Two-Peak Temporal Distribution of Stroke Onset in Greek Patients

Abstract

A circadian distribution with a single peak of stroke onset in the morning hours has been described in various countries. Analysis of the temporal pattern of symptom onset in a series of 1,253 Greek first-ever stroke patients revealed a circadian distribution with two incidence peaks between 08.00 and 10.00 h, and between 16.00 and 18.00 h. Considering the different etiopathogenic types of stroke, the same two-peak time pattern was evaluated in all stroke subgroups with the only exception of lacunar stroke, which seems to predominantly occur during night and sleep. A secondary stroke onset peak in the late afternoon has not been previously described in such detail. A relation between the second, however lower, frequency peak and the traditional Greek habit of afternoon sleep (siesta) could be assumed and deserves further investigation.

Diurnal variation of endothelial function and arterial stiffness in hypertension

“…The two-peak temporal deterioration of vascular function observed in this study grossly coincides with the observed morning and evening increased incidence of cardiovascular events. [1][2][3][4][5] Thus, variation of arterial stiffening and endothelial function may have implications for our understanding of the diurnal peaks in cardiac and vascular events. However, it should be underscored that second peaking of vascular dysfunction due to arterial stiffening may not be robustly substantiated as it most probably depends on temporal peaking of BP, which is not always observed in the evening.…”

“…Cardiovascular events such as stroke, sudden death and acute myocardial infarction have an increased incidence in the morning [1][2][3][4][5] and a smaller peak in the evening. The mechanisms involved in this variation in cardiovascular events are not clear, and may involve various factors such as augmented sympathetic activation, 6,7 haemodynamic changes, 8 neurohumoral factors and increases in coagulation.…”

Diurnal and Seasonal Variation of Stroke Incidence in Patients with Cardioembolic Stroke due to Atrial Fibrillation

“…Details and diagnostic categories of this study have previously been published [23]. All patients were examined by an internist and a neurologist within the first 48 h. In the same period, a noncontrast CT scan of the brain was also performed.…”

“…Since cardioembolic (CE) stroke is identified as the most frequent stroke subtype and AF seems to be the most important stroke risk factor in Greece [21,22], we investigated the circadian and seasonal variation in stroke incidence in patients with CE stroke due to AF, willing to examine if the recently described 2-peak diurnal variation of stroke onset in overall stroke patients in Greece [23] also appears among stroke patients of the above-defined target group.…”

Time series analysis of stroke onset

“…Drugi maksimum broja obolelih se u nekim studijama prepoznaje tokom popodneva i rane večeri (86)(87)(88)(89).…”