Circadian variation in acute ischemic stroke among Iraqi patients
https://doi.org/10.14412/2074-2711-2026-3-67-72
Abstract
Globally, acute ischemic stroke is a major cause of morbidity and mortality that has a substantial effect on quality of life and public health systems. An increasing amount of data points to the role of circadian rhythms – the endogenous, roughly 24-hour cycles that govern a number of physiological and behavioral processes in humans – in the incidence and severity of acute ischemic stroke.
Objective: to study the relationship between circadian patterns and ischemic stroke onset regarding theischemicstroke subtypes.
Material and methods. This was a cross sectional study included 192 patients diagnosed with ischemic stroke.The data collected were age, gender, past medical history, family history, social history, medication history, symptom onset time, imaging findings, and chronic illness.
Results. The mean age of patients was 64.8±12.5 years. Large-artery atherosclerosis and cardioembolisim were the most common ischemic stroke subtype, accounted for 46.9% and 29.7% respectively, while 23.4% were small vessel occlusion (lacunar). Furthermore, anterior circulation was the most common site of stroke (77%). The most common time of stroke was at morning between 7:00–11:59 AM (36.98%) followed by 1:00–6:00 AM. There is significant association between type and time of stroke where most of large-artery atherosclerosis strokes (72.2%) and cardioembolism strokes (57.9%) were between 12:00–11:59 AM while the small vessel occlusion strokes (lacunar) were mostly between 12:00–11:59 PM.
Conclusion. The observed circadian pattern of ischemic stroke, which shows a peak occurrence in the morning between 7:00–11:59 AM, has been supported by this study. Small vessel occlusion strokes (lacunar) had a less clear pattern than Large-artery atherosclerosis and cardioembolisim type, which showed strong morning predominance. There were no discernible correlations between the time of a stroke and vascular or sociodemographic risk variables.
About the Authors
Z. Abd Raheef
Middle Euphrates Neurosciences Center (MENC)
Iraq
Competing Interests:
Iraq
54001, Al-Haydariah, 20 street Imam, Al-Najaf
Competing Interests:
There are no conflicts of interest.
S.A. Goloom
Middle Euphrates Neurosciences Center (MENC)
Iraq
Competing Interests:
Iraq
54001, Al-Haydariah, 20 street Imam, Al-Najaf
Competing Interests:
There are no conflicts of interest.
H.A. Al-Khalidi
Middle Euphrates Neurosciences Center (MENC) ; Faculty of Medicine, Kufa University
Iraq
Competing Interests:
Iraq
Hasanain A. Al-Khalidi
54001, Al-Haydariah, 20 street Imam, Al-Najaf
Competing Interests:
There are no conflicts of interest.
References
1. Feigin VL, Norrving B, Mensah GA. Global Burden of Stroke. Circ Res. 2017 Feb 3;120(3):439-48. doi: 10.1161/CIRCRESAHA.116.308413
2. Haus E, Smolensky M. Biological clocks and shift work: circadian dysregulation and potential long-term effects. Cancer Causes Control. 2006 May;17(4):489-500. doi: 10.1007/s10552-005-9015-4
3. Thosar SS, Butler MP, Shea SA. Role of the circadian system in cardiovascular disease. J Clin Invest. 2018 Jun 1;128(6):2157- 67. doi: 10.1172/JCI80590
4. Zhang Y, Liu L, Zhao X, et al. New insight into ischemic stroke: Circadian rhythm in poststroke angiogenesis. Front Pharmacol. 2022 Aug 9;13:927506. doi: 10.3389/fphar.2022.927506
5. Bedrosian TA, Nelson RJ. Timing of light exposure affects mood and brain circuits. Transl Psychiatry. 2017 Jan 31;7(1):e1017. doi: 10.1038/tp.2016.262
6. Takahashi JS. Transcriptional architecture of the mammalian circadian clock. Nat Rev Genet. 2017 Mar;18(3):164-79. doi: 10.1038/nrg.2016.150
7. Kamat PK, Khan MB, Smith C, et al. The time dimension to stroke: Circadian effects on stroke outcomes and mechanisms. Neurochem Int. 2023 Jan;162:105457. doi: 10.1016/j.neuint.2022.105457
8. Reddy S, Reddy V, Sharma S. Physiology, Circadian Rhythm. Treasure Island (FL): StatPearls; 2022.
9. Brenna A, Albrecht U. Phosphorylation and Circadian Molecular Timing. Front Physiol. 2020 Nov 26;11:612510. doi: 10.3389/fphys.2020.612510
10. Hussain AM, Lafta RK. Burden of non-communicable diseases in Iraq after the 2003 war. Saudi Med J. 2019 Jan;40(1):72-8. doi: 10.15537/smj.2019.1.23463
11. Ripamonti L, Riva R, Maioli F, et al. Daily Variation in the Occurrence of Different Subtypes of Stroke. Stroke Res Treat. 2017;2017:9091250. doi: 10.1155/2017/9091250
12. Fodor DM, Marta MM, Perju-Dumbrava L. Implications of Circadian Rhythm in Stroke Occurrence: Certainties and Possibilities. Brain Sci. 2021 Jun 29;11(7):865. doi: 10.3390/brainsci11070865
13. Adams RD, Victor M. Principles of Neurology. 10th ed. McGraw-Hill; 2014.
14. Yun SP, Jung WS, Moon SK, et al. Circadian Variation of Acute Stroke. J Korean Med. 2007;28(4):8-12.
15. Al-Ahwal SA, Ragab OA, Elsafa AAA, Ghali AA. Circadian and circannual patterns of stroke. Egypt J Neurol Psychiatry Neurosurg. 2019;55(1):1-7.
16. Koo Y, Yu S, Cho KH, Jung KY. Circadian Variation of Stroke Onset and Other Clinical Characteristics: A Single-Center Study. J Korean Sleep Res Soc. 2014;11:61-5. doi: 10.13078/jksrs.14011
17. Yun Im Choi, Il-Kyo Seo, Doh-Eui Kim, et al. Same Pattern of Circadian Variation according to the Season in the Timing of Ischemic Stroke Onset: Preliminary Report. Sleep Med Res. 2015;6(2):72-6. doi: 10.17241/smr.2015.6.2.72
18. Casetta I, Granieri E, Fallica E, et al. Patient demographic and clinical features and circadian variation in onset of ischemic stroke. Arch Neurol. 2002;59(1):48-53.
19. Kario K, Pickering TG, Umeda Y, et al. Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives. Circulation. 2003 Mar 18;107(10):1401-6. doi: 10.1161/01.cir.0000056521.67546.aa
20. Butt MU, Zakaria M, Hussain HM. Circadian pattern of onset of ischaemic and haemorrhagic strokes, and their relation to sleep/wake cycle. J Pak Med Assoc. 2009;59(3):129-32.
21. Nahrir S, Khan A, Alsenani F. Uncommon stroke disorders characteristics of wake-up stroke through the timing – an experience from an Arab cohort. Int J Stroke. 2014;9:315-6.
22. Omama S, Yoshida Y, Ogawa A, et al. Differences in circadian variation of cerebral infarction, intracerebral haemorrhage and subarachnoid haemorrhage by situation at onset. J Neurol Neurosurg Psychiatry. 2006;77(12):1345-9.
23. Tsai CF, Thomas B, Sudlow CL. Epidemiology of stroke and its subtypes in Chinese vs white populations: a systematic review. Neurology. 2013;81(3):264-72.
24. Wang Y, Li L, Wei H, et al. Diurnal variation of ischemic stroke incidence: A hospital-based study. J Stroke Cerebrovasc Dis. 2012;21(3):178-84.
25. Kabir MR, Hasan ABMK, Hasan MK, et al. Circadian variation in stroke: a hospital-based study. Int J Adv Med. 2019;6(4):1236-40. doi: 10.18203/2349-3933.IJAM20193277
26. Patil SN. Clinical Profile & Circadian Variation in Onset of CVA in Tertiary Care Hospital. J Med Sci Clin Res. 2019;7(2). doi: 10.18535/JMSCR/V7I2.179
27. Rahman M, Rahman Md, Ahmed M, et al. Circadian Variation of Stroke in a Tertiary Level Hospital. Asian J Med Health. 2024. doi: 10.9734/ajmah/2024/v22i3991
28. Frid P, Drake M, Giese AK, et al. Detailed phenotyping of posterior vs. anterior circulation ischemic stroke: a multi-center MRI study behalf of the Stroke Genetics Network (SiGN), the International Stroke Genetics Consortium (ISGC), and the MRI-Genetics Interface Exploration (MRI-GENIE) Study. J Neurol. 2020 Mar;267(3):649-58. doi: 10.1007/s00415-019-09613-5
29. Gorelick, PB, Kim JS. Epidemiology, Risk Factors, and Stroke Mechanisms. Singapore: Springer; 2021. P. 21-33. doi: 10.1007/978-981-15-6739-1_3
30. Reidler P, Brehm A, Sporns PB, et al. Circadian rhythm of ischaemic core progression in human stroke. J Neurol Neurosurg Psychiatry. 2023 Jan;94(1):70-3. doi: 10.1136/jnnp-2021-326072
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For citations:
Abd Raheef Z, Goloom S, Al-Khalidi H. Circadian variation in acute ischemic stroke among Iraqi patients. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2026;18(3):67-72. https://doi.org/10.14412/2074-2711-2026-3-67-72
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