Obstructive sleep apnea linked to wake-up strokes

Hsieh, Sun‐Wung; Lai, Chiou-Lian; Liu, Ching-Kuan; Hsieh, Ching‐Hua; Hsu, Chung‐Yao

doi:10.1007/s00415-011-6370-9

Cited by 59 publications

(62 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our study, as well as previous studies, confirmed the association of WUS with SDB, which is a treatable risk factor of vascular diseases. [17][18][19] Using respiratory polysomnography (Autoset Portable Plus II device) in 164 patients with diagnosis of acute stroke, Martinez Garcia et al found significantly higher AHI (33.3 vs. 24.7), greater nighttime desaturation, and a greater probability of SDB symptoms prior to stroke in strokes occurred during sleep or on waking compared to the strokes that occurred during the rest of the day. 18 Bassetti et al among 152 patients with acute ischemic stroke found age, diabetes mellitus, and nighttime stroke onset to be independent predictors of AHI.…”

Section: Discussionmentioning

confidence: 99%

Association of Sleep Disordered Breathing with Wake-Up Acute Ischemic Stroke: A Full Polysomnographic Study

Šiarnik

Kollár

Čarnická

et al. 2016

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

Study Objectives: Sleep disordered breathing (SDB) is a frequent comorbidity in stroke patients. SDB is one of the independent risk factors for ischemic stroke. Conversely, stroke may contribute to SDB onset or aggravate premorbid SDB. Multiple mechanisms underlying SDB might be responsible for the development of stroke. The aim of this study was to compare polysomnographic, clinical, and laboratory characteristics of wake-up (WUS) and non-wake-up acute ischemic strokes (NWUS). Methods: We prospectively enrolled 88 patients with acute ischemic stroke. Clinical characteristics of the population were recorded on admission, and blood samples were obtained in the fasting condition following morning. SDB was assessed using standard overnight polysomnography in the acute phase of the stroke. Results: WUS were present in 16 patients (18.2%), and NWUS in 72 patients (81.8%). In WUS compared to NWUS, we observed significantly higher values of apnea-hypopnea index (24.8 vs. I NTRO DUCTI O NA recent population-based study has shown that wake-up strokes (WUS) comprise 14% of all ischemic strokes. The same study concludes, that WUS do not differ from non-wake up strokes (NWUS) in clinical features, risk factors, or outcome.1 There is a diurnal variation in the onset of stroke. Sleep tends to promote ischemic stroke, and there is a higher frequency of strokes occurring in the morning.2,3 Sleep disordered breathing (SDB) is present in up to 72% of stroke patients and is one of the independent risk factors for stroke. 4,5 However, stroke may also aggravate premorbid SDB or even contribute to SDB onset. 6 Multiple mechanisms might link SDB with the onset of cerebral ischemia during the sleep, including coagulation changes, hemodynamic changes, blood pressure (BP) surges, inflammatory overactivity, increased arterial stiffness, increased sympathetic tone, paradoxical embolization, or the development of cardiac arrhythmias. 7-11Currently, WUS patients are excluded from revascularization therapy; therefore, a thorough search for predictors and risk factors of WUS is desirable. The aim of this study was to compare polysomnographic, clinical, and laboratory characteristics of WUS and NWUS with mild-to-moderate severity. SCIENTIFIC INVESTIGATIONS Association of Sleep M ETHO DSThe study population consists of patients hospitalized in the stroke unit of the 1 st Department of Neurology, Comenius University Bratislava from January 2011 to December 2014 with the BRIEF SUMMARY Current Knowledge/Study Rationale: Currently, wake-up stroke patients are excluded from revascularization therapy, so a precise search for predictors and risk factors of wake-up strokes is desirable. The aim of this study was to compare polysomnographic, clinical, and laboratory characteristics of wake-up strokes and non-wake-up strokes with mild-to-moderate severity. Study Impact: We emphasize the importance of significantly higher frequency of moderate-to-severe sleep apnea syndrome among the wake-up stroke population, as this population is indicated for positive...

show abstract

Section: Discussionmentioning

confidence: 99%

Association of Sleep Disordered Breathing with Wake-Up Acute Ischemic Stroke: A Full Polysomnographic Study

Šiarnik

Kollár

Čarnická

et al. 2016

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

show abstract

“…6,8 Polysomnography is the gold-standard technique to diagnose sleep apnea and sleep-disordered breathing. However, it is not universally available and requires a sleep laboratory.…”

Section: July 2016mentioning

confidence: 99%

“…NOD was observed in 16.8% in our study, which was lower than the reported prevalence of sleep apnea after stroke using polysomnography. 6,7,9,23 In addition, we excluded patients treated with oxygen to minimize bias. This could have affected the lower rate of sleep-disordered breathing in our patients, despite the absolute numbers being small.…”

mentioning

confidence: 99%

“…1,2,4 Given that WUS occurs when patients are asleep, sleep disorders have been implicated in the development of WUS. 5,6 Specifically, sleep-disordered breathing may be associated with the development of WUS. Nocturnal hypoxia may trigger ischemia [6][7][8][9] or may increase the risk of ischemic event probably mediated by hypertension.…”

mentioning

confidence: 99%

“…5,6 Specifically, sleep-disordered breathing may be associated with the development of WUS. Nocturnal hypoxia may trigger ischemia [6][7][8][9] or may increase the risk of ischemic event probably mediated by hypertension. Previous reports have suggested the possible association between WUS and sleep-disordered breathing.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Nocturnal Desaturation in the Stroke Unit Is Associated With Wake-Up Ischemic Stroke

Kim

Jeong

et al. 2016

Stroke

View full text Add to dashboard Cite

Background and Purpose-Wake-up stroke (WUS) represents a quarter of all ischemic strokes and may be a specific subgroup. Nocturnal desaturation secondary to sleep-disordered breathing is an independent risk factor for stroke, but the association between nocturnal desaturation and WUS remains unclear. We investigated the relationship between nocturnal desaturation using oxygen desaturation index and WUS in patients with acute stroke in the stroke unit. Methods-A total of 298 patients admitted for acute ischemic stroke to the stroke unit between July 2013 and May 2015 were enrolled. The oxygen desaturation index was calculated using pulse oximetry data sampled every 1 minute during 9 hours on the first night (10:00 PM-7:00 AM) of the stroke unit admission, and nocturnal desaturation was defined as an oxygen desaturation index of 5 at least per hour. We compared the clinical characteristics and nocturnal desaturations between patients with and without WUS. Results-Among all patients (age, 67.7±12.6 years; male, 54.4%), 26.5% patients had WUS. The proportion of nocturnal desaturation was significantly greater in patients admitted with WUS (29.1% versus 12.3%, P=0.001). The age, sex, risk factors except for hyperlipidemia, stroke severity, and stroke mechanisms were similar between the 2 groups. After adjustment for covariates, it was found that nocturnal desaturation was significantly more common in the WUS group (odds ratio, 3.25; 95% confidence interval, 1.63-6.46). Conclusions-Nocturnal desaturation was more frequently observed in patients admitted with WUS during the first night in the stroke unit. This suggests that nocturnal desaturation is a possible modifiable risk factor for the occurrence of WUS. Baseline and Clinical AssessmentBaseline characteristics, including demographic data (age and sex) and vascular risk factors (hypertension, diabetes mellitus, hyperlipidemia, smoking history [current or past regular smoking], body mass index [BMI], and a past history of stroke/transient ischemic attack) were evaluated. Hypertension was defined as a history of antihypertensive treatment, a systolic blood pressure ≥140 mm Hg, or a diastolic blood pressure ≥90 mm Hg. 14 Hyperlipidemia was defined as a history of lipid-lowering medication, a serum total cholesterol level of >240 mg/dL, or a serum level of low-density lipoprotein cholesterol >160 mg/dL.15 Diabetes mellitus was defined as a hemoglobin A1C level of ≥6.5%, fasting blood glucose level of ≥7.0 mmol/L, nonfasting blood glucose level of ≥11.1 mmol/L, or the use of insulin or oral hypoglycemic drugs. 16 All of the patients were initially evaluated for stroke severity based on the National Institutes of Health Stroke Scale (NIHSS) neurological examination at SU admission. Ischemic strokes were categorized as large-artery atherosclerosis (LAA), small-vessel occlusion, cardioembolism, other determined, and undetermined based on the Trial of Org 10172 in Acute Stroke Treatment criteria. 17The ischemic lesion locations were divided into anterior circulation (ante...

show abstract

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

et al. 2021

View full text Add to dashboard Cite

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.

show abstract

Obstructive sleep apnea linked to wake-up strokes

Cited by 59 publications

References 35 publications

Association of Sleep Disordered Breathing with Wake-Up Acute Ischemic Stroke: A Full Polysomnographic Study

Association of Sleep Disordered Breathing with Wake-Up Acute Ischemic Stroke: A Full Polysomnographic Study

Nocturnal Desaturation in the Stroke Unit Is Associated With Wake-Up Ischemic Stroke

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

Contact Info

Product

Resources

About