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Substitutions of Sleep, Physical Activity, and Sedentary Behaviour and the Risk of Dementia and Stroke
Sanne J W Hoepel, M. Kamran Ikram, M. Arfan Ikram, Trudy Voortman, Annemarie Ida Luik. Journal of Sleep Research, 2025-08-12
Topic: Risk, prevention and care in population studies
Sleep, sedentary behaviour, and physical activity (PA) are important for brain health. Spending more time in one behaviour always substitutes time in another, which may affect associations and should be considered in prevention strategies. We assessed how substitutions of sleep, sedentary behaviour, and PA are associated with incident dementia and stroke, using compositional analysis. Participants (mean age: 71.3 ± 9.26 years, 51.6% female) without prevalent dementia (N = 1899) or stroke (N = 1854) from the Rotterdam Study wore an accelerometer for ≥ 4 days to estimate the duration of sleep, sedentary behaviour, light PA, and moderate-to-vigorous PA. Participants were continuously followed up for dementia (median: 4.5 years) and stroke (median: 5.1 years). Compositional Cox regression with isotemporal substitution analysis was used to assess associations of 30-min pair-wise substitutions with dementia and stroke. In total, 50 (2.6%) participants were diagnosed with dementia and 75 (4.0%) with a first-time stroke. Spending more time in moderate-to-vigorous PA and less in other behaviours was associated with a lower risk of dementia (Hazard Ratio [HR] for 30 min less sedentary behaviour 0.36; 95% CI: 0.24-0.55) and so was more sleep and less sedentary behaviour (HR: 0.87; 0.79-0.97) or light PA (HR: 0.43; 0.27-0.68). Those with more light PA and less sedentary behaviour had a higher risk of dementia (HR: 1.78; 1.19-2.66). Only having more sleep and less sedentary behaviour was associated with having a stroke (HR: 1.14; 1.03-1.27). More time in sleep and moderate-to-vigorous PA, substituting particularly sedentary behaviour, may be a modifiable risk factor for dementia. No consistent effects for stroke were found, warranting future research.
Key findings
- We assessed how substitutions of sleep, sedentary behaviour, and PA are associated with incident dementia and stroke, using compositional analysis.
- Spending more time in moderate-to-vigorous PA and less in other behaviours was associated with a lower risk of dementia (Hazard Ratio [HR] for 30 min less sedentary behaviour 0.36; 95% CI: 0.24-0.55) and so was more sleep and less sedentary behaviour (HR: 0.87; 0.79-0.97) or light PA (HR: 0.43; 0.27-0.68).
- Those with more light PA and less sedentary behaviour had a higher risk of dementia (HR: 1.78; 1.19-2.66).
- Only having more sleep and less sedentary behaviour was associated with having a stroke (HR: 1.14; 1.03-1.27).
Why it matters
In this cohort, replacing sedentary behaviour with moderate-to-vigorous physical activity, light activity or sleep was linked to lower dementia risk. These findings come from an observational study and cannot show that changing behaviour directly prevents dementia.
Study details
- Participants1,899
- Effect size51.6%; 2.6%; 4.0%
- Evidence strengthLow
How this study scored 42/100
Published in a peer-reviewed journal. Scored zero for study design and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of Sleep Research) |
| Journal's citation record | 2 / 4 | Journal of Sleep Research: journal h-index 177 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 3 / 4 | 1,899 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 1 / 7 | Cited 1 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.3 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 1 / 6 | Cited 0.5× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 1 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Annemarie Ida Luik: h-index 45 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Erasmus MC: institution h-index 1,321 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 40793962) |
| Free to read | 2 / 2 | Free to read |
| Total | 42 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1111/jsr.70166
- PubMed: 40793962
- Original source →
- Free full text: Journal of Sleep Research →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Hoepel, S. J. W., Ikram, M. K., Ikram, M. A., Voortman, T., & Luik, A. I. (2025). Substitutions of Sleep, Physical Activity, and Sedentary Behaviour and the Risk of Dementia and Stroke. Journal of Sleep Research. https://doi.org/10.1111/jsr.70166
Vancouver
Hoepel SJW, Ikram MK, Ikram MA, Voortman T, Luik AI. Substitutions of Sleep, Physical Activity, and Sedentary Behaviour and the Risk of Dementia and Stroke. Journal of Sleep Research. 2025. doi:10.1111/jsr.70166. PMID: 40793962.
BibTeX
@article{hoepel2025-40793962,
author = {Hoepel, Sanne J W and Ikram, M. Kamran and Ikram, M. Arfan and Voortman, Trudy and Luik, Annemarie Ida},
title = {{Substitutions of Sleep, Physical Activity, and Sedentary Behaviour and the Risk of Dementia and Stroke}},
journal = {Journal of Sleep Research},
year = {2025},
doi = {10.1111/jsr.70166},
pmid = {40793962},
url = {https://doi.org/10.1111/jsr.70166}
}
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