Circadian rhythm of ischaemic core progression in human stroke

Reidler, Paul; Sporns, Peter; Burbano, Vanessa Granja; Stueckelschweiger, Lena; Broocks, Gabriel; Liebig, Thomas; Psychogios, Marios‐Nikos; Ricke, Jens; Dimitriadis, Konstantinos; Dichgans, Martin; Kunz, Wolfgang G.; Tiedt, Steffen

doi:10.1136/jnnp-2021-326072

Cited by 32 publications

(35 citation statements)

References 12 publications

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“…This study proposed that the lower body temperature at night, among other factors, may have had a potential impact on their results [ 38 ]. Conversely, other studies have claimed that, although suffering a stroke at night is less frequent, they usually are more severe [ 26 , 39 ] and exhibit faster infarct progression [ 40 ], which supports the data observed in the present study.…”

Section: Discussionsupporting

confidence: 92%

Influence of Temperature Chronobiology on Stroke Outcome

Alonso-Alonso¹,

Sampedro-Viana²,

Rodríguez‐Yáñez

et al. 2023

IJMS

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The circadian system regulates numerous physiological variables, including body temperature. Additionally, a circadian patter has been described in stroke onset. Considering this, we hypothesised that the chronobiology of temperature may have an impact on stroke onset and functional outcomes. We also studied the variation of blood biomarkers according to stroke onset time. This is a retrospective observational study. Of the patients included, 2763 had a stroke between midnight and 8:00 h; 1571 between 8:00–14:00 h; and 655 between 14:00 h and midnight. Axillary temperature was measured at admission. At this time, blood samples were collected for biomarker analysis (TNF-α, IL-1β, IL-6, IL-10, and glutamate). Temperature was higher in patients admitted from 8:00 h to midnight (p < 0.0001). However, the percentage of poor outcome at 3 months was highest in patients from midnight to 8:00 h (57.7%, p < 0.001). The association between temperature and mortality was highest during night time (OR: 2.79; CI 95%: 2.36–3.28; p < 0.001). These patients exhibited high glutamate (220.2 ± 140.2 µM), IL-6 (32.8 ± 14.3 pg/mL) and low IL-10 (9.7 ± 14.3 pg/mL) levels. Therefore, temperature chronobiology could have a significant impact on stroke onset and functional outcome. Superficial body hyperthermia during sleep seems to be more dangerous than during wakefulness. Further studies will be necessary to confirm our data.

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Section: Discussionsupporting

confidence: 92%

Influence of Temperature Chronobiology on Stroke Outcome

Alonso-Alonso¹,

Sampedro-Viana²,

Rodríguez‐Yáñez

et al. 2023

IJMS

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“…The current large-scale study of ischemic stroke clinical presentation and course is consonant with recent smaller studies of ischemic stroke imaging. An analysis of CT perfusion imaging data in patients with anterior large vessel occlusion stroke found larger initial ischemic core volume with night-onset compared with day-onset strokes [29]. Core growth from onset to imaging proceeded was also faster in night-onset than day-onset strokes.…”

Section: Plos Medicinementioning

confidence: 98%

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

et al. 2022

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Background Preclinical data suggest circadian variation in ischemic stroke progression, with more active cell death and infarct growth in rodent models with inactive phase (daytime) than active phase (nighttime) stroke onset. We aimed to examine the association of stroke onset time with presenting severity, early neurological deterioration (END), and long-term functional outcome in human ischemic stroke. Methods and findings In a Korean nationwide multicenter observational cohort study from May 2011 to July 2020, we assessed circadian effects on initial stroke severity (National Institutes of Health Stroke Scale [NIHSS] score at admission), END, and favorable functional outcome (3-month modified Rankin Scale [mRS] score 0 to 2 versus 3 to 6). We included 17,461 consecutive patients with witnessed ischemic stroke within 6 hours of onset. Stroke onset time was divided into 2 groups (day-onset [06:00 to 18:00] versus night-onset [18:00 to 06:00]) and into 6 groups by 4-hour intervals. We used mixed-effects ordered or logistic regression models while accounting for clustering by hospitals. Mean age was 66.9 (SD 13.4) years, and 6,900 (39.5%) were women. END occurred in 2,219 (12.7%) patients. After adjusting for covariates including age, sex, previous stroke, prestroke mRS score, admission NIHSS score, hypertension, diabetes, hyperlipidemia, smoking, atrial fibrillation, prestroke antiplatelet use, prestroke statin use, revascularization, season of stroke onset, and time from onset to hospital arrival, night-onset stroke was more prone to END (adjusted incidence 14.4% versus 12.8%, p = 0.006) and had a lower likelihood of favorable outcome (adjusted odds ratio, 0.88 [95% CI, 0.79 to 0.98]; p = 0.03) compared with day-onset stroke. When stroke onset times were grouped by 4-hour intervals, a monotonic gradient in presenting NIHSS score was noted, rising from a nadir in 06:00 to 10:00 to a peak in 02:00 to 06:00. The 18:00 to 22:00 and 22:00 to 02:00 onset stroke patients were more likely to experience END than the 06:00 to 10:00 onset stroke patients. At 3 months, there was a monotonic gradient in the rate of favorable functional outcome, falling from a peak at 06:00 to 10:00 to a nadir at 22:00 to 02:00. Study limitations include the lack of information on sleep disorders and patient work/activity schedules. Conclusions Night-onset strokes, compared with day-onset strokes, are associated with higher presenting neurologic severity, more frequent END, and worse 3-month functional outcome. These findings suggest that circadian time of onset is an important additional variable for inclusion in epidemiologic natural history studies and in treatment trials of neuroprotective and reperfusion agents for acute ischemic stroke.

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“…1,2 Epidemiological studies have found that the incidence of ischemic stroke is higher in the early hours of the morning, which has been reported to be up to 49% higher than in the other 18 hours of the day. 3 Furthermore, clinical outcomes of patients with acute ischemic stroke (AIS) also follow a circadian curve, with nighttime stroke resulting in faster infarct progression, 4 higher presenting neurologic severity, more frequent early neurological deterioration and worse 3-month functional outcome. 5 These findings motivated studies that investigate the temporal effects on the reperfusion therapy.…”

Section: Introductionmentioning

confidence: 99%

Association between the time of day at stroke onset and functional outcome of acute ischemic stroke patients treated with endovascular therapy

Wang

et al. 2022

J Cereb Blood Flow Metab

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To investigate the association between time-of-day of stroke onset and functional outcome in patients with acute ischemic stroke(AIS) treated with endovascular thrombectomy(EVT). AIS patients treated with EVT between January 2013 and December 2018 were recruited and divided them into four 6-h interval groups according to the time-of-day of stroke onset. A total of 438 patients were enrolled, 3-month favorable outcome were achieved in 58.6%, 43.7%, 36.6%, and 30.5% of patients in the 00:00–06:00, 06:00–12:00, 12:00–18:00, and 18:00–24:00 groups, respectively (adjusted OR 0.61, 95% CI 0.40–0.93; p = 0.020). Compared with the 18:00–24:00 interval, patients in the 00:00–06:00 interval (adjusted OR 4.01, 95%CI 1.02–15.80, p = 0.047) and the 06:00–12:00 interval (adjusted OR 3.24, 95% CI 1.09–9.64, p = 0.034) were more likely to achieve favorable outcome. The time-of-day of stroke onset was not associated with 3-month mortality (adjusted p = 0.829), symptomatic intracerebral hemorrhage (sICH, adjusted p = 0.296), or early successful recanalization (adjusted p = 0.074). In conclusion, in AIS patients treated with EVT, those onsets either between 00:00 and 06:00 or between 06:00 and 12:00 appeared to be associated with a higher proportion of favorable outcomes at 3 months, but the time-of-day at stroke onset was not associated with the incidence of sICH, rate of early successful recanalization, or 3-month mortality.

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Circadian rhythm of ischaemic core progression in human stroke

Cited by 32 publications

References 12 publications

Influence of Temperature Chronobiology on Stroke Outcome

Influence of Temperature Chronobiology on Stroke Outcome

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

Association between the time of day at stroke onset and functional outcome of acute ischemic stroke patients treated with endovascular therapy

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