Background
Wake-up stroke (WUS) accounts for up to 29.6% of ischemic strokes, but its mechanisms
are poorly understood. The purpose of this study is to identify risk factors and characteristics
of WUS.
Methods
Seven-two ischemic strokes were classified as WUS or non-WUS. Collected were demographic
information, medical history, cholesterol profile, and stroke characteristics including
severity (National Institutes of Health Stroke Scale [NIHSS]) and mechanism (Trial
of Org 10172 in Acute Stroke Treatment criteria). Subjects completed questionnaires
screening for sleep apnea (Berlin questionnaire) and assessing sleep characteristics.
Results
There were 72 ischemic strokes, of which 28 WUS (38.9%). WUS and non-WUS patients
were similar in regard to stroke risk factors. WUS patients tended to be African American
and were significantly younger. WUS was significantly more likely to result from small-vessel
disease mechanism (42.9% versus 14.0%; P = .006) and tended to be less severe WUS (NIHSS score 3 [1, 4] versus 4 [2, 11];
P = .13) than non-WUS. Groups did not differ in regard to scoring positively on the
Berlin questionnaire, but WUS sufferers were more likely to snore frequently (90.5%
versus 70.0%, P = .08). The lipid profile was significantly worse in WUS compared with non-WUS (low-density
lipoprotein 124.6 ± 38.4 versus 103.7 ± 36.8; P = .03; cholesterol to high-density lipoprotein ratio 5.2 ± 1.6 versus 4.3 ± 1.6;
P = .02).
Conclusions
WUS is more likely to result from small-vessel disease mechanism. Poorer cholesterol
profile and frequent snoring may contribute to WUS.
Key Words
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Article info
Publication history
Published online: December 20, 2013
Accepted:
October 24,
2013
Received in revised form:
October 7,
2013
Received:
September 4,
2013
Footnotes
The authors have no conflicts of interest to disclose.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.10.021
Copyright
Published by Elsevier Inc.
