Circadian preference and stroke characteristics: A descriptive study

Truksinas, Eveli; Frange, Cristina; Paz, Giuliano da; Vago, Eliana Lottenberg; Andersen, Mônica Levy; Tufik, Sérgio; Coelho, Fernando Morgadinho Santos

doi:10.1080/07420528.2021.2021228

Cited by 3 publications

(2 citation statements)

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“…28 There is very limited data on whether chronotype affects stroke outcome or should guide therapeutic decisions; the only published study on this was a retrospective study of 115 people, of whom only 2 had a late chronotype. 200…”

Section: Clinical Evidence and Implications Of A Time-of-day-dependen...mentioning

confidence: 99%

Stroke in the Time of Circadian Medicine

Mergenthaler,

Balami,

Neuhaus

et al. 2024

Circulation Research

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Time-of-day significantly influences the severity and incidence of stroke. Evidence has emerged not only for circadian governance over stroke risk factors, but also for important determinants of clinical outcome. In this review, we provide a comprehensive overview of the interplay between chronobiology and cerebrovascular disease. We discuss circadian regulation of pathophysiological mechanisms underlying stroke onset or tolerance as well as in vascular dementia. This includes cell death mechanisms, metabolism, mitochondrial function, and inflammation/immunity. Furthermore, we present clinical evidence supporting the link between disrupted circadian rhythms and increased susceptibility to stroke and dementia. We propose that circadian regulation of biochemical and physiological pathways in the brain increase susceptibility to damage after stroke in sleep and attenuate treatment effectiveness during the active phase. This review underscores the importance of considering circadian biology for understanding the pathology and treatment choice for stroke and vascular dementia and speculates that considering a patient’s chronotype may be an important factor in developing precision treatment following stroke.

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Section: Clinical Evidence and Implications Of A Time-of-day-dependen...mentioning

confidence: 99%

Stroke in the Time of Circadian Medicine

Mergenthaler,

Balami,

Neuhaus

et al. 2024

Circulation Research

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“…Ischemic and intracerebral hemorrhage (ICH) seem to have a similar circadian distribution (2, 3,8,9). Several underlying mechanisms related to the circadian variation of stroke onset have been described that may explain the predominance in the hours around awakening, such as disregulations in BP, especially in reverse-dippers (10,11), a higher incidence of atrial fibrillation (12,13), and elevated levels of cortisol, blood viscosity, and platelet aggregability related to the transition to an upright posture (14)(15)(16)(17)(18)(19).…”

Section: Background and Purposementioning

confidence: 99%

Time of the day and season distribution among stroke code subtypes: differences between ischemic stroke, intracranial hemorrhage, and stroke mimic

Menéndez Albarracín,

Valls Carbó,

Rabaneda Lombarte

et al. 2024

Front. Neurol.

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BackgroundCircadian variations in the timing of the onset of stroke symptoms have been described, showing a morning excess of cardiovascular risk. To date, no differences have been found between stroke subtype and time distribution throughout the day. The present study aims to compare the seasonal and circadian rhythm of symptoms onset in ischemic, hemorrhagic, and stroke mimic patients.MethodsThis study was conducted prospectively at a hospital and involved a cohort of stroke alert patients from 2018 to 2021. Stroke subtypes were classified as ischemic stroke, intracerebral hemorrhage (ICH), transient ischemic attack (TIA), and stroke mimic. Clinical variables were recorded, and each patient was assigned to a 4-h interval of the day according to the time of onset of symptoms; unwitnessed stroke patients were analyzed separately. Seasonal changes in stroke distribution were analyzed at 3-month intervals.ResultsA total of 2,348 patients were included in this analysis (ischemic 67%, ICH 13%, mimic 16%, and TIA 3%). Regardless of stroke subtype, most of the patients were distributed between 08–12 h and 12–16 h. Significant differences were found in the time distribution depending on stroke subtype, with ICH predominating in the 4–8 h period (dawn), most of which were hypertensive, TIA in the 12–16 h period (afternoon), and stroke mimic in the 20 h period (evening). The ischemic stroke was evenly distributed throughout the different periods of the day. There were no differences in the seasonal pattern between different stroke subtypes, with winter being the one that accumulated the most cases.ConclusionThe present study showed different circadian patterns of stroke subtypes, with a predominance of ICH at dawn and stroke mimic in the afternoon. The stroke circadian rhythm resembles previous studies, with a higher incidence in the morning and a second peak in the afternoon.

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