The Influence Of The Habitual Sleep-wake Pattern For Acute Stroke Onset Time

Objective:To investigate the circadian rhythm about the time of acute stroke onset, discuss the influence of patient’s customary sleep-wake pattern for stroke onset time,to find evidence for forecasting the onset time,and to strive time for early diagnosis and treatment. Methods:We consecutively studied patients with acute stroke in the department of Neurology of 2nd affiliated Hospital of Nanchang University from Dec. 2013 to Feb. 2015. After MRI/CT examination,the patients would been examined by Morningness-Eveningness Questionnaire(MEQ). According to the MEQ scores,the patients were divided into morning-type group(MEQ≥59),intermediate-type group(41<MEQ<59) and evening-type group(MEQ≤41).Then comparatively analyzed the clinical data among the three groups of each subtype, including average age,gender,onset time, blood pressure,glycemic level,dyslipdemial(including TG,cholesterol,HDL and LDL), HCY,smoking,alcohol intake, Body Mass Index,nerve function impairment and so on. Focus research was the relationship between acute stroke onset time and habitual sleep-wake pattern. Result:1.In total,358 patients with acute stroke were collected:312 patients with ischemic stroke(87.2%) and 46 patients with hemorrhagic stroke(12.8%). The total subtypes showed onset peak in 24-hour pattern at 04:00-11:59(49.4%). Ischemic stroke performed the onset peak at 04:00-11:59(50.3%).Hemorrhagic stroke showed two onset peaks at 08:00-11:59(28.3%) and 16:00-19:59(26.1%).2.Among ischemic stroke patients,morning-type group showed the onset peak at 04:00-11:59(P<0.05) and evening-type group at 12:00-19:59(P<0.05). Intermediatetype group did not show obvious peak(P>0.05).The median of onset time in each group were 8,12 and 17 o’clock and there was an obvious significant between each other(P<0.001).Most patients of morning-type group occurred within 6 hours after waking up,but most of the evening-type patients occurred within 6-12 hours after waking up(P<0.05).3.In hemorrhagic stroke patients,morning-type group showed the onset peak at 04:00-11:59(P<0.05) and evening-type group at 12:00-23:59(P<0.05). Intermediate-type group did not show any clear peak(P>0.05).The median of onste time in each group were 9,13.5 and 17 o’clock(P<0.001).4.Morning-type patients of ischemic stroke had a higher morbidity of carotid atherosclerosis. Conclusion:Acute stroke onset time showed circadian rhythm.Habitual sleep-wake pattern can influence the onset time of acute stroke. Morning-type patients of ischemic stroke had a higher morbidity of carotid atherosclerosis. Morningness-Eveningness Questionnaire can be a useful measure for detecting the onset time of stroke.