title: Wake-up stroke: Clinical characteristics, sedentary lifestyle, and daytime sleepiness.
abstract: Wake-up stroke (WUS) is defined when the exact time of the beginning of the symptoms cannot be determined, for the deficits are perceived upon awakening. Sleep alterations are important risk factors for stroke and cardiovascular diseases. This study evaluates the characteristics of patients with and without WUS, the presence of daytime sleepiness, and associated risk factors.
  Patients with ischemic stroke were investigated about the presence of WUS. Clinical and demographic characteristics were evaluated. Stroke severity was studied by the National Institutes of Health Stroke Scale (NIHSS) and the Modified Rankin Scale (MRS), and daytime sleepiness severity was studied by the Epworth Sleepiness Scale (ESS).
  Seventy patients (57.1% men) aged from 32 to 80 years (58.5±13.3) were studied. WUS was observed in 24.3%. Arterial hypertension (67.1%), type 2 diabetes (27.1%), and hyperlipidemia (22.8%) were frequent. Type 2 diabetes and sedentary lifestyle were more common in patients with WUS (p<0.05). Overall, mild, moderate or very few symptoms of stroke (NIHSS<5) were predominant (62.3%). Among all cases, 20% had excessive daytime sleepiness (ESS>10). No differences were found between patients with and without WUS as regards stroke severity or excessive daytime sleepiness. Patients with excessive daytime sleepiness were younger and had more sedentary lifestyle (p<0.05). Individuals with previous history of heavy drinking had more daytime sleepiness (p=0.03).
  Wake-up stroke occurs in approximately 25% of stroke cases. In this study, patients with WUS had more diabetes and sedentary lifestyle. Daytime sleepiness is frequent and is associated with sedentary lifestyle and heavy drinking.
authors.affiliation: MD, MSc, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brazil.
authors.forename: Deborath Lucia de Oliveira
authors.initials: DL
authors.lastname: Diniz
authors.affiliation: Physiotherapist, UFC, Fortaleza, CE, Brazil.
authors.forename: Pedro Rodrigues
authors.initials: PR
authors.lastname: Barreto
authors.affiliation: MD, PhD, Professor of Pneumology, UFC, Fortaleza, CE, Brazil.
authors.forename: Pedro Felipe Carvalhedo de
authors.initials: PF
authors.lastname: Bruin
authors.affiliation: MD, MSc, PhD, Neurologist, Professor of Neurology, UFC, Fortaleza, CE, Brazil.
authors.forename: Veralice Meireles Sales de
authors.initials: VM
authors.lastname: Bruin
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000150:complications; D002545:Brain Ischemia / Q000150:complications; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000503:physiopathology; D006970:Disorders of Excessive Somnolence / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D012890:Sleep / Q000502:physiology*; D018709:Statistics, Nonparametric; D020521:Stroke / Q000209:etiology* / Q000503:physiopathology*; D013997:Time Factors; D055815:Young Adult