Circadian Variation of Stroke in a Tertiary Level Hospital

Abstract

Introduction: Stroke, a primary global health concern, is the fifth leading cause of death in Bangladesh, with a prevalence of 0.3%. While 85% of stroke cases globally are cerebral infarctions, Asian countries exhibit stroke patients on average 15 years younger than developed countries. Survival studies reveal strokes exceeding coronary events in hypertensive patients. Observational data suggests circadian, circaseptan, and circannual variations in stroke occurrence, with a morning peak. Circadian rhythm in ischemic stroke is higher in the early morning. Thrombotic strokes, influenced by platelet aggregation and fibrinolysis, often occur in the morning. Haemorrhagic strokes result from blood vessel ruptures. Population-specific circadian patterns remain unconfirmed. Aim of the Study: The study aims to find out the relation of circadian variation of stroke. Methods: This cross-sectional study, conducted at Sylhet MAG Osmani Medical College Hospital, Bangladesh, analyzed 100 stroke patients over six months. Ethical approval was obtained, and informed consent was taken. Inclusion criteria covered patients with clinical and imaging stroke diagnoses, while exclusion criteria excluded transient ischemic attack, previous stroke, head injury history, and refusal to participate. Stroke onset time was categorized into four six-hour intervals. Demographic data, risk factors, and comorbidities were recorded, and brain CT scans were performed. Data analysis used SPSS version 22, employing descriptive statistics, Chi-square Test, and Student's t-test. Significance was set at p<0.05. Results were presented in tables. Results: The study involves 100 participants, primarily aged 60-70 (50%), predominantly male (76%), residing 62% in urban and 38% in rural areas. Occupationally, 35% are businessmen, 24% are housewives, and 15% are service holders and laborers. Smoking status shows 58% smokers. Stroke types include 57% ischemic strokes and 39% hemorrhagic strokes. Hypertension (72%) is the significant risk factor. Stroke symptoms predominantly occur between 06:01 and 12:00 (46%). These insights comprehensively understand the study population's demographics, lifestyle, and clinical characteristics. Conclusion: The study established circadian patterns in stroke onset, with the highest frequency between 06:00-12:00 and the lowest between 18:01-24:00. Ischemic stroke was the most common subtype, followed by hemorrhagic stroke and fewer subarachnoid hemorrhages. Managing blood pressure and coagulation during peak onset times could aid stroke prevention, but further extensive studies are needed for validation.