OBSTRUCTIVE SLEEP APNEA AS A RISK FACTOR FOR WAKE-UP STROKE: A CASE REPORT

Apnéia obstrutiva do sono como fator de risco para Wake-Up Stroke: Relato de Caso

Resumo

Introduction: Wake-up Stroke (WUS) is characterized by the onset of symptoms during sleep, with an unknown exact time of onset, making thrombolytic treatment challenging. Obstructive Sleep Apnea (OSA) is considered an independent risk factor for stroke. This case report discusses a WUS episode in a patient with a history of sleep disorder.

Methods: A retrospective, observational, and analytical study in the form of a case report, using information from the patient and physical medical records, conducted at tertiary hospital in southwest Paraná, Brazil.

Case Description: A 74-year-old female patient with grade I obesity, systemic arterial hypertension, atrial flutter, and obstructive sleep disorder was admitted after waking up with a neurological deficit, having gone to bed asymptomatic. She presented with right-sided hemiplegia, aphasia, and confusion. Upon admission, a brain CT scan showed no evidence of ischemic lesions. The patient was managed clinically, without thrombolytic administration. After seven days, a new CT scan revealed hypodense lesions in the lenticulocapsular region and the left frontal lobe. Four weeks after the episode, there was significant improvement in deficits, with mild right-sided motor weakness and persistence of anomic aphasia.

Conclusion: Recognizing OSA as a risk factor for WUS reinforces the need for early diagnosis and proper management of sleep-related breathing disorders in patients at risk of cerebrovascular events. Extending the thrombolysis window, based on advanced neuroimaging, may redefine the management of WUS and reduce the global impact of stroke.