“Wakeup” to Reality!

Abstract

A small-vessel left paramedian pontine ischemic infarction on awakening from sleep in a 74-year-old woman with hypercholesterolemia triggered an evaluation for untreated severe obstructive sleep apnea (OSA). This case illustrates how the clinical presentation of OSA is different in older and younger adults. Older adults with OSA are more likely to report not feeling well rested in the morning, to have higher scores on the Epworth Sleepiness Scale, and to have greater frequency of nocturia. It is important to consider untreated OSA in patients who have ischemic stroke on awakening from sleep. Most strokes occur between 6 a.m. and noon, but strokes during sleep warrant consideration of untreated OSA. OSA is highly prevalent in patients after stroke or transient ischemic attack. OSA is associated with poorer outcomes after ischemic strokes.