Risk Factors And Outcome Of Wake-up Stroke

Objective: To explore the clinical risk factors and prognosis of wake-up stroke(WUS).Methods: Data of inpatients with ischemic stroke were collected from Department of Neurology,Affiliated Zhongda Hospital,Southeast University in Jiangsu Province from February 2017 to February 2018.According to the attack time,the cases were divided into WUS group and non-WUS(NWUS)group.The demographic and baseline clinical data were compared between the two groups,then the predictive factors of WUS were analyzed.According to the National Health Research Stroke Scale(NIHSS)scores at discharge and the modified Rankin Scale(mRS)scores at 90 days after discharge,the cases were divided into early favorable group(NIHSS ≤ 4 points)and early unfavorable group(NIHSS ≥ 5 points),late favorable group(mRS ≤ 2 points)and late unfavorable group(mRS ≥ 3 points).The clinical characteristics,prognosis and major risk factors were compared respectively between the two groups.Results: A total of 641 patients were acute ischemic stroke,including 96 patients(15.0%)with WUS,and 62 patients met the inclusion criteria of the WUS group.62 patients with NWUS were randomly selected.Univariate analysis showed that the proportion of a history of stroke or TIA in the WUS group was significantly higher than that in the NWUS group(P = 0.011).There was no significant difference in other demographic characteristics and risk factors(all P > 0.05),including age,sex,recurrence within one year,atrial fibrillation,obstructive sleep apnea risk,hypertension,diabetes mellitus.Stroke-related pneumonia,smoking,NIHSS scores,mRS scores,infarct location and TOAST etiology.In terms of prognosis,stroke-related pneumonia(P = 0.0028)and atrial fibrillation(P = 0.0078)were independently associated with early outcomes,while age(P < 0.0001),stroke-associated pneumonia(P = 0.0020),risk of obstructive sleep apnea(P = 0.0004)and gender(P = 0.0014)were independently associated with late clinical outcomes.Conclusion: A history of stroke or TIA is an independent risk factor for WUS.risk of obstructive sleep apnea,stroke-associated pneumonia,gender and atrial fibrillation are independent risk factors for unfavorable outcome of acute ischemic stroke,while WUS is not associated with clinical outcome of ischemic stroke.