Department of Neurosurgery, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany.
Department of Neurology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany.
Eur J Neurol. 2023 Jul;30(7):2070-2078. doi: 10.1111/ene.15804. Epub 2023 Apr 12.
Data on the temporal distribution of the bleeding time of intracranial aneurysms are limited to a few small studies. With this study, the aim was to analyze time patterns of the occurrence of aneurysmal subarachnoid hemorrhage (SAH), particularly focusing on the impact of patients' socio-demographic and clinical characteristics on the ictus timing.
The study is based on an institutional SAH cohort with 782 consecutive cases treated between January 2003 and June 2016. Data were collected on the ictus time, patients' socio-demographic and clinical characteristics, as well as the initial severity and outcome. Univariate and multivariate analyses were performed on the bleeding timeline.
There were two peaks in the circadian rhythm of SAH, one in the morning (7-9 a.m.) and the other in the evening (7-9 p.m.). The strongest alterations in the bleeding time patterns were observed for weekdays, patients' age, sex and ethnicity. Individuals with chronic alcohol and painkiller consumption showed a higher bleeding peak between 1 and 3 p.m. Finally, the bleeding time showed no impact on the severity, clinically relevant complications and the outcome of SAH patients.
This study is one of the very few detailed analyses of the impact of specific socio-demographic, ethnic, behavioral and clinical characteristics on the rupture timing of aneurysms. Our results point to the possible relevance of the circadian rhythm for the rupture event, and therefore might be useful in the elaboration of preventive measures against aneurysm rupture.
关于颅内动脉瘤出血时间的时间分布数据仅限于少数几项小型研究。本研究旨在分析动脉瘤性蛛网膜下腔出血（SAH）发作的时间模式，尤其侧重于患者的社会人口统计学和临床特征对发病时间的影响。
本研究基于一个机构性的 SAH 队列，纳入了 2003 年 1 月至 2016 年 6 月期间连续收治的 782 例患者。收集了发病时间、患者的社会人口统计学和临床特征、初始严重程度和结局等数据。对出血时间线进行了单变量和多变量分析。
SAH 的昼夜节律有两个高峰，一个在早上（7-9 点），另一个在晚上（7-9 点）。工作日、患者年龄、性别和种族对出血时间模式的改变最大。慢性饮酒和止痛药使用者的出血高峰出现在下午 1 点至 3 点之间。最后，出血时间对 SAH 患者的严重程度、临床相关并发症和结局没有影响。
本研究是少数几项详细分析特定社会人口统计学、种族、行为和临床特征对动脉瘤破裂时间影响的研究之一。我们的研究结果表明，昼夜节律可能与破裂事件有关，因此可能有助于制定预防动脉瘤破裂的措施。
