Lundholm Michelle D, Rooney Melissa, Maas Matthew B, Attarian Hrayr, Prabhakaran Shyam
From the Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Stroke. 2017 Jun;48(6):1668-1670. doi: 10.1161/STROKEAHA.116.016202. Epub 2017 Apr 28.
Wake-up strokes (WUS) account for ≈20% to 30% of ischemic strokes. Studies have shown that increased autonomic instability as measured by blood pressure variability (BPV) is greater in stroke patients than nonstroke patients, but no studies have compared BPV in WUS versus non-WUS patients.
From a single-center prospective registry, we identified consecutive ischemic stroke patients. BPV was calculated as the coefficient of variation of the mean arterial pressure during the first 24 hours after hospitalization. We assessed 24-hour BPV as a continuous measure and in quartiles in WUS versus non-WUS patients using univariable and multivariable statistics.
Among 369 patients (64.9±16.5 years; 50.1% male; 64.7% white), 78 were WUS (21.1%). Clinical characteristics and medical history were not different between WUS and non-WUS patients except WUS patients were older (69.0 versus 63.8 years; =0.015) and more frequently had previous ischemic stroke (29.5% versus 17.2%; =0.012). Initial 24-hour BPV (11.77 versus 10.76; =0.098) was similar between groups. However, WUS patients had greater nocturnal BPV (10.50 versus 8.95; =0.030), whereas daytime BPV was similar between groups (10.96 versus 10.47, =0.459). In multivariate analysis, the highest quartile (≥11.48 mm Hg) of nocturnal BPV was independently associated with WUS (adjusted odds ratio, 1.95; confidence interval, 1.13-3.39; =0.017).
In this single-center study, we observed that greater nocturnal BPV during the first 24 hours after hospitalization occurred in WUS than non-WUS patients. Nocturnal autonomic instability warrants further study as a potential mechanism of WUS.
醒后卒中（WUS）约占缺血性卒中的20%至30%。研究表明，通过血压变异性（BPV）测量的自主神经不稳定性增加在卒中患者中比非卒中患者更明显，但尚无研究比较WUS患者与非WUS患者的BPV。
从一个单中心前瞻性登记处，我们确定了连续的缺血性卒中患者。BPV计算为住院后前24小时平均动脉压的变异系数。我们使用单变量和多变量统计方法，将24小时BPV作为连续测量指标，并在WUS患者与非WUS患者中按四分位数进行评估。
在369例患者（64.9±16.5岁；50.1%为男性；64.7%为白人）中，78例为WUS（21.1%）。WUS患者与非WUS患者的临床特征和病史无差异，只是WUS患者年龄更大（69.0岁对63.8岁；P=0.015），且既往有缺血性卒中的频率更高（29.5%对17.2%；P=0.012）。两组间初始24小时BPV（11.77对10.76；P=0.098）相似。然而，WUS患者夜间BPV更高（10.50对8.95；P=0.030），而两组间日间BPV相似（10.96对10.47，P=0.459）。在多变量分析中，夜间BPV最高四分位数（≥11.48 mmHg）与WUS独立相关（调整后的优势比，1.95；置信区间，1.13 - 3.39；P=0.017）。
在这项单中心研究中，我们观察到住院后前24小时WUS患者的夜间BPV高于非WUS患者。夜间自主神经不稳定性作为WUS的潜在机制值得进一步研究。
