nÃo hà / Wake-up stroke (WUS) define um Acidente Vascular Cerebral (AVC) detectado quando o indivÃduo desperta com sintomas de AVC. Cerca de 25% dos casos de AVC sÃo WUS. O papel que as alteraÃÃes do sono e comorbidades desempenham nesses casos permanece por ser estabelecido. O objetivo deste estudo foi avaliar as caracterÃsticas clÃnicas, as alteraÃÃes do ritmo vigÃlia-sono e os fatores associados a evoluÃÃo e gravidade dos sintomas em casos de AVC com e sem WUS. Trata-se de estudo de coorte prospectivo de carÃter observacional. Pacientes com AVC isquÃmico (N=102), dos quais 28,4% com WUS, foram avaliados no evento vascular inicial e apÃs 3 e 12 meses. Os pacientes (30-83 anos) eram provenientes da unidade de terapia de AVC do Hospital Geral de Fortaleza e foram recrutados entre 2013-2015. Foram incluÃdos aqueles que apresentavam AVC isquÃmico nos Ãltimos 15 dias, NIHSS>25, quadro clÃnico estÃvel, e condiÃÃes cognitivas suficientes para realizar as avaliaÃÃes. Foram estudadas as caracterÃsticas clÃnico-demogrÃficas e as comorbidades associadas. Um registro do sono foi feito com polÃgrafo nivel III (Stardust Phillips Respironics) para investigar a apneia do sono. Um Ãndice de apneia e hipopneia (IAH)>20 foi considerado o ponto de corte para definir a presenÃa da apneia obstrutiva do sono (AOS). QuestionÃrios sobre desempenho funcional (Escala de Rankin Modificada â ERM), habilidades motoras (Escala de Barthel Modificada âEBM) e sonolÃncia (Escala de sonolÃncia de Epworth-ESE) foram aplicados prospectivamente, realizando-se uma avaliaÃÃo inicial, uma segunda avaliaÃÃo por telefone 3 meses depois e uma terceira avaliaÃÃo por telefone vez apÃs 12 meses à avaliaÃÃo inicial. SonolÃncia Excessiva Diurna (SED) foi definida como um ESE>10. A amostra estudada (N=102, 64% masculino) apresentava hipertensÃo (73%), diabetes (29,4%), cardiopatia (16,7%), sedentarismo (69,6%), tabagismo (32,4%) e etilismo (17,6%). Na amostra total, observou-se variaÃÃo do IAH (1,20-57,3), da SpO2 mÃdia (82-97%) e do Ãndice de dessaturaÃÃo (5-94). Foram registrados IAH>20 (35,3%). NÃo houve diferenÃas clÃnicas e poligrÃficas entre os casos com e sem WUS. Diabetes tipo 2 associou-se com WUS (OR=0,37 CI: 0,15-0,92; p=0,03). Os pacientes com AOS apresentavam maiores Ãndices cintura-quadril (p=0,01). Os pacientes com SED eram mais jovens (p=0,009). A avaliaÃÃo longitudinal nÃo mostrou diferenÃa na gravidade dos sintomas nos casos com e sem WUS. Prospectivamente, os casos com AOS evoluÃram com pior desempenho funcional (ERM, p=0,02). / Wake-up stroke (WUS) defines a cerebrovascular accident (CVA) detected when the individual awakens with symptoms of stroke. About 25% of cases of stroke are WUS. The role that sleep disorders and comorbidities play in these cases is yet to be established. The aim of this study is to evaluate clinical characteristics, changes in sleep-wake cycle and factors that influence the development and severity of symptoms in cases of stroke with and without WUS. This is a longitudinal study of observational nature. Patients with ischemic stroke (N=102), 28.4% with WUS, were evaluated at baseline and after 3 and 12 months. Patients (30-85 years old) were recruited from the stroke care unit of the General Hospital of Fortaleza from 2013 to 2015. We included those that had ischemic stroke in the last 15 days, NIHSS<15, stable clinical condition, and that were able to answer behavior questionnaires. The clinical and demographic characteristics and associated comorbidities were studied. A sleep recording was done with level III polygraph (Stardust Phillips Respironics) to investigate sleep apnea. An apnea-hypopnea index (AHI)> 20 was considered the cutoff point to define the presence of obstructive sleep apnea (OSA). Questionnaires on functional performance (modified Rankin Scale â MRS), motor skills (modified Barthel Scale âMBS) and sleepiness (Epworth Sleepiness Scale â ESS) were applied. Excessive Daytime Sleepiness (EDS) was defined as an ESS> 10. Prospectiveley, pacients are evaluated (ESS, MRS, MBS) after 3 months and 12 months after the initial evaluation by telephone. In the sample studied (N = 102, 64% male), hypertension (73%), diabetes (29.4), heart disease (16.7%), physical inactivity (69.6%), smoking (32.4%) and alcohol consumption (17.6) were found. In the total sample, AHI (1.20 to 57.3), SpO2 (82-97%) and the desaturation index (5-94). We recorded AHI> 5 (92.9%), AHI> 15 (44.7%), AHI> 20 (35.3%) and AHI> 30 (11.8%) were variable. Cases with and without WUS did not differ regarding clinical and polygraphic characteristics. Type 2 diabetes was associated with WUS (OR = 0.37 CI: 0.15 to 0.92; p = 0.03). Individuals with OSA had higher waist-hip ratios (p = 0.01). Patients with EDS were younger (p = 0.009). The longitudinal evaluation showed no difference in the severity of symptoms in cases with and without WUS. Prospectiveley, cases with OSA evolved with worse functional performance (ERM, p = 0.02). Conclusion: Among patients with ischemic stroke, WUS manifests itself in about 1/3 of cases and it associates with type 2 diabetes. Those with stroke and OSA (AHI> 20) evolve with worse functional performance after one year.
| Identifer | oai:union.ndltd.org:IBICT/oai:www.teses.ufc.br:11732 |
| Date | 23 August 2016 |
| Creators | Pedro Rodrigues Barreto |
| Contributors | Veralice Meireles Sales de Bruin, Pedro Braga Neto, Pedro Felipe Carvalhedo de Bruin, Jose Nilson Rodrigues de Menezes |
| Publisher | Universidade Federal do CearÃ, Programa de PÃs-GraduaÃÃo em CiÃncias MÃdicas, UFC, BR |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da UFC, instname:Universidade Federal do Ceará, instacron:UFC |
| Rights | info:eu-repo/semantics/openAccess |
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