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Outcome after Stroke upon Awakening

Published online by Cambridge University Press:  02 December 2014

Janel O. Nadeau
Affiliation:
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
Jiming Fang
Affiliation:
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
Moira K. Kapral
Affiliation:
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
Frank L. Silver
Affiliation:
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
Michael D. Hill
Affiliation:
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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Abstract:

Background:

An estimated 20-25% of all strokes occur during sleep and these patients wake up with their deficits. This study evaluated outcomes among patients who woke up with stroke compared to those who were awake at stroke onset.

Methods:

Using data from the Registry of the Canadian Stroke Network Phases 1 and 2, we compared demographics, clinical data and six-month outcomes between patients with stroke-on-awakening versus stroke-while-awake. Strokes of all types (ischemic stroke, transient ischemic attack, intracerebral hemorrhage and subarachnoid hemorrhage) were included. Standard descriptive statistics, multivariable logistic regression and general linear modeling were applied to the data to compare variables.

Results:

Among 2,585 stroke patients, 349 (13.5%) woke up with stroke and 2,236 (86.5%) did not. Patients with stroke-on-awakening were more likely to have higher blood pressure and to suffer ischemic stroke, but stroke severity, measured by level of consciousness, did not differ. Mortality both at discharge and at six-month follow-up did not differ between the two cohorts. However, patients with stroke-on-awakening were less likely to return home, and their median Stroke Impact Scale-16 scores were 7.0 points lower compared to those with stroke-while-awake.

Conclusions:

There are minor demographic and clinical differences between patients with stroke-on-awakening and stroke-while-awake. Functional outcomes are slightly worse among patients with stroke-on-awakening, an effect which was driven by poor outcomes among patients with subarachnoid hemorrhage.

Résumé:

RÉSUMÉ: Introduction:

Environ 20 à 25% de tous les accidents vasculaires cérébraux (AVC) surviennent pendant le sommeil et le patient constate le déficit à son réveil. Cette étude évalue l’issue chez ces patients par rapport à ceux qui étaient éveillés au moment du début de leur AVC.

Méthodes:

Nous avons comparé les données démographiques, les données cliniques et l’issue à six mois chez ces deux groupes de patients identifiés par le Registry of the Canadian Stroke Network phase 1 et 2. Les patients ayant subi un AVC de tous types ont été inclus (AVC ischémique, ischémie cérébrale transitoire, hémorragie intracérébrale et hémorragie sous-arachnoïdienne). La comparaison des variables a été effectuée au moyen des procédures statistiques descriptives standard, de l’analyse de régression logistique multivariée et de la modélisation linéaire générale.

Résultats:

349 (13,5%) des 2,585 patients atteints d’AVC ont constaté le deficit dû à l’AVC au réveil alors que chez les 2,236 (86,5%) autres l’AVC est survenu pendant que le patient était éveillé. Les patients atteints d’AVC au réveil étaient plus susceptibles d’avoir une tension artérielle plus élevée et d’être atteints d’un AVC ischémique. La sévérité de l’AVC, mesurée par le niveau de conscience, et la mortalité à la sortie de l’hôpital et à six mois, étaient les mêmes dans les deux groupes. Cependant, la probabilité du retour à domicile était moindre chez les patients atteints d’AVC au réveil et leur score médian au Stroke Impact Scale-16 était plus faible de 7,0 points par rapport à celui des patients dont l’AVC est survenu pendant la période d’éveil.

Conclusions:

Il existe des différences démographiques et cliniques mineures entre les patients ayant constaté l’AVC au réveil par rapport à ceux dont l’AVC est survenu en période d’éveil. L’issue fonctionnelle est légèrement moins bonne chez les patients qui constatent l’AVC au réveil, une constatation due en grande partie à l’issue moins favorable des patients ayant subi une hémorragie sous-arachnoïdienne.

Type
Original Articles
Copyright
Copyright © The Canadian Journal of Neurological 2005

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