Analysis Of Clinical Features,Cerebral Hemodynamics And Blood Pressure Variability In Wake Up Stroke

Part Ⅰ Analysis of clinical characteristics of first episode wake up strokeObjective(s): In this study,the clinical characteristics and prognosis of wake-up stroke patients with first onset were investigated,and more comprehensive understanding of wake-up stroke would provide a clinical basis for prevention and treatment strategies.Methods: This study retrospectively collected patients with first-episode acute ischemic stroke who were hospitalized in the the Second Affiliated Hospital of Kunming Medical University from July 2019 to June 2020.According to whether they occurred during sleep,they were divided into Wake up stroke(WUS)and non-Wake up stroke(NWUS).The baseline clinical data,severity of neurological deficit,laboratory indicators,carotid vascular ultrasound plaque characteristics,imaging data and early prognosis were compared between the two groups.Results:1.A total of 174 patients with first-ever acute ischemic stroke were included in this study,including 54 patients(31.0%)in the WUS group and 120 patients(69.0%)in the NWUS group.The two groups were compared in terms of gender,BMI,hypertension,diabetes mellitus,atrial fibrillation,drinking history,smoking history,homocysteine(Hcy),fasting glucose,glycated hemoglobin(Hb A1c),2-hour postprandial glucose,triglycerides(TG),low-density lipoprotein(LDL-C),high-density lipoprotein(HDL-C),first NIHSS score on admission,m RS score on discharge,infarct location,length of hospital stay,and hospitalization costs,There was no significant difference between the two groups(all P > 0.05).2.The indicators with statistically significant differences(P < 0.05)in the above univariate analysis,including age,TG,RBC,HCT,and neck plaque nature(no plaque,stable plaque,vulnerable plaque),were included to construct the multivariate Logistic regression equation.RBC was related to HCT,and there was an interaction between the two variables,so RBC×HCT was included in the regression equation as an interaction term.The results showed that RBC×HCT had a statistically significant effect on WUS(OR: 2.565,95%CI: 1.075-6.120,P=0.034).It was found that there was a correlation between stable plaque type and WUS in the nature of plaques in the neck(OR: 2.549,95% CI: 1.061-6.120,P = 0.036),and there was no statistical significance between the effects of age,TG,vulnerable plaque on WUS(P > 0.05).Conclusion(s):1.Among patients with first-ever ischemic stroke,WUS patients were younger at onset than NWUS patients,and both had no differences in the severity of neurological deficits,lesion distribution,early prognosis,long hospital stay,and total costs of hospitalization.2.Triglyceride levels,RBC and HCT values were higher in WUS patients with first onset compared to NWUS patients and may be important risk factors for WUS.3.In contrast to the degree of carotid sclerosis in patients with nwus,the degree of carotid sclerosis in patients with first onset WUS was dominated by the absence of plaque,suggesting that the two may have different pathogenesis.Part Ⅱ Association of cerebral hemodynamics and blood pressure variability with wake up strokeObjective(s): Blood pressure variability and cerebral blood flow maps in patients with WUS were assessed by 24-hours ambulatory blood pressure monitoring and Transcranial Doppler examination.To compare the characteristics of blood pressure changes and hemodynamic changes between WUS and nwus NWUS patients,thereby better guiding the treatment options of WUS and improving the long-term outcomes of patients.Methods:A total of 189 patients with acute ischemic stroke diagnosed in the Hospital of the Second Affiliated Hospital of Kunming Medical University from December2021 to August 2022 were selected.According to the diagnostic criteria in the "Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke 2018",And according to whether the onset occurred during sleep,they were divided into wake stroke group(WUS)and non-wake up stroke group(NWUS).The general information,laboratory tests,imaging data,Transcranial Doppler(TCD),and 24-hours ambulatory blood pressure monitoring(ABPM)datas were collected.The mean velocity(Vm)and Pulsatility index(PI)of bilateral anterior cerebral artery(ACA),middle cerebral artery(MCA),posterior cerebral artery(PCA)and basilar artery(BA)were detected by transcranial Doppler ultrasound to evaluate cerebral hemodynamics.Parameters of 24-hour Ambulatory blood pressure monitoring(ABPM)were used to assess blood pressure variability.The above indicators in the WUS and NWUS were statistically analyzed to explore the differences in clinical characteristics of patients,and the risk factors affecting the occurrence of WUS.According to the initial NIHSS score,the WUS patients were divided into mild neurological deficit group(NIHSS≤4 points)and moderate to severe neurological deficit group(NIHSS≥5points).According to the m RS score at discharge,the WUS patients were divided into the good early prognosis group(m RS≤2 points)and the poor early prognosis group(m RS>2 points).We also statistically analyzed cerebral hemodynamics and blood pressure variability among WUS patients with different neurological deficit severities and different early prognoses.Results:1.Univariate analysis showed that there were no significant differences in age,gender,BMI,hypertension,diabetes,atrial fibrillation/atrial flutter,previous stroke history,and drinking history between the WUS group and the NWUS group(P >0.05).There were no significant differences in TG,TC,HDL-C,LDL-C,fasting blood glucose,2h postprandial blood glucose,Hb A1 c,RBC,HGB,HCT and other laboratory tests between WUS and NWUS(P > 0.05).2.Comparative analysis of cerebral hemodynamic indicators,The PI in the WUS was higher than that in the NWUS(P < 0.05),There were no significant differences in other cerebral hemodynamic indexes including Vm of anterior cerebral artery,posterior cerebral artery,basilar artery,and Vm of middle cerebral artery between the two groups(P > 0.05).3.Comparative analysis of ambulatory blood pressure related indicators found that coefficient of variation of nocturnal diastolic blood pressure(d DCV),coefficient of variation of nocturnal diastolic blood pressure(n DCV),coefficient of variation of24-hour systolic blood pressure(24h SCV),coefficient of variation of 24-hour diastolic blood pressure(24h DCV),standard deviation of daytime diastolic blood pressure(d DBP-SD),standard deviation of nighttime diastolic blood pressure(n DBP-SD),and 24-hour diastolic blood pressure in the WUS group were compared.The standard deviation of tension(24h DBP-SD)was higher,and the difference was statistically significant(P < 0.05).There was no significant difference in other indicators(P > 0.05).Including admission systolic blood pressure,admission diastolic blood pressure,coefficient of variation of daytime systolic blood pressure(d SCV),coefficient of variation of nocturnal systolic blood pressure(n SCV),standard deviation of daytime systolic blood pressure(d SBP-SD),standard deviation of night systolic blood pressure(n SBP-SD),24-hour standard deviation of systolic blood pressure(24h SBP-SD),and 24-hour weighted standard of systolic blood pressure difference(24h SBP-w SD)4.The risk factors in univariate analysis were included in multivariate Logistic regression analysis.The results showed that 24 h DCV(OR:1.176,95%CI:1.019-1.357,P=0.027)and n DBP-SD(OR:1.253,95%CI:1.019-1.541,P=0.032)had a statistically significant effect on WUS(P < 0.05).4.Based on the initial NIHSS score,the patients with WUS were divided into mild group(NIHSS≤4points)and moderate and severe group(NIHSS≥5 points).Univariate analysis showed that only d DCV had statistically significant difference in blood pressure variability and cerebral hemodynamic indicators(P < 0.05).5.According to the m RS Score at discharge,the WUS patients were divided into the good early prognosis group(m RS≤2 points)and the poor early prognosis group(m RS > 2 points).The blood pressure variability and cerebral hemodynamics of the two groups were only statistically significant in d DCV and n DBP-SD(P < 0.05).Conclusion(s):1.WUS and NWUS patients have similar risk factors,disease severity,TOAST stroke etiological classification and early functional prognosis.2.The cerebral hemodynamic index PI of middle cerebral artery is higher in the WUS group,and the increase of middle cerebral artery PI is correlated with the occurrence of WUS.3.Compared with the NWUS,the blood pressure variability in the WUS increased,mainly in the daytime and nighttime and 24 hours.diastolic blood pressure variability.4 dDCV is related to the initial severity of WUS patients.dDCV and nDBP-SD are related to the poor early prognosis of WUS patients.