Increased Risk of Ischemic Stroke during Sleep in Apneic Patients

BACKGROUND AND PURPOSE: The literature indicates that obstructive sleep apnea (OSA) increases the risk of ischemic stroke. However, the causal relationship between OSA and ischemic stroke is not well established. This study examined whether preexisting OSA symptoms affect the onset of acute ischemic stroke. METHODS: We investigated consecutive patients who were admitted with acute ischemic stroke, using a standardized protocol including the Berlin Questionnaire on symptoms of OSA prior to stroke. The collected stroke data included the time of the stroke onset, risk factors, and etiologic subtypes. The association between preceding OSA symptoms and wake-up stroke (WUS) was assessed using multivariate logistic regression analysis. RESULTS: We identified 260 subjects with acute ischemic strokes with a definite onset time, of which 25.8% were WUS. The presence of preexisting witnessed or self-recognized sleep apnea was the only risk factor for WUS (adjusted odds ratio=2.055, 95% confidence interval=1.035–4.083, p=0.040). CONCLUSIONS: Preexisting symptoms suggestive of OSA were associated with the occurrence of WUS. This suggests that OSA contributes to ischemic stroke not only as a predisposing risk factor but also as a triggering factor. Treating OSA might therefore be beneficial in preventing stroke, particularly that occurring during sleep.

Application of mechanical thrombectomy in the patients with wake-up stroke / 上海交通大学学报（医学版）

Wake-up stroke (WUS), which is characterized by the uncertain onset time and poor short-term outcome, accounts for 25% of stroke. Due to the above two points, how to choose the treatment methods remains to be researched. The mechanical thrombectomy is the first-line treatment of acute ischemic stroke (AIS). DAWN and DEFUSE-3 studies have recently demonstrated that the treatment window can be expanded to 24 hours, so the endovascular treatment may be effective and safe in some WUS patients according to the existence of "the mismatch of clinical score and imaging infart core" by CT perfusion imaging and other modern imaging methods. This article summarized the application of mechanical thrombectomy in WUS treatment in recent years.

Wake Up and Non-Wake up stroke: A comparative Hospital Based Study.

Background: Almost 25% of all acute ischemic strokes occur during sleep with the patients or relatives become aware of the neurological deficits as they wake up. The present study was conducted with an aim to find out the prevalence of wakeup stroke along with clinical profile and outcome of wake up stroke as compared to non-wake up stroke. Methods: All patients of age group 18 years or more presenting with stroke during the 12-month study period were included. Data was compared with non-wakeup stroke by applying Chi square test, Fischer exact test and Yates corrections was used to evaluate the association between the variables defining the clinical profile and outcome. Results: Patients of non wake-up stroke were higher (63%) as compared to wake-up stroke (37%). Out of 37 wake-up stroke patients, ischemic stroke was found in 23(62.16%) and hemorrhagic stroke in 14(37.83%) patients. Out of 14(37.83%) wakeup strokes; in 8(57.14%) patients lesion was parenchymal and in 5(35.71%) multiple lesions were present. Higher incidence of diabetes mellitus in wake up strokes was found. Atherothrombotic and cardioembolic strokes contribute to majority of the cases of ischemic stroke. Conclusions: The incidence of stroke increases dramatically with advancing age irrespective of gender. .Diabetes mellitus emerged as the main risk factor in wake-up stroke. In wake up hemorrhagic stroke, the higher percentage of thalamic bleed was found. Improvement was appreciated more in non wake-up stroke as compared to wake-up stroke.