Outcome after stroke upon awakening.
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 2585 stroke patients, 349 (13.5%) woke up with stroke and 2236 (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.
Nadeau
Janel O
JO
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.
Fang
Jiming
J
Kapral
Moira K
MK
Silver
Frank L
FL
Hill
Michael D
MD
D000368:Aged; D002545:Brain Ischemia / Q000401:mortality / Q000503:physiopathology; D002170:Canada / Q000453:epidemiology; D002543:Cerebral Hemorrhage / Q000401:mortality / Q000503:physiopathology; D002940:Circadian Rhythm / Q000502:physiology*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology; D002546:Ischemic Attack, Transient / Q000401:mortality / Q000503:physiopathology; D007902:Length of Stay; D008297:Male; D009460:Neurologic Examination; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011379:Prognosis; D020127:Recovery of Function / Q000502:physiology; D012042:Registries / Q000706:statistics & numerical data; D012890:Sleep / Q000502:physiology*; D020521:Stroke / Q000401:mortality* / Q000503:physiopathology; D013345:Subarachnoid Hemorrhage / Q000401:mortality / Q000503:physiopathology; D014851:Wakefulness / Q000502:physiology*