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Abstract
Background: Based on the higher frequency of paroxysmal atrial fibrillation during night and early morning hours, we sought to analyze the association between newly diagnosed atrial fibrillation and wake-up ischemic cerebrovascular events.
Methods: We prospectively assessed every acute ischemic stroke and TIA patient admitted to our hospital between 2008 and 2011. We used a forward step-by-step multiple logistic regression analysis to assess the relationship between newly diagnosed atrial fibrillation and wake-up ischemic stroke or TIA, after adjusting for significant covariates.
Results: The study population comprised 356 patients, 274 (77.0%) with a diagnosis of acute ischemic stroke and 82 (23.0%) with TIA. A total of 41 (11.5%) of these events occurred during night sleep. A newly diagnosed atrial fibrillation was detected in 27 patients of 272 without known atrial fibrillation (9.9%). We found an independent association between newly diagnosed atrial fibrillation and wake-up ischemic stroke and TIA (odds ratio 3.6, 95% confidence interval 1.2–7.7, p = 0.019).
Conclusions: The odds of detecting a newly diagnosed atrial fibrillation were 3-fold higher among wake-up cerebrovascular events than among non–wake-up events. The significance of this independent association between newly diagnosed atrial fibrillation and wake-up ischemic stroke and TIA and the role of other comorbidities should be investigated in future studies.
GLOSSARY
- AF=
- atrial fibrillation;
- CHADS2=
- congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and prior stroke or TIA;
- CHA2DS2-VASc=
- congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or TIA–vascular disease, age 65–74 years, female sex;
- CI=
- confidence interval;
- NIHSS=
- NIH Stroke Scale;
- SDB=
- sleep-disordered breathing;
- TOAST=
- Trial of ORG 10172 in Acute Stroke Treatment;
- WUS=
- wake-up ischemic strokes
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at www.neurology.org
- Received November 2, 2012.
- Accepted in final form February 6, 2013.
- © 2013 American Academy of Neurology
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