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

• Published in: Brain and behavior 2021-08, Vol.11 (8), p.e2284-n/a
• Main Authors: Haula, Tuuli‐Maria, Puustinen, Juha, Takala, Mari, Holm, Anu
• Format: Article
• Language: English
• Subjects: Asymptomatic; Blood pressure; Hospitalization; Hospitals; Informed consent; ischemic stroke; Medical records; obstructive sleep apnea; Original Research; Patients; Registration; Rehabilitation; Sleep apnea; Software; Stroke; Transient ischemic attack; wake‐up stroke
• ISSN: 2162-3279; 2162-3279
• DOI: 10.1002/brb3.2284

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. The aim of this observational longitudinal study is to determine the relationship between WUS and OSA .We conclude that the proportion of moderate to severe OSA is higher stroke and TIA patients with WUS compared to patients with non‐WUS. WUS have worse short‐term outcomes measured in mRS. Further studies are needed to determine if OSA is causally linked to WUS.