Circadian Variation in Onset of Acute Ischemic Stroke

Marsh, E. Eugene; Biller, José; Adams, Harold P.; Marler, John R.; Hulbert, J. R.; Love, Betsey B.; Gordon, David

doi:10.1001/archneur.1990.00530110032012

Cited by 145 publications

(110 citation statements)

References 22 publications

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“…The possibility that stroke occurs during sleep but is noticed when the patient wakes up in the morning was ruled out in previous studies. 10,12,16 Our results support this conclusion, since a significant proportion of strokes occurred after awakening. The first hour after awakening seems to be the most common period of onset of IS, as had been reported.…”

Section: Discussionsupporting

confidence: 85%

“…[10][11][12][13][14][15][16][17][18] Although several previous reports of diurnal variation in stroke suggested that stroke was more common at night during sleep, 1,19 no reasonable explanation is provided for the pathophysiologic mechanism leading to cerebral infarction. The possibility that stroke occurs during sleep but is noticed when the patient wakes up in the morning was ruled out in previous studies.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

“…8,9 Similar circadian variation of cerebral ischemia was also reported but with contradictory findings. [10][11][12][13][14][15][16] While there are considerable variations in patient populations and methods, most of the previous studies note a peak onset in the morning hours, [17][18][19] particularly at the time of awakening. 20 The aim of the present study was to investigate the possibility that acute ischemic stroke (IS) has a circadian variation and IS occurs more often at certain times of the day in Turkish sufferers whose awakening time is probably different from western populations.…”

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confidence: 99%

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Very Early Morning Increase in Onset of Ischemic Stroke

Torun

Özdemir

1994

Annals of Saudi Medicine

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A study was conducted on 525 consecutive patients ranging in age from 36 years to 86 years to determine whether diurnal variation occurs in the onset of acute ischemic stroke. There was a clear (D max =0.19, P<0.01) diurnal variation with a significant (t=-4.96, P<0.001) peak between four a.m. and six a.m. Strokes occurred more often during the two hours following awakening than during any other time of the day. The peak time of ischemic stroke in our study was about two hours earlier than in previous reports, probably because of the different waking times of the studied populations. We concluded that the time of awakening influences the circadian distribution rather than the time of day itself. Ann Saudi Med 1994;14(3):201-203. S Torun, G Özdemir, Very Early Morning Increase in Onset of Ischemic Stroke. 1994; 14(3): 201-203 Ischemic vascular events have been reported repeatedly to occur following a circadian rhythm.1-3 Most of these reports deal with myocardial ischemia, 4,5 acute myocardial infarction, 6,7 and sudden cardiac death. 8,9 Similar circadian variation of cerebral ischemia was also reported but with contradictory findings. [10][11][12][13][14][15][16] While there are considerable variations in patient populations and methods, most of the previous studies note a peak onset in the morning hours, [17][18][19] particularly at the time of awakening. 20The aim of the present study was to investigate the possibility that acute ischemic stroke (IS) has a circadian variation and IS occurs more often at certain times of the day in Turkish sufferers whose awakening time is probably different from western populations. Material and MethodsProspectively collected data on 525 patients with acute IS, admitted to our Department of Neurology between December 1986 and May 1990 were analyzed. Only the cases in which the diagnosis of IS was ascertained by computed tomography (CT), and only strokes of acute onset in which symptoms reached their maximum in less than eight hours and remained present for more than three weeks were considered.The time of onset of symptoms attributed to IS and the time of awakening were obtained from the patient, family members, or other observers.We considered the time of onset to be the hour in which the patient or an observer first became aware of the event. In patients who first noticed their stroke symptoms on waking, it was presumed that the IS had occurred during sleep. Details of whether the patient was active or at rest when the IS occurred were also recorded.The frequency of symptom onset was tabulated for two hourly intervals in the day beginning one minute after the previous hour (i.e., 12:01 a.m. to 2 a.m., 2:01 a.m. to 4 a.m., etc.). The Student's t-test and Kolmogorov-Smirnov type statistics were used for statistical analysis involving comparison of distributions of IS over a 24 hour period. ResultsOur study included 525 patients with acute IS, consisting of 295 males and 230 females ranging in age from 36 to 86 years (mean age 64.2). There was a clear and significant diur...

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Very Early Morning Increase in Onset of Ischemic Stroke

Torun

Özdemir

1994

Annals of Saudi Medicine

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“…OSAS, uyanma sırasında klinik olarak gözlenen trombozis ve embolik fenomenin tetikleyicisi olabilir. OSAS ile bağlantılı olarak katekolamin düzeylerinin ve platelet aktivasyonunun artması, trombus oluşumunu ve SVO riskini sabah sürecindeki normal hematolojik ortamda daha da artırabilir (53).…”

Section: Protrombotik Ortamunclassified

Sleep related breathing disorders and cerebrovascular diseases

Erdinç¹

2010

Türk Beyin Damar Hast Derg

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ÖZETObstrüktif uyku apne sendromu (OSAS), yüksek prevalanslı ve sıklıkla gözden kaçan, solunumla ilişkili bir uyku bozukluğudur. Uykuda üst hava yollarının gevşeyerek hava yolunu tıkaması sonucu oluşur. Gece boyunca sık uyanmalar, hipoksemi, uykunun bölünmesi ve uyku kalitesinin düşmesi ile izlenir. Şiddetli horlama, tanıklı apneler ve gün içi aşırı uykululuk durumu en önemli semptomlardır. Artmış sempatik aktivite, metabolik ve inflamatuvar markerlar, OSAS ve serebrovasküler hastalıklar arasındaki olası ortak mekanizmayı açıklayabilir. Tedavi seçenekleri için bu mekanizmaların çok iyi bilinmesi gerekir. OSAS'ın erken tanısı ve tedavisi bireyleri serebrovasküler ve diğer komplikasyonlardan koruyabilecektir. SLEEP RELATED BREATHING DISORDERS AND CEREBROVASCULAR DISEASES ABSTRACTObstructive sleep apnea (OSA) is a form of sleep disordered breathing, with a high prevalence rate and is often underdiagnosed. It is characterized by frequent episodes of upper airway collapse during sleep, causing recurrent arousals, intermittent hypoxaemia, sleep fragmentation and poor sleep quality. The common clinical symptoms are heavy snoring, witnessed apnea and daytime hypersomnolence, which would help to identify the affected individuals. Increased sympathetic drive, activation of metabolic and inflammatory markers, and impaired vascular function are some of the proposed mechanisms that could explain the association between OSA and cerebrovascular diseases. Understanding these mechanisms is important for identifying treatment strategies. Increased sympathetic drive, activation of metabolic and inflammatory markers, and impaired vascular function are some of the proposed mechanisms that could explain the association between OSA and cardiovascular diseases. Early recognition and treatment of obstructive sleep apnoea may prevent from adverse health consequences.Yazışma Adresi: Oğuz Osman ERDİNÇ Eskişehir Osmangazi Üniversitesi Tıp Fakültesi Nöroloji Anabilim Dalı, ESKİŞEHİR 1 DERLEME REVIEW Epidemiyoloji OSAS'ın prevalans değerleri kadınlarda %9, erkeklerde %24 şeklinde bildirilmiştir (3). SVO da aynı şekilde sık rastlanılan bir tablodur ve ABD'de üçüncü sıklıkta gelen ölüm nedeni olarak bilinmektedir. Olgu sayısı yılda 700.000'e ulaşmış ve akut nörolojik yakınmalarla başvuran olguların yarısını oluşturmuştur (4). Dünyada ele alındığında, SVO ikinci majör ölüm veya uzun süreli maluliyet nedenidir (5). Obstrüktif apne hipopne indeksine (AHI) göre hafif ve orta şiddetteki OSAS'ın varlığı bile, hastaların SVO için önleyici tedavi almaları gerektiğini göstermektedir (6). HorlamakHorlamak, OSAS'ın en önemli belirtecidir (7). Sık horlama faktörü aynı zamanda, hipertansiyon, kalp hastalıkları, demans ve SVO için oldukça önemlidir (8).Horlamak orta yaşlı erkeklerde ortalama %40-45, aynı yaş grupta kadınlarda %25-30 sıklığındadır. Uykuda meydana gelen SVO olguları horlama ile Solunum ile ilişkili uyku bozuklukları (SUB) içinde en sık rastlanılanı obstrüktif uyku apne sendromudur (OSAS). Klinik semptomlar çok iyi bilinmez veya tanımlanmaz ise...

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Circadian Variation in Stroke

Alberts

1991

Archives of Neurology

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Circadian Variation in Onset of Acute Ischemic Stroke

Cited by 145 publications

References 22 publications

Very Early Morning Increase in Onset of Ischemic Stroke

Very Early Morning Increase in Onset of Ischemic Stroke

Sleep related breathing disorders and cerebrovascular diseases

Circadian Variation in Stroke

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