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

Abstract

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.

Nomogram for predicting moderate-to-severe sleep-disordered breathing in patients with acute ischaemic stroke: a retrospective cohort study

“…A prior study with 95 TIA and mild to moderate stroke patients showed that WUS was associated with moderate-to-severe OSA and worse short-term outcomes. 14 We also found a strong correlation between WUS and SDB, with patients with WUS having an approximately 21.91 times higher risk of SDB when compared with those without WUS. A possible explanation for this might be the occurrence of severe hypoxia at night, which contributed to the WUS in patients with SDB.…”

No Difference in Sleep Desaturations Severity between Patients with Wake-Up and Non-Wake-Up Stroke: A PRESS Study Results

“…Their meta-analysis included 13 studies and showed that SAS-prevalence is significantly higher in WUS patients [ 8 ], with a significantly higher severity of sleep apnea according to AHI and ODI ( p = 0.017 , and p = 0.035 ). This topic was researched by Barreto et al, Haula et al, and Schütz et al [ 32 , 33 , 34 ] and the results of cited studies suggested that preexisting sleep apnea is associated with the occurrence of WUS or even with worse short-term outcomes measured in mRS [ 33 ]. Kim et al in 2018, using the Berlin Questionnaire [ 10 ], found that preexisting witnessed or self-recognized sleep apnea was significantly more frequent in WUS when compared to the non-WUS population (28.3% vs. 16.6%, p = 0.036).…”

Presence of Self-Reported Sleep Alterations After Stroke and Their Relationship With Disability: A Longitudinal Study

“…6 Furthermore, obstructive sleep apnea is an independent risk factor for stroke, and studies suggest a relationship between obstructive sleep apnea and the occurrence of ischemic stroke during sleep, with the first signs of stroke first noted upon awakening from sleep (wake-up stroke). 7,8 The main obstructive sleep apnea symptoms include snoring, sleep fragmentation, witnessed apneas, morning headaches, decreased concentration, memory loss, and excessive daytime sleepiness. Excessive daytime sleepiness is a common symptom in stroke individuals and can be explained by insufficient sleep, sleep fragmentation, or the presence of sleep disorders.…”