Tanimoto Aki, Mehndiratta Prachi, Koo Brian B
Case Western Reserve University School of Medicine, Cleveland, Ohio.
Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio.
J Stroke Cerebrovasc Dis. 2014 Jul;23(6):1296-9. doi: 10.1016/j.jstrokecerebrovasdis.2013.10.021. Epub 2013 Dec 19.
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.
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.
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).
WUS is more likely to result from small-vessel disease mechanism. Poorer cholesterol profile and frequent snoring may contribute to WUS.
觉醒期卒中（WUS）占缺血性卒中的比例高达29.6%，但其发病机制尚不清楚。本研究旨在确定WUS的危险因素和特征。
72例缺血性卒中被分为WUS组或非WUS组。收集了人口统计学信息、病史、血脂情况以及卒中特征，包括严重程度（美国国立卫生研究院卒中量表[NIHSS]）和发病机制（急性卒中治疗中组织纤溶酶原激活剂10172试验标准）。受试者完成了筛查睡眠呼吸暂停的问卷（柏林问卷）并评估了睡眠特征。
共有72例缺血性卒中，其中28例为WUS（38.9%）。WUS组和非WUS组在卒中危险因素方面相似。WUS患者多为非裔美国人，且年龄显著更小。WUS更有可能由小血管疾病机制导致（42.9%对14.0%；P = 0.006），且与非WUS相比，WUS往往病情较轻（NIHSS评分3[1,4]对4[2,11]；P = 0.13）。两组在柏林问卷上的阳性评分无差异，但WUS患者更常打鼾（90.5%对70.0%，P = 0.08）。与非WUS相比，WUS患者的血脂情况明显更差（低密度脂蛋白124.6±38.4对103.7±36.8；P = 0.03；胆固醇与高密度脂蛋白比值5.2±1.6对4.3±1.6；P = 0.02）。
WUS更有可能由小血管疾病机制导致。较差的血脂情况和频繁打鼾可能与WUS有关。
