PLOS MED: Circadian differences in stroke onset - serious consequences with greater likelihood of nocturnal onset

Although it is known that there is an increase in adverse cardiovascular events such as stroke and myocardial infarction in the morning , there are only a few relatively small studies on the relationship between stroke onset time and short-term/long-term outcomes, with inconsistent results .

Preclinical data suggest that there is a diurnal variation in the progression of ischemic stroke, with more active cell death and infarct growth at the onset of stroke during the inactive (day) phase than during the active (night) phase in rodent models

In a nationwide multicenter observational cohort study in Korea from May 2011 to July 2020, we assessed the effects of circadian rhythm on initial stroke severity (NIHSS score on admission), END, and favorable functional outcomes (3 Monthly mRS scores 0-2 and 3-6)

The results showed that after adjustment for age, sex, previous stroke, pre-stroke mRS score, admission NIHSS score, hypertension , diabetes , hyperlipidemia, smoking, atrial fibrillation, pre-stroke antiplatelet use, pre-stroke statin use, vascular After covariates such as reconstruction, stroke onset season, and onset-to-admission time , night-onset stroke was more likely to have END than day-onset stroke (incidence rate 14.

When stroke onset times were grouped by 4-hour intervals, a monotonic gradient in NIHSS scores was noted, rising from a trough at 06:00 to 10:00 to a peak between 02:00 and 06:00

references:

Association of ischemic stroke onset time with presenting severity, acute progression, and long-term outcome: A cohort study.