Abstract Details

Title Clues to the Mechanism of Wake-Up Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P07 - (-)

Poster/Presentation
Number 225

Objective

Background BACKGROUND: The relationship between ischemic stroke and obstructive sleep apnea (OSA) is complex. OSA is an independent risk factor for incident stroke and is associated with poor neurologic recovery following stroke. Stroke occurring during sleep or wake-up stroke (WUS) is common, accounting for about one-quarter of all ischemic strokes.

Design/Methods DESIGN/METHODS: 53 subjects with ischemic and hemorrhagic stroke were studied. Subjects completed questionnaires screening for OSA (Berlin questionnaire) and assessing sleep characteristics. Other collected data included age, gender, stroke severity (NIH Stroke Scale), stroke localization and mechanism.

Results RESULTS: WUS occurred in 22 out of 53 subjects (41.5%); 1 of 8 (12.5%) hemorrhagic strokes and 21 of 45 (43.8%) ischemic strokes. Positive screening for OSA by Berlin questionnaire occurred in 33 out of 53 subjects (62.3%); 66.7% of WUS and 47.8% of non-WUS among the ischemic stroke subjects (p=0.21). Of those suffering ischemic stroke, subjects with WUS were significantly younger (62.0±16.8 vs. 71.2±13.0; p=0.048) and trended toward having higher low-density lipoprotein levels (124.6±41.5 vs 106.0±39.0; p=0.07). WUS were significantly less severe by NIH stroke scale (3.7±4.7 vs 8.2±7.5; p=0.02) and those suffering WUS reported fewer hours of total sleep time at night (6.2±3.5 vs. 8.0±2.3; p=0.06). Small vessel ischemic strokes occurred more commonly in WUS although this difference was not statistically significant (47.4% in WUS and 29.2% in non-WUS; p=0.21).

Conclusions CONCLUSIONS: WUS is common among ischemic strokes and is associated with less severe neurologic deficit. Persons suffering WUS report fewer hours of habitual sleeping time but are not more likely to screen positive for sleep apnea. Additional research is needed to determine if mechanistic differences exist between WUS and non-WUS and if WUS relates to sleep apnea.

Authors/Disclosures
Prachi Mehndiratta, MD PRESENTER	Dr. Mehndiratta has nothing to disclose.
	No disclosure on file
	No disclosure on file
Brian Koo, MD	Dr. Koo has received personal compensation in the range of $500-$4,999 for serving as a Consultant for American Regent. Dr. Koo has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Speckhals Law. The institution of Dr. Koo has received research support from Department of Defense.
David Hojnacki, MD, FAAN (University At Buffalo, Jacobs Neurological Institute)	Dr. Hojnacki has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Hojnacki has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Hojnacki has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen.

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