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Stroke during sleep and obstructive sleep apnea: there is a link

  • Yousef MohammadEmail author
  • Ahmed Almutlaq
  • Abdullah Al-Ruwaita
  • Amjad Aldrees
  • Abdulaziz Alsubaie
  • Fawaz Al-Hussain
Original Article

Abstract

Objectives

The onset of ischemic stroke symptoms has been established to have a diurnal variation, with a sizeable proportion (8–28%) occurring during sleep. Obstructive sleep apnea (OSA) has been established as an important risk factor for ischemic stroke. However, data on the relationship between OSA and wake-up stroke (WUS) has been scarce. The aim of our study is to determine the relationship between OSA and WUS.

Methods

This is a case-control study conducted on acute stroke patients who presented to one of two major medical centers in Riyadh of Saudi Arabia. Those who woke up with the symptoms were labeled as WUS, and those whose stroke occurred while awake were labeled as non wake-up stroke (NWUS). The Berlin Questionnaire, which was submitted to either the patient or his/her partner, was used to determine the frequency of OSA in the two groups.

Results

One hundred seven patients (60% males) with acute stroke were admitted between March 2016 and March 2017. Of the 40 patients with WUS, 29 (72.5%) had underlying OSA based on the Berlin Questionnaire, whereas only 30 (45%) of the 67 patients with NWUS have underlying OSA. Logistic regression analysis showed OSA is highly prevalent in the patients with WUS (OR = 3.25; 95% CI = 1.397–8.38; p = 0.0053).

Conclusion

OSA is an important risk factor for ischemic stroke during sleep. Health care providers must be vigilant in inquiring about symptoms suggestive of OSA in every ischemic stroke patient, especially the patient whose stroke occurred during sleep.

Keywords

Stroke Wake-up Obstructive sleep apnea Berlin Questionnaire 

Notes

Funding information

The authors extend their appreciation to the Deanship of Scientific Research at King Saud University for funding this work through research group NO (RGP-1438-008).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  1. 1.Department of Internal MedicineKing Saud UniversityRiyadhSaudi Arabia

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