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Very recent studies in the general population suggest that the presence of multiple SWD increases cardio\u2010cerebrovascular risk. Hence, the aim of this study was to asssess whether a novel score capturing the burden of multiple SWD, a so called \"sleep burden index\", is predictive for subsequent CCE including death in a prospectively followed cohort of stroke patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with acute ischemic stroke or transient ischemic attack (TIA) were prospectively recruited. Four SWD were analyzed: (i) SDB with respirography; (ii) insomnia (defined using the insomnia severity index [ISI]); (iii) restless legs syndrome (RLS; defined using the International RLS Study Group rating scale); and (iv) self\u2010estimated sleep duration at 1 and 3\u2009months. A \u201csleep burden index\u201d, calculated using the mean of <jats:italic>z<\/jats:italic>\u2010transformed values from assessments of these four SWD, was created. The occurrence of CCE was recorded over a mean\u2009\u00b1\u2009standard deviation (SD) follow\u2010up of 3.2\u2009\u00b1\u20090.3\u2009years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We assessed 437 patients (87% ischemic stroke, 13% TIA, 64% males) with a mean \u00b1 SD age of 65.1\u2009\u00b1\u200913.0\u2009years. SDB (respiratory event index \u2265\u20095\/h) was present in 66.2% of these patients. Insomnia (ISI\u2009\u2265\u200910), RLS and extreme sleep duration affected 26.2%, 6.4% and 13.7% of the patients 3 months post\u2010stroke. Seventy out of the 437 patients (16%) had at least one CCE during the follow\u2010up. The sleep burden index was associated with a higher risk for subsequent CCE, including death (odds ratio\u20091.80 per index unit, 95% confidence interval 1.19\u20132.72; <jats:italic>p<\/jats:italic>\u00a0=\u00a00.0056).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The presence of multiple SWDs constitutes a risk for subsequent CCE (including death) within the first 3\u2009years following stroke. Larger systematic studies should assess the utility of the sleep burden index for patients' risk stratification in clinical practice.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.15784","type":"journal-article","created":{"date-parts":[[2023,3,13]],"date-time":"2023-03-13T11:57:16Z","timestamp":1678708636000},"page":"1696-1705","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Multiple sleep\u2013wake disturbances after stroke predict an increased risk of cardio\u2010cerebrovascular events or death: A prospective cohort study"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7247-0760","authenticated-orcid":false,"given":"Simone B.","family":"Duss","sequence":"first","affiliation":[{"name":"Department of Neurology, Inselspital Bern University Hospital, University of Bern  Bern Switzerland"},{"name":"Interdisciplinary Sleep\u2010Wake\u2010Epilepsy\u2010Center, Inselspital Bern University Hospital, University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corrado","family":"Bernasconi","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital Bern University Hospital, University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Steck","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital Bern University Hospital, University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne\u2010Kathrin","family":"Brill","sequence":"additional","affiliation":[{"name":"Interdisciplinary Sleep\u2010Wake\u2010Epilepsy\u2010Center, Inselspital Bern University Hospital, University of Bern  Bern Switzerland"},{"name":"Department of Pulmonary Medicine and Allergology, Inselspital Bern University Hospital, University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Manconi","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital Bern University Hospital, University of Bern  Bern Switzerland"},{"name":"Sleep Medicine Unit Neurocenter of Southern Switzerland, EOC, Ospedale Civico  Lugano Switzerland"},{"name":"Faculty of Biomedical Sciences Universit\u00e0 della Svizzera Italiana  Lugano Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1627-2882","authenticated-orcid":false,"given":"Martijn","family":"Dekkers","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital Bern University Hospital, University of Bern  Bern Switzerland"},{"name":"Interdisciplinary Sleep\u2010Wake\u2010Epilepsy\u2010Center, Inselspital Bern University Hospital, University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus H.","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital Bern University Hospital, University of Bern  Bern Switzerland"},{"name":"Interdisciplinary Sleep\u2010Wake\u2010Epilepsy\u2010Center, Inselspital Bern University Hospital, University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4535-0245","authenticated-orcid":false,"given":"Claudio L. 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