmark; Department of Molecular and Clinical Medicine (A.R.), University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Medicine (A.A.), International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; Department of Medicine (P.L.-J.), Instituto de Investigaciones MASIRA, Universidad de Santander, Bucaramanga, Colombia; Department of Medicine (D.X.), St John's Medical College and Research Institute, Bangalore, India; and Department of Medicine (X.W.), Beijing Hypertension League Institute, China.ORCID 0000-0002-5409-6605
Alvaro AvezumFrom the Department of Medicine (C.E.M.C., C.J., A.A.-I., M.O.D.), University of Galway, Ireland; Department of Medicine (S.Y., S.R.), Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), Faculty of Health and Medical Sciences, University of Western Australia, Perth; Department of Medicine (S.O.), Rush Alzheimer Disease Research Center in Chicago, IL; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen, Denmark; Department of Molecular and Clinical Medicine (A.R.), University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Medicine (A.A.), International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; Department of Medicine (P.L.-J.), Instituto de Investigaciones MASIRA, Universidad de Santander, Bucaramanga, Colombia; Department of Medicine (D.X.), St John's Medical College and Research Institute, Bangalore, India; and Department of Medicine (X.W.), Beijing Hypertension League Institute, China.
Patricio Lopez-JaramilloFrom the Department of Medicine (C.E.M.C., C.J., A.A.-I., M.O.D.), University of Galway, Ireland; Department of Medicine (S.Y., S.R.), Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), Faculty of Health and Medical Sciences, University of Western Australia, Perth; Department of Medicine (S.O.), Rush Alzheimer Disease Research Center in Chicago, IL; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen, Denmark; Department of Molecular and Clinical Medicine (A.R.), University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Medicine (A.A.), International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; Department of Medicine (P.L.-J.), Instituto de Investigaciones MASIRA, Universidad de Santander, Bucaramanga, Colombia; Department of Medicine (D.X.), St John's Medical College and Research Institute, Bangalore, India; and Department of Medicine (X.W.), Beijing Hypertension League Institute, China.
Denis XavierFrom the Department of Medicine (C.E.M.C., C.J., A.A.-I., M.O.D.), University of Galway, Ireland; Department of Medicine (S.Y., S.R.), Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), Faculty of Health and Medical Sciences, University of Western Australia, Perth; Department of Medicine (S.O.), Rush Alzheimer Disease Research Center in Chicago, IL; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen, Denmark; Department of Molecular and Clinical Medicine (A.R.), University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Medicine (A.A.), International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; Department of Medicine (P.L.-J.), Instituto de Investigaciones MASIRA, Universidad de Santander, Bucaramanga, Colombia; Department of Medicine (D.X.), St John's Medical College and Research Institute, Bangalore, India; and Department of Medicine (X.W.), Beijing Hypertension League Institute, China.
Xingyu WangFrom the Department of Medicine (C.E.M.C., C.J., A.A.-I., M.O.D.), University of Galway, Ireland; Department of Medicine (S.Y., S.R.), Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), Faculty of Health and Medical Sciences, University of Western Australia, Perth; Department of Medicine (S.O.), Rush Alzheimer Disease Research Center in Chicago, IL; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen, Denmark; Department of Molecular and Clinical Medicine (A.R.), University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Medicine (A.A.), International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; Department of Medicine (P.L.-J.), Instituto de Investigaciones MASIRA, Universidad de Santander, Bucaramanga, Colombia; Department of Medicine (D.X.), St John's Medical College and Research Institute, Bangalore, India; and Department of Medicine (X.W.), Beijing Hypertension League Institute, China.
Sumathy RangarajanFrom the Department of Medicine (C.E.M.C., C.J., A.A.-I., M.O.D.), University of Galway, Ireland; Department of Medicine (S.Y., S.R.), Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), Faculty of Health and Medical Sciences, University of Western Australia, Perth; Department of Medicine (S.O.), Rush Alzheimer Disease Research Center in Chicago, IL; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen, Denmark; Department of Molecular and Clinical Medicine (A.R.), University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Medicine (A.A.), International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; Department of Medicine (P.L.-J.), Instituto de Investigaciones MASIRA, Universidad de Santander, Bucaramanga, Colombia; Department of Medicine (D.X.), St John's Medical College and Research Institute, Bangalore, India; and Department of Medicine (X.W.), Beijing Hypertension League Institute, China.
Martin O'DonnellFrom the Department of Medicine (C.E.M.C., C.J., A.A.-I., M.O.D.), University of Galway, Ireland; Department of Medicine (S.Y., S.R.), Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), Faculty of Health and Medical Sciences, University of Western Australia, Perth; Department of Medicine (S.O.), Rush Alzheimer Disease Research Center in Chicago, IL; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen, Denmark; Department of Molecular and Clinical Medicine (A.R.), University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Medicine (A.A.), International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; Department of Medicine (P.L.-J.), Instituto de Investigaciones MASIRA, Universidad de Santander, Bucaramanga, Colombia; Department of Medicine (D.X.), St John's Medical College and Research Institute, Bangalore, India; and Department of Medicine (X.W.), Beijing Hypertension League Institute, China.
for INTERSTROKE
Population Health Research Institute · CA
Funding
CIHR
Abstract
BACKGROUND AND
objectivesSymptoms of sleep disturbance are common and may represent important modifiable risk factors of stroke. We evaluated the association between a spectrum of sleep disturbance symptoms and the risk of acute stroke in an international setting.
methodsThe INTERSTROKE study is an international case-control study of patients presenting with first acute stroke and controls matched by age (±5 years) and sex. Sleep symptoms in the previous month were assessed through a questionnaire. Conditional logistic regression estimated the association between sleep disturbance symptoms and acute stroke, expressed as odds ratios (ORs) and 95% CIs. The primary model adjusted for age, occupation, marital status, and modified Rankin scale at baseline, with subsequent models adjusting for potential mediators (behavioral/disease risk factors).
resultsOverall, 4,496 matched participants were included, with 1,799 of them having experienced an ischemic stroke and 439 an intracerebral hemorrhage. Short sleep (<5 hours: OR 3.15, 95% CI 2.09-4.76), long sleep (>9 hours: OR 2.67, 95% CI 1.89-3.78), impaired quality (OR 1.52, 95% CI 1.32-1.75), difficulty getting to sleep (OR 1.32, 95% CI 1.13-1.55) or maintaining sleep (OR 1.33, 95% CI 1.15-1.53), unplanned napping (OR 1.48, 95% CI 1.20-1.84), prolonged napping (>1 hour: OR 1.88, 95% CI 1.49-2.38), snoring (OR 1.91, 95% CI 1.62-2.24), snorting (OR 2.64, 95% CI 2.17-3.20), and breathing cessation (OR 2.87, 95% CI 2.28-3.60) were all significantly associated with an increased odds of acute stroke in the primary model. A derived obstructive sleep apnea score of 2-3 (2.67, 2.25-3.15) and cumulative sleep symptoms (>5: DISCUSSION: We found that sleep disturbance symptoms were common and associated with a graded increased risk of stroke. These symptoms may be a marker of increased individual risk or represent independent risk factors. Future clinical trials are warranted to determine the efficacy of sleep interventions in stroke prevention.
Indexed as
Sleep Apnea, ObstructiveSleep Apnea SyndromesStrokeCase-Control StudiesHumansRisk FactorsSleep
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