Wake-up stroke is not associated with sleep-disordered breathing in women

Brown, Devin L.; Li, Chengwei; Chervin, Ronald D.; Case, Erin; Garcia, Nelda; Tower, Susan; Lisabeth, Lynda D.

doi:10.1212/cpj.0000000000000412

Cited by 13 publications

(10 citation statements)

References 15 publications

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“…In our previous study, higher proportion of males had OSA. In a study by Brown et al (2018) they did not find a relationship between female, SDB, and mild WUS (Brown et al, 2018).…”

Section: Discussionmentioning

confidence: 83%

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Wake‐up strokes are linked to obstructive sleep apnea and worse early functional outcome

et al. 2021

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Background and Aims: Presence of sleep-disordered breathing (SDB) and especially obstructive sleep apnea (OSA) is a known risk factor for ischemic stroke. Additionally, SDB effects negatively on recovery after stroke. Up to one fourth of strokes are present on awakening. The link between OSA and wake-up stroke (WUS) has been suggested.We aim to determine the association between OSA and WUS in a Finnish stroke unit cohort. Material and Methods: An observational prospective longitudinal study consisted of 95 TIA (transient ischemic attack) and mild to moderate stroke patients referred to a Stroke Unit in Finland. Respiratory polygraphy was performed within 72 h of hospital admission. Patients were classified into WUS and non-WUS, and functional outcome measures (mRS, rehabilitation, hospitalization time) were collected. Functional outcomes and prevalence of OSA were compared between non-WUS and WUS.Results: OSA (AHI > 15/h) was more frequent among WUS than non-WUS (71% and 36%, respectively, p = 0.009). Functional outcome measured with mRS was worse in patients with WUS than non-WUS on registration day and at hospital discharge (p = 0.001). Need for rehabilitation in WUS was 43% of cases compared to 23% of non-WUS (p = 0.067). Hospitalization time was longer (5-15days) in 55% of WUS and 41% of non-WUS patients (p = 0.261). Conclusion:Moderate-to-severe OSA is related to WUS compared to non-WUS. In addition, WUS have worse short-term outcomes measured in mRS. Further studies are needed to determine if OSA is causally linked to WUS.

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“…In our previous study, higher proportion of males had OSA. In a study by Brown et al (2018) they did not find a relationship between female, SDB, and mild WUS (Brown et al, 2018).…”

Section: Discussionmentioning

confidence: 83%

“…In a study by Brown et al. (2018) they did not find a relationship between female, SDB, and mild WUS (Brown et al., 2018).…”

Section: Discussionmentioning

confidence: 96%

Wake‐up strokes are linked to obstructive sleep apnea and worse early functional outcome

et al. 2021

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“…The cross-sectional analysis of data from the Sleep Apnea in Transient Ischemic Attack and Stroke (SLEEP TIGHT) study has also shown in 81 stroke patients who underwent polysomnography in the subacute phase (median interval from stroke: 48 days) that patients with WUS had 12 significantly higher rates of severe OSA but this difference was only significant for men (AHI>30: 45.0% vs. 17.6%; p=0.03) [74]. Such a difference in sex was recently confirmed by Brown et al in 259 women with acute ischemic stroke who benefited from apnea screening using the ApneaLink Plus device (AL; Resmed, Poway, CA, USA) a median 11 days poststroke: WUS was not associated with the presence or severity of OSA in unadjusted or adjusted analysis (prevalence of respiratory event index ≥10/h: 55.4% in WUS vs 52.4% in non-WUS women) [75].…”

Section: Osa Is a Risk Factor Of Strokementioning

confidence: 78%

“…A recent prospective study has found an independent association between newly diagnosed atrial fibrillation (AF) and WUS; the odds of detecting a newly diagnosed AF were 3-fold higher among wake-up cerebrovascular events than among non-wake-up events [24]. In this prospective study including 356 patients (274 stroke and 82 transient ischemic attack, median age 72 years (interquartile range, IQR [62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79]), AF was detected with immediate and continuous electrocardiographic monitoring for at least 72 hours after admission: 41 (11.5%) events occurred during night sleep. Among WUS patients, 17.1% were newly diagnosed with AF (vs. 6.3% of non-WUS patients, p=0.015), and the association remained significant after adjusting for age, sex, hypertension, severity of neurological deficit on admission, left ventricular fraction, atrial area, and diabetes mellitus [24].…”

Section: Circadian Factormentioning

confidence: 99%

Wake-up stroke: From pathophysiology to management

Peter‐Derex

Derex

2019

Sleep Medicine Reviews

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“…A population-based prospective study of WUS in women enrolled 466 participants; of whom, 25% reported that strokes began during nocturnal sleep in 25%, during a nap in 4%, awake in 66%, and unknown in 5%. 18 Sleep apnea testing was performed a median of 11 days (IQR 5, 17) after stroke onset. Sleep disordered breathing (SDB) was not associated with WUS in unadjusted or adjusted analysis.…”

Section: What Predisposes To Stroke In Sleep?mentioning

confidence: 99%

Stroke: What's Sleep Got to Do With It?

Zafar

Dhruv

Anwar

et al. 2022

Journal of Clinical Neurophysiology

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Ischemic strokes most often occur between 6 AM and 12 AM after awakening from sleep but up to 30% occur during sleep. Wake-up strokes (WUS) are new focal neurological deficit(s) persisting for $ 24 hours attributable to an ischemic event present on patient awakening. Obstructive sleep apnea (OSA) is a major risk factor for WUS because it compounds the instability of the morning environment and increases the likelihood of cardiovascular events, including hypertension, atrial fibrillation, right-to-left shunts, and stroke. Circadian-driven alterations in structural, homeostatic, and serological factors also predispose to WUS. Also, WUS patients are often not considered candidates for time-dependent intravenous thrombolysis therapy because of an uncertain onset time. However, using the tissue clock (positive diffusion weighted imaging-negative fluidattenuated inversion recovery mismatch) dates the WUS as 3 to 4.5 hours old and permits consideration for intravenous thrombolysis and if needed mechanical thrombectomy. Given the high prevalence of moderate/severe OSA in stroke patients and its impact on stroke outcomes, screening with overnight pulse oximetry and home sleep apnea test is needed. Treating OSA poststroke remains challenging. Polysomnographic changes in sleep architecture following acute/subacute stroke may also impact upon stroke outcome.

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Wake-up stroke is not associated with sleep-disordered breathing in women

Abstract: In this population-based study, WUS represented about 30% of all generally mild severity ischemic strokes in women and was not associated with SDB.

Cited by 13 publications

References 15 publications

Wake‐up strokes are linked to obstructive sleep apnea and worse early functional outcome

Wake‐up strokes are linked to obstructive sleep apnea and worse early functional outcome

Wake-up stroke: From pathophysiology to management

Stroke: What's Sleep Got to Do With It?

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