Trouble Falling Asleep, Staying Asleep Linked to Increased Risk of Stroke

By American Academy of Neurology

People who have insomnia symptoms such as trouble falling asleep, staying asleep and waking up too early, may be more likely to have a stroke, according to a study published in Neurology. In addition, researchers found the risk was much higher in people under 50 years old. The study does not prove that insomnia symptoms cause stroke; it only shows an association.

"There are many therapies that can help people improve the quality of their sleep, so determining which sleep problems lead to an increased risk of stroke may allow for earlier treatments or behavioral therapies for people who are having trouble sleeping and possibly reducing their risk of stroke later in life," said study author Wendemi Sawadogo, MD, MPH, Ph.D., of Virginia Commonwealth University in Richmond and member of the American Academy of Neurology.

The study involved 31,126 people with an average age of 61. Participants had no history of stroke at the beginning of the study.

Participants were asked four questions about how often they had trouble falling asleep, trouble with waking up during the night, trouble with waking up too early and not being able to return to sleep, and how often they felt rested in the morning. Response options included "most of the time", "sometimes" or "rarely or never." Scores ranged from zero to eight, with a higher number meaning more severe symptoms.

The people were then followed for an average of nine years. During that time, there were 2,101 cases of stroke.

After adjusting for other factors that could affect the risk of stroke including alcohol use, smoking and level of physical activity, researchers found that people with one to four symptoms had a 16% increased risk of stroke compared to people with no symptoms. Of the 19,149 people with one to four symptoms, 1,300 had a stroke. Of the 6,282 people with no symptoms, 365 had a stroke. People with five to eight symptoms of insomnia had a 51% increased risk. Of the 5,695 people with five to eight symptoms, 436 had a stroke.

The link between insomnia symptoms and stroke was stronger in participants under age 50 with those who experienced five to eight symptoms having nearly four times the risk of stroke compared to people with no symptoms. Of the 458 people under age 50 with five to eight symptoms, 27 had a stroke. People age 50 or older with the same number of symptoms had a 38% increased risk of stroke compared to people with 33 had a stroke.

"This difference in risk between these two age groups may be explained by the higher occurrence of stroke at an older age, " Sawadogo added. "The list of stroke risk factors such as high blood pressure and diabetes can grow as people age, making insomnia symptoms one of many possible factors. This striking difference suggests that managing insomnia symptoms at a younger age may be an effective strategy for stroke prevention. Future research should explore the reduction of stroke risk through management of sleeping problems."

This association increased further for people with diabetes, hypertension, heart disease and depression.

A limitation of the study was that people reported their own symptoms of insomnia, so the information may not have been accurate.

More information: Neurology (2023).

Journal information: Neurology 

Stakeholder Listening Sessions for CAPS Check Rule Changes

The Colorado Department of Human Services’ Adult Protective Services program welcomes your participation in stakeholder listening sessions on June 28 and 29 to review draft rule changes [current draft linked here for reference] for the CAPS Check process. This draft rulemaking process is underway to implement the recently passed Senate Bill 23-040 ("Staffing Agency CAPS Checks"), which created role clarity for CAPS Checks when employers obtain staffing resources through a third-party agency meeting the definition of "staffing agency" as defined in the bill. The bill also authorizes previously prohibited information sharing between agencies supplying staff to employers and the employers receiving staff to ensure efficiency and reduction of duplicated efforts. These changes are set to go into effect in January 2024. Rulemaking will proceed over the coming months. We would appreciate your feedback! 

We will hold two virtual listening sessions for interested stakeholders. Meeting information for both sessions is below. If you are unable to attend these sessions, they will be recorded and posted to the APS website and the CAPS Check Unit (CCU) website within one week of the meetings, and the websites will be maintained with current information throughout the rulemaking process, including additional opportunities for public comment. Listening sessions will include a very brief overview of the draft rule changes, with the remainder of the time open for public questions and comments.  

Listening Session Details:

June 28, 9-10 a.m.
Join online:  https://meet.google.com/zph-rnfp-efe
Join by phone: 225.629.1220 PIN: 520 367 795#

June 29, 2:30-3:30 p.m.
Join online: https://meet.google.com/fvb-uocf-djn
Join by phone:  224.420.9573 PIN: ‪513 161 967#

For additional questions related to this rulemaking, you can also provide feedback in the following ways:

• Feedback form: You are welcome to complete our feedback form to send us any thoughts, questions or concerns about the rule draft. We will collect and monitor this form periodically throughout the rulemaking process. 
• Contact us directly: 
  • Stefanie Woodard, APS Program Director: [email protected]
  • Kara Harvey, Aging and Adult Services Division Director: [email protected]

COVID Relief Opportunities

NAHC

Tuesday,  June 20, 2023 (1:00 PM – 2:00 PM MT)

The Health Resources & Services Administration (HRSA) recently announced that it stopped making payments to providers under the Provider Relief Fund (PRF) and the COVID-19 Uninsured Program (UIP). HRSA made that announcement even though the Fiscal Responsibility Act of 2023 actually reserved billions of dollars in unobligated COVID-19 relief funding. 

If you are pending Phase 3 or Phase 4 application or reconsideration request for PRF dollars or was not paid for services covered by the UIP program, join this webinar! 

During the webinar, speakers will cover opportunities to (1) challenge the HRSA policy decision ending PRF distributions and (2) pursue payment for services covered by the UIP program. 

REGISTER

PMHC Survey and One Pager on Medicaid Access Rule

As you know, our national associations NAHC, HCAOA and PMHC are working on feedback to CMS about the proposed Medicaid Access rule.  While the organizations support the bulk of the proposed rule, all three organizations are concerned about a proposal that would mandate 80 percent of a reimbursement rate for Medicaid home care to go to compensation and 20 percent to go to everything else. See attached one pager for more information on the proposed rule and this specific proposal.  

Please complete the following 12 question survey from the Partnership for Medicaid Home-Based Care (PMHC) no later than June 16, 2023.  Responses will be anonymous, but the collective information will give our national associations a sense of impact to the home care industry that can be shared with CMS and other policymakers.  

5 Minute Provider Survey on 80/20 threshold – to be completed by June 16
https://www.surveymonkey.com/r/TJK29WR

Also, please find the Medicaid Cost Collection Tool, designed by MAJC to collect information about the major cost-centers that account for your Medicaid-related expenditures. This workbook is intended to inform NAHC's Medicaid Access Rule advocacy and responses will not be shared publicly. All information provided within will be kept confidential, and calculations used in public documents will be made in the aggregate and will not identify any specific organization.

The first sheet of the Excel file contains instructions on how to populate the data fields. If you have any questions about how to fill out the workbook or how the data may be used, please contact Damon Terzaghi, Director of Medicaid Advocacy, at [email protected]

Due to the July 3, 2023, deadline for comments on the proposed rule, we are working under very tight timelines and we hope you understand the importance of this data request. We respectfully request that you submit a response no later than June 16, 2023.