Abstract
Background and Purpose: Sleep related Stroke (SRS) is common and has been associated with cerebral small
vessel diseases (SVD) in ischemic strokes (ISs). We tested the hypothesis that SRS
is associated with SVD in both ischemic and hemorrhagic stroke. Methods: Prospectively collected data from patients consecutively enrolled after intracerebral
hemorrhage (ICH) related to SVD or after IS were analyzed. Symptom onset was recorded
as SRS versus awake. Each ICH was grouped according to lobar and deep locations. The
IS cohort was etiologically characterized based on the Causative Classification of
Stroke system. Frequencies of SRS within and between ICH and IS cohorts as well as
its associations (etiology, risk factors) were analyzed. Results: We analyzed 1812 IS (mean age 67.9 years ± 15.9 years, 46.4% female) and 1038 ICH
patients (mean age 72.5 years ± 13.0 years, 45.4% female). SRS was significantly more
common among SVD-related ICH patients (n = 276, 26.6%) when compared to all IS (n = 363,
20.0%, P < .001) and in both, small artery occlusion (SAO) related IS and lobar ICH within
the respective IS and ICH cohorts (16.3% SRS versus 9.1% awake for SAO within all
IS, P < .001; and 57.1% SRS versus 47.7% awake for lobar bleeds within all ICH, P = .008). These associations remained significant after controlling for age, sex and
risk factors. Conclusions: SRS was associated with SVD. The SAO etiology and cerebral amyloid angiopathy related
lobar ICH suggest that the presence of SVD can interact with sleep or arousal related
hemodynamic changes to cause ischemic and hemorrhagic stroke.
Key Words
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Article info
Publication history
Published online: January 13, 2020
Accepted:
December 15,
2019
Received in revised form:
December 13,
2019
Received:
October 22,
2019
Footnotes
Funding: This work was supported by the NIH (K23-NS083711, R01-NS070834, R01-NS059710, K23NS064052, R01NS082285, R01NS086905, R01AG026484, K23AG02872605, R01-NS073344).
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104606
Copyright
© 2019 Elsevier Inc. All rights reserved.
