Abstract
BackgroundCerebrovascular event peaks occur in the morning (≈ 9:00 am) with another one peak in the evening (≈ 8:00 pm) and a trough at night. Knowledge about circadian influences on mechanisms involved in cerebrovascular events is important for optimising the timing of therapy, preventing behavioural triggers at potentially risky circadian phases and selecting the timing of diagnostic procedures. This work aims to evaluate circadian and circannual patterns of stroke onset, and variation in pattern of stroke onset in the month of Ramadan.Patients and methodsThe study was conducted on 98 stroke patients and 98 age- and sex-matched normal subjects. All patients had a documented time of stroke symptom onset. End-tidal carbon dioxide and core body temperature were served as measures of endogenous circadian phase. Cerebral blood flow velocity was measured using transcranial colour-coded duplex. Circadian rhythm of blood pressure and heart rate variability were also assessed.ResultsBoth ischaemic and haemorrhagic stroke showed a circadian variation regarding their onset, with the peak in the morning and the nadir during night-time. We found a pathologically reduced or abolished circadian blood pressure variation after stroke.ConclusionStroke was more frequent in the morning; also, it was less likely to occur during the summer and autumn than the winter or spring. Stroke prevention with therapies that target the morning rise in risk factors could be advantageous in reducing the overall risk of stroke.
Highlights
Knowledge of stroke onset periodicity may elucidate the pathophysiological mechanisms of strokes and give a new hope for their prevention [1, 2]
Stroke was more frequent in the morning; it was less likely to occur during the summer and autumn than the winter or spring
Stroke prevention with therapies that target the morning rise in risk factors could be advantageous in reducing the overall risk of stroke
Summary
Knowledge of stroke onset periodicity may elucidate the pathophysiological mechanisms of strokes and give a new hope for their prevention [1, 2]. Stroke patients had rhythmic variation in blood pressure, fibrinolytic system, platelet function, vascular tone, cerebral vasomotor regulation and coagulation factors [4]. Cerebral blood flow velocity (CBFV) varies during 24 h of the day rhythm, suggesting regulation by a circadian oscillator. Circadian patterns of blood pressure (BP) changes were reported after stroke, which may have a prognostic and therapeutic implication [6]. Knowledge about circadian influences on mechanisms involved in cerebrovascular events is important for optimising the timing of therapy, preventing behavioural triggers at potentially risky circadian phases and selecting the timing of diagnostic procedures. This work aims to evaluate circadian and circannual patterns of stroke onset, and variation in pattern of stroke onset in the month of Ramadan
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