Obstructive Sleep Apnea and Wake-up Stroke - A 12 Months Prospective Longitudinal Study

Area of Science:

• Neurology
• Sleep Medicine
• Cardiovascular Research

Background:

• Wake-up strokes (WUS) are strokes diagnosed upon waking, with unclear links to sleep disturbances.
• Understanding the clinical profile and sleep-related factors in WUS is crucial for patient management.

Purpose of the Study:

• To investigate clinical characteristics, sleep-disordered breathing, and outcomes in patients with WUS compared to non-WUS.
• To identify factors associated with WUS and assess the impact of sleep apnea on stroke recovery.

Main Methods:

• A cohort of 102 ischemic stroke patients underwent clinical evaluation and portable sleep monitoring.
• Apnea-Hypopnea Index (AHI) was used to quantify sleep apnea severity (AHI ≥ 20 for OSA).
• Clinical outcomes were assessed at 3 and 12 months using Modified Rankin and Barthel Indices.

Main Results:

• WUS occurred in approximately 33% of patients.
• High prevalence of sleep apnea was observed (AHI ≥ 5 in 92.9%, AHI ≥ 20 in 35.3%).
• Type 2 diabetes mellitus (T2D) was independently associated with WUS (OR=2.76).
• Patients with OSA (AHI ≥ 20) showed worse functional outcomes at 12 months (MR, P=0.02).

Conclusions:

• WUS is a significant subtype of stroke, often accompanied by sleep apnea.
• Obstructive sleep apnea (OSA) is prevalent in stroke patients and independently predicts poorer functional recovery.
• T2D is linked to WUS, suggesting a connection to cerebral small vessel disease.