Background

Aneurysmal subarachnoid hemorrhage (aSAH) is known to be triggered by several specific human activities. Sleep, by contrast, has not been considered a triggering activity for aSAH, and clinical characteristics of patients who sustain aSAH during sleep have rarely been reported in the literature.

Methods

This is a retrospective analysis on the data acquired through a multicenter aSAH registry. Between January 2019 and December 2021, a total of 732 aSAH patients had been registered into our database. After excluding 109 patients whose activities at aSAH onset had been unidentifiable, the remaining 623 aSAH patients were dichotomized to 59 patients who sustained aSAH during sleep (Sleep group) and 564 patients who sustained aSAH during daytime activities (Awake group). Two-group comparison of demographic variables and multivariate logistic regression analysis were performed to clarify their clinical characteristics and identify potential risk factors.

Results

The Sleep group exhibited significantly higher frequencies of diabetes (15.5 % vs. 6.4 %, p = 0.01) and antiplatelet use (13.8 % vs. 4.6 %, p=0.004) than the Awake group. Furthermore, multivariate logistic regression analysis showed that diabetes (OR, 3.051; 95 % CI, 1.281-7.268; p = 0.012) and antiplatelet use (OR, 3.640; 95 % CI, 1.422-9.316; p = 0.007) were correlated with aSAH occurring during sleep. There were no significant inter-group differences in the patient outcomes evaluated at discharge.

Conclusion

The current results indicate that risk factors may exist for aSAH occurring during sleep. Further investigations on how comorbidities such as diabetes, antiplatelet use and sleep apnea affect human hemodynamic and hemostatic parameters during sleep is warranted to better understand those relationships.

中文翻译：

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睡眠期间发生的动脉瘤性蛛网膜下腔出血：临床特征和危险因素

背景

已知动脉瘤性蛛网膜下腔出血 (aSAH) 是由几种特定的人类活动引发的。相比之下，睡眠并未被认为是 aSAH 的触发活动，并且文献中很少报道睡眠期间持续 aSAH 的患者的临床特征。

方法

这是对通过多中心 aSAH 登记获得的数据进行的回顾性分析。2019年1月至2021年12月期间，共有732名aSAH患者登记到我们的数据库中。排除 109 名在 aSAH 发作时活动无法识别的患者后，剩余 623 名 aSAH 患者被分为 59 名在睡眠期间持续 aSAH 的患者（睡眠组）和 564 名在白天活动期间持续 aSAH 的患者（清醒组）。对人口统计学变量进行两组比较和多因素逻辑回归分析，以阐明其临床特征并识别潜在的危险因素。

结果

睡眠组患糖尿病的频率（15.5% vs. 6.4%， p  = 0.01）和抗血小板药物使用频率（13.8% vs. 4.6%，p =0.004）显着高于清醒组。此外，多变量逻辑回归分析显示，糖尿病（OR，3.051；95% CI，1.281-7.268；p  = 0.012）和抗血小板药物的使用（OR，3.640；95% CI，1.422-9.316；p  = 0.007）与aSAH相关发生在睡眠期间。出院时评估的患者结局没有显着的组间差异。

结论

目前的结果表明睡眠期间发生aSAH可能存在危险因素。为了更好地理解这些关系，有必要进一步研究糖尿病、抗血小板药物的使用和睡眠呼吸暂停等合并症如何影响睡眠期间的人体血流动力学和止血参数。