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Wake-up stroke: From pathophysiology to management.

Laure Peter-Derex1, Laurent Derex2

  • 1Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France; Lyon Neuroscience Research Center, PAM Team, INSERM UMRS 1028, CNRS UME 5292, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France.

Sleep Medicine Reviews
|October 11, 2019
PubMed
Summary
This summary is machine-generated.

Wake-up strokes (WUS), a significant portion of ischemic strokes, occur upon waking. Recent advances allow reperfusion therapy in selected WUS patients with salvageable brain tissue.

Keywords:
Circadian rhythmMechanical thrombectomyObstructive sleep apneaREM sleepSleepThrombolysisWake-up stroke

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Area of Science:

  • Neurology
  • Chronobiology
  • Sleep Medicine

Background:

  • Wake-up strokes (WUS) constitute 20% of ischemic strokes with an unknown onset time.
  • Stroke onset exhibits a chronobiological pattern, peaking in the early morning hours.
  • Circadian rhythms, sleep-wake cycles, and obstructive sleep apnea influence WUS occurrence.

Purpose of the Study:

  • To review the understanding of wake-up strokes.
  • To explore the association between sleep patterns and stroke onset.
  • To discuss the evolving role of reperfusion therapy in WUS management.

Main Methods:

  • Literature review focusing on chronobiology, sleep, and stroke.
  • Analysis of radiological evaluation techniques for WUS.
  • Examination of clinical trial data on reperfusion therapy in WUS.

Main Results:

  • WUS onset correlates with circadian fluctuations and REM sleep.
  • Obstructive sleep apnea is highly prevalent in WUS patients.
  • Advanced imaging identifies salvageable brain tissue, enabling successful reperfusion therapy in selected WUS cases.

Conclusions:

  • Sleep and circadian factors significantly impact WUS.
  • WUS are no longer an absolute contraindication for reperfusion therapy.
  • Improved diagnostic tools and patient selection enhance treatment outcomes for WUS.