Spontaneous Intracerebral Hemorrhage Occurring During Sleep: Clinical Characteristics and Risk Factors.

Area of Science:

• Neurology
• Nephrology
• Endocrinology

Background:

• Spontaneous intracerebral hemorrhage (ICH) during sleep is understudied compared to ischemic stroke.
• Limited research exists on the clinical characteristics and risk factors of sleep-onset ICH.
• This study addresses the knowledge gap regarding nocturnal ICH.

Purpose of the Study:

• To investigate the clinical features and risk factors of intracerebral hemorrhage (ICH) occurring during sleep.
• To compare outcomes between patients experiencing ICH during sleep versus wakefulness.
• To evaluate the prognostic value of different clinical presentations in sleep-onset ICH.

Main Methods:

• Retrospective analysis of 119 patients with sleep-onset ICH and 401 with wake-onset ICH (2012-2017).
• Comparison of demographics and outcomes between sleep and awake groups.
• Multivariate regression to identify risk factors for sleep-onset ICH.
• Classification of sleep-onset ICH presentations (deficits, headache, failure to wake) to assess outcomes.

Main Results:

• The sleep group had higher frequencies of chronic kidney disease (CKD) and diabetes mellitus.
• CKD was identified as a significant risk factor for ICH during sleep.
• In-hospital mortality was significantly higher in the sleep group.
• Failure to wake up was associated with a higher mortality rate.

Conclusions:

• ICH during sleep is associated with poorer patient outcomes.
• Nocturnal hypertension in patients with CKD and diabetes may contribute to increased sleep-onset ICH incidence.
• Clinical presentation, specifically failure to wake, can serve as a prognostic indicator for sleep-onset ICH.