Obstructive Sleep Apnea and Wake-up Stroke - A 12 Months Prospective Longitudinal Study.

BACKGROUND: Wake-up stroke (WUS) are strokes that are noted upon awakening in patients previously going to bed in a normal state of health. The role of sleep abnormalities in WUS is uncertain. The objective was to determine clinical characteristics, respiratory abnormalities during sleep and outcomes in patients with WUS versus non-WUS. METHODS: At baseline, patients with ischemic stroke were examined clinically and with a portable sleep recorder. Apnea-Hypopnea Index greater than or equal to 20 defined a cut-off severity index. At follow-up (3 and 12-months), patients were re-evaluated clinically and with questionnaires: Epworth Sleepiness Scale, Modified Rankin (MR) and Modified Barthel Index Results: Among all (N = 102, 64% male), hypertension (73%), Type 2 diabetes (29.4), heart disease (16.7%), physical inactivity (69.6%), smoking (32.4%) and alcohol consumption (17.6) were found. Apnea-Hypopnea Index (AHI) greater than 5 (92.9%), AHI greater than 15 (44.7%), AHI greater than or equal to 20 (35.3%) and AHI greater than 30 (11.8%) were registered. Cases with and without WUS did not differ regarding polygraphic findings. Long apneas (apnea duration > 20 s) was equally found in patients with WUS (23.1%) and non-WUS (23.7%). Type 2 diabetes mellitus (T2D) was independently associated with WUS (OR = 2.76; CI: 1.10-6.05; P = .03). Prospectively, symptom severity was not different between WUS and non-WUS. Overall, patients with OSA (IAH≥20) evolved with worse functional performance (MR, P = .02). CONCLUSIONS: Wake-up stroke occurred in approximately 1 of 3 of cases. Irrespective of WUS, half of the patients had moderate to severe sleep apnea; those with OSA (AHI≥ 20) evolved with worse functional performance after 1 year. WUS was associated with TDM reinforcing a relationship with cerebral small vessel disease.

International Survey on the Management of Wake-Up Stroke.

BACKGROUND: Patients who wake up having experienced a stroke while asleep represent around 20% of acute stroke admissions. According to international guidelines for the management of acute stroke, patients presenting with wake-up stroke are not currently eligible to receive revascularization treatments. In this study, we aimed to assess the opinions of stroke experts about the management of patients with wake-up stroke by using an international multicenter electronic survey. METHOD: This study consisted of 8 questions on wake-up stroke treatment. RESULTS: Two hundred invitations to participate in the survey were sent by e-mail. Fifty-nine participants started the survey, 4 dropped out before completing it, and 55 completed the full questionnaire. We had 55 participants from 22 countries. CONCLUSIONS: In this study, most stroke experts recommended a recanalization treatment for wake-up stroke. However, there was considerable disagreement among experts regarding the best brain imaging method and the best recanalization treatment. The results of ongoing randomized trials on wake-up stroke are urgently needed.