醒后卒中（中风）：从病理生理学到治疗。

Peter Derex L等，睡眠医学版，2019 12



摘要


醒后卒中（WUS）是指患者在醒来时发现的确切发病时间未知的中风。它们占所有缺血性中风的20%。缺血性卒中发病的时间生物学模式在发病的第一个早晨出现的频率较高，可能与血压、心率、止血过程的昼夜波动和房颤发作的发生有关。中风发作时间的调节也涉及睡眠-觉醒周期，因为快速眼动睡眠会增加风险。此外，睡眠可能通过神经保护作用影响患者对中风症状的表达和感知，也影响脑组织缺血过程。阻塞性睡眠呼吸暂停综合征在WUS患者中尤为普遍。直到最近，醒后卒中还被认为是再灌注治疗的禁忌症，因为溶栓治疗的起效时间和潜在的脑出血风险未知。在过去的几年中，人们对醒后卒中重新产生了兴趣，这与醒后卒中患者的影像学评价的改进以及最近在晚期脑显像中显示可挽救脑组织存在时对选定患者的再灌注临床疗效的证明有关。

Wake-up stroke: From pathophysiology to management.

Peter-Derex L,et al  Sleep Med Rev             2019  12MOREAbstract           翻译         Wake-up strokes (WUS) are strokes with unknown exact time of onset as they are noted on awakening by the patients. They represent 20% of all ischemic strokes. The chronobiological pattern of ischemic stroke onset, with higher frequency in the first morning hours, is likely to be associated with circadian fluctuations in blood pressure, heart rate, hemostatic processes, and the occurrence of atrial fibrillation episodes. The modulation of stroke onset time also involves the sleep-wake cycle as there is an increased risk associated with rapid-eye-movement sleep. Furthermore, sleep may have an impact on the expression and perception of stroke symptoms by patients, but also on brain tissue ischemia processes via a neuroprotective effect. Obstructive sleep apnea syndrome is particularly prevalent in WUS patients. Until recently, WUS was considered as a contra-indication to reperfusion therapy because of the unknown onset time and the potential cerebral bleeding risk associated with thrombolytic treatment. A renewed interest in WUS has been observed over the past few years related to an improved radiological evaluation of WUS patients and the recent demonstration of the clinical efficacy of reperfusion in selected patients when the presence of salvageable brain tissue on advanced cerebral imaging is demonstrated.