缺血性和出血性中风发病的昼夜节律模式及其与睡眠/觉醒周期的关系。

Circadian pattern of onset of ischaemic and haemorrhagic strokes, and their relation to sleep/wake cycle.

作者信息

Butt Mujeeb-Ur-Rehman Abid, Zakaria Manzar, Hussain Hadi M

机构信息

Department of Medicine, Combined Military Hospital Lahore, Pakistan.

出版信息

J Pak Med Assoc. 2009 Mar;59(3):129-32.

PMID:19288934

Abstract

OBJECTIVE

To determine whether there is a circadian pattern of onset of ischaemic and haemorrhagic strokes, and their relation to sleep/wake cycle.

METHODS

A descriptive study with prospective data was conducted at the Combined Military Hospital Lahore from Jan 2004 to Dec 2007. Eight hundred patients above 26 years of age who had their first ever stroke were included in the study. Strokes were classified into cerebral infarction (CIF), intra-cerebral bleed (ICB) and subarachnoid haemorrhage (SAH). Diagnosis was confirmed either by CT or MRI scan of brain.

RESULTS

Out of 800 patients, 80% were males and 20% were females. There were 438 (55%) cases of CIF, 329 (41%) of ICB and 33 (4%) of SAH. The age of the patients ranged from 26 to 84 years. Of all stroke cases, 592 (74%) occurred when the patients were awake and 208 (26%) occurred during sleep (p < 0.001). ICB cases showed significant variation with respect to wake/sleep cycle (p < 0.001). In CIF and SAH cases there was insignificant association with wake/sleep state of the patient, (p < 0.180 and 0.792 respectively). Of all strokes 22.5% occurred between 4 am - 8 am, followed by 20.7% between 4 pm - 8 pm, 20.1% between 8 am - 12 noon, 19.5% between 12 noon to 4 PM, 12.7% between 12 midnight and 4 am while 4.3% cases occurred between 8 pm and 12 midnight. The maximum number of CIF (28.5%) occurred between 4 am- 8 am, maximum ICB (29.8%) between 8 am to 12 noon and maximum SAH (30.3%) between 4 pm - 8 pm. The CIF and SAH cases showed smaller peaks between 4 pm to 8 pm and 8 am to 12 noon respectively. The lowest number of ICB cases (4.9%) were around mid night. Significant circadian variation was found in CIF and ICB patients (p < 0.001), however it was insignificant for SAH cases (p = 0.391).

CONCLUSION

The findings of this study confirm the presence of circadian variation among cases of ischaemic stroke and intra cerebral bleed while no circadian variation was found in subarachnoid haemorrhage. CIF, ICB and SAH predominantly occur in early morning hours, late morning hours and in late afternoon to early evening respectively. Only intracerebral bleed was affected by wake/sleep state.

摘要

目的

确定缺血性和出血性中风的发病是否存在昼夜节律模式，以及它们与睡眠/觉醒周期的关系。

方法

2004年1月至2007年12月在拉合尔联合军事医院进行了一项带有前瞻性数据的描述性研究。纳入800名26岁以上首次发生中风的患者。中风分为脑梗死（CIF）、脑内出血（ICB）和蛛网膜下腔出血（SAH）。通过脑部CT或MRI扫描确诊。

结果

800名患者中，80%为男性，20%为女性。有438例（55%）CIF，329例（41%）ICB和33例（4%）SAH。患者年龄在26至84岁之间。在所有中风病例中，592例（74%）发生在患者清醒时，208例（26%）发生在睡眠期间（p<0.001）。ICB病例在清醒/睡眠周期方面有显著差异（p<0.001）。在CIF和SAH病例中，与患者的清醒/睡眠状态的关联不显著（分别为p<0.180和0.792）。在所有中风病例中，22.5%发生在凌晨4点至8点之间，其次是下午4点至8点之间的20.7%，上午8点至中午12点之间的20.1%，中午12点至下午4点之间的19.5%，午夜12点至凌晨4点之间的12.7%，而4.3%的病例发生在晚上8点至午夜12点之间。CIF的最大发病数（28.5%）发生在凌晨四点至八点之间，ICB的最大发病数（29.8%）发生在上午八点至中午12点之间，SAH的最大发病数（30.3%）发生在下午4点至8点之间。CIF和SAH病例在下午4点至8点和上午8点至中午12点之间分别出现较小的峰值。ICB病例数最少（4.9%）是在午夜前后。在CIF和ICB患者中发现了显著昼夜变化（p<0.001），然而对于SAH病例则不显著（p=0.391）。