Prevalence of wake-up stroke: a systematic review and meta-analysis

Wake-up stroke (WUS) is a subgroup of ischemic stroke in which patients show no abnormality before sleep, while wake up with neurological deficits, and the prevalence varied widely across studies. To obtain a true estimate of WUS, we conducted a systematic review and meta-analysis of previously published data. PubMed, the Cochrane Library, Web of Science, Embase, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure Database (CNKI), Wanfang Database and Weipu Database (VIP) were searched from their inception through 1 April 2025 to identify population-based, observational studies that reported the prevalence of WUS. The meta-analysis included 37 studies involving 196,744 individuals. The pooled prevalence of WUS was 23.1% (95% CI: 21.1%−25.1%, I² = 98.8%). The results of the subgroup analysis showed that the pooled prevalence of WUS was 22.8% (95% CI: 21%−25%) in women and 24% (95% CI: 22%−26%) in men. The pooled prevalence of WUS based on the cross-sectional studies and cohort studies, respectively, was 25.1% (95% CI: 23%−27%) and 17.4% (95% CI: 15%−20%). Based on the regional analysis, the prevalence of WUS was 25% (95% CI: 23%−27%) in Asia, 18.5% (95% CI: 14%−22%) in Europe, and 24.1% (95% CI: 18%–31%) in North America. The prevalence of WUS is 23.1%, with higher rates observed in men and the Asian region. Increased awareness and training among healthcare professionals are essential for early recognition, potentially improving diagnosis and management in emergency settings. Promoting education on WUS is also vital for reducing associated morbidity and mortality.