Implications of Circadian Rhythm in Stroke Occurrence: Certainties and Possibilities

• Published in: Brain sciences Vol. 11; no. 7; p. 865
• Main Authors: Fodor, Dana Marieta, Marta, Monica Mihaela, Perju-Dumbravă, Lăcrămioara
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 29-06-2021; MDPI
• Subjects: Blood pressure; Catecholamines; Cerebral infarction; chronoprophylaxis; chronotherapy; Circadian rhythm; Circadian rhythms; functional outcome; Hemorrhage; Hypertension; internal clock; Nervous system; Neurology; Physical activity; Physiology; Rehabilitation; Review; Risk factors; Sleep; Stroke; Veins & arteries
• ISSN: 2076-3425; 2076-3425
• DOI: 10.3390/brainsci11070865

Stroke occurrence is not randomly distributed over time but has circadian rhythmicity with the highest frequency of onset in the morning hours. This specific temporal pattern is valid for all subtypes of cerebral infarction and intracerebral hemorrhage. It also correlates with the circadian variation of some exogenous factors such as orthostatic changes, physical activity, sleep-awake cycle, as well as with endogenous factors including dipping patterns of blood pressure, or morning prothrombotic and hypofibrinolytic states with underlying cyclic changes in the autonomous system and humoral activity. Since the internal clock is responsible for these circadian biological changes, its disruption may increase the risk of stroke occurrence and influence neuronal susceptibility to injury and neurorehabilitation. This review aims to summarize the literature data on the circadian variation of cerebrovascular events according to physiological, cellular, and molecular circadian changes, to survey the available information on the chronotherapy and chronoprophylaxis of stroke and its risk factors, as well as to discuss the less reviewed impact of the circadian rhythm in stroke onset on patient outcome and functional status after stroke.