DOI: http://dx.doi.org/10.18203/2349-3933.ijam20193277

Circadian variation in stroke: a hospital-based study

Mohammed Ruhul Kabir, A. B. M. Kamrul Hasan, Mohammed Kamrul Hasan, Shishir Ranjan Chakraborty, Matiur Rahman

Abstract


Background: Proof of a circadian rhythm in the occurrence of cerebral infarction and other types of stroke might provide clues to factors which immediately precipitate these events, which in turn might lead to more rational treatments. The aims of the current study were to find out the circadian variation of stroke onset and to determine the risk factors related to circadian variation.

Methods: This cross-sectional study was conducted in a tertiary hospital of Bangladesh from July to December 2014 among 67 diagnosed cases of ischemic and hemorrhagic stroke of first attack. Times of onset of stroke and wake-sleep state were recorded.

Results: The mean age of the study subjects was 62.1 years, 64.2% were male. Among them, 59.7% had an ischemic stroke and 40.3% had a hemorrhagic stroke. The occurrence of stroke was most common during 6 am to 12 pm (47.8%), followed by 12 am to 6 am (25.4%), 12 pm to 6 pm (17.9%), and 6 pm to 12 am (9.0%). Circadian variation of stroke was homogenous and statistically insignificant in association with age group when categorized as below 65 years and 65 years or above years, sex, smoking habit, and presence or absence of diabetes mellitus, atrial fibrillation, and dyslipidemia. But hypertension and ischemic heart disease (IHD) were significantly associated with circadian variation of stroke. The occurrence of ischemic stroke and hemorrhagic stroke was most common from 6 am to 12 pm (47.5% and 48.1%) respectively. When considered separately, significant circadian variation noted for ischemic stroke and hemorrhagic strokes were also noted.

Conclusions: The study contributes further evidence for the circadian variation in the occurrence of ischemic stroke and hemorrhagic stroke. Attempts to prevent their occurrence must take into account this circadian variation.


Keywords


Circadian rhythm, Hemorrhagic stroke, Hypertension, Stroke, IHD, Ischemic stroke

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References


Parvin S, Hoque MM, Sultana N, Naoshin Z. Study of serum non-HDL cholesterol in cerebrovascular disease. Bangladesh J Med Sci. 2010;9(3):143-9.

Meschia JF. Addressing the heterogeneity of the ischemic stroke phenotype in human genetics research. Stroke. 2002;33(12):2770-4.

Larrue V, von Kummer R, del Zoppo G, Bluhmki E. Hemorrhagic transformation in acute ischemic stroke: potential contributing factors in the European Cooperative acute stroke study. Stroke. 1997;28(5):957-60.

Kawakami C, Ohshige K, Tochikubo O. Circadian variation in cardiovascular emergencies among the elderly. Clinical Expe Hypertension. 2008;30(1):23-31.

Curtis AM, Cheng Y, Kapoor S, Reilly D, Price TS, FitzGerald GA. Circadian variation of blood pressure and the vascular response to asynchronous stress. Proceedings National Acad Sci. 2007;104(9):3450-5.

Gupta A, Shetty H. Circadian variation in stroke–a prospective hospital‐based study. Int J Clinic Prac. 2005;59(11):1272-5.

Elliott WJ. Circadian variation in the timing of stroke onset: a meta-analysis. Stroke. 1998;29(5):992-6.

Butt MU, Zakaria M, Hussain HM. Circadian pattern of onset of ischaemic and haemorrhagic strokes, and their relation to sleep/wake cycle. JPMA. J Pak Med Associat. 2009;59(3):129-32.

American Diabetes Association. Clinical Practice Recommendations 2014. Diab Care. 2014;37:S14-80.

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289(19):2560-72.

Casetta I, Granieri E, Fallica E, la Cecilia O, Paolino E, Manfredini R. Patient demographic and clinical features and circadian variation in onset of ischemic stroke. Arch Neurol. 2002;59(1):48-53.

Kelly-Hayes M, Wolf PA, Kase CS, Brand FN, Mc Guirk JM, D’Agostino RB. Temporal patterns of stroke onset: the Framingham Study. Stroke. 1995;26(8):1343-7.

Lago A, Geffner D, Tembl J, Landete L, Valero C, Baquero M. Circadian variation in acute ischemic stroke: a hospital-based study. Stroke. 1998;29(9):1873-5.

Argentino C, Toni D, Rasura M, Violi F, Sacchetti ML, Allegretta A, et al. Circadian variation in the frequency of ischemic stroke. Stroke. 1990;21(3):387-9.

Nyquist PA, Brown RD, Wiebers DO, Crowson CS, O’Fallon WM. Circadian and seasonal occurrence of subarachnoid and intracerebral hemorrhage. Neurol. 2001;56(2):190-3.

White WB. Cardiovascular risk and therapeutic intervention for the early morning surge in blood pressure and heart rate. Blood Pressure Monitoring. 2001;6(2):63-72.

Stergiou GS, Vemmos KN, Pliarchopoulou KM, Synetos AG, Roussias LG, Mountokalakis TD. Parallel morning and evening surge in stroke onset, blood pressure, and physical activity. Stroke. 2002;33(6):1480-6.

Bassetti C, Aldrich M. Night time versus daytime transient ischaemic attack and ischaemic stroke: a prospective study of 110 patients. J Neuro, Neurosurg Psychiat. 1999;67(4):463-7.

Chamorro A, Vila N, Ascaso C, Elices E, Schonewille W, Blanc R. Blood pressure and functional recovery in acute ischemic stroke. Stroke. 1998;29(9):1850-3.

Cohen MC, Rohtla KM, Lavery CE, Muller JE, Mittleman MA. Meta-analysis of the morning excess of acute myocardial infarction and sudden cardiac death. Am J Cardiol. 1997;79(11):1512-6.

Elliott WJ. Cyclic and circadian variations in cardiovascular events. Am J Hypertens. 2001;14(S6):291S-5S.

Passero S, Reale F, Ciacci G, Zei E. Differing temporal patterns of onset in subgroups of patients with intracerebral hemorrhage. Stroke. 2000;31(7):1538-44.

Kluft C, Jie AF, Rijken DC, Verheijen JH. Daytime fluctuations in blood of tissue-type plasminogen activator (t-PA) and its fast-acting inhibitor (PAI-1). Thrombo Haemost. 1988;60(02):329-32.