Circadian Variation in Ictus of Aneurysmal Subarachnoid Hemorrhage

Abstract

Background  

Temporal patterns in aneurysmal subarachnoid hemorrhage (aSAH) may provide insight into modulation, and therefore, prevention of hemorrhage. We investigated the time of hemorrhage and its relationship to traditional risk factors among patients admitted with aSAH.

Methods  

Admitted patients with aSAH were prospectively followed through outcomes and baseline demographics were abstracted through chart review. The group temporal distribution by hour of onset was summarized with cosinor nonlinear least squares. aSAH onset was gathered into night (2300–0500), morning (0500–1100), afternoon (1100–1700), and evening (0500–2300) daily phases. The odds ratio (OR) with 95% CI was calculated for having an aSAH during the morning, afternoon, and evening hours using night as a reference. Multinomial logit models were fitted using aSAH cases across time blocks to determine their associations with different risk factors.

Results  

202 patients had the hour of hemorrhage available, and 49 had phase identifiable [total 251: 38 (15%) night, 98 (39%) morning, 58 (23%) afternoon, 57 (23%) evening]. The peak hours of aSAH were between 0700 and 0800 representing 13% of the sample, with a significant cosinor-fitted phase of 7.33(95% CI 5.30, 9.36). For all aSAH cases, morning onset was significantly more common than night onset (OR = 2.58, 95% CI = 1.77–3.75). Nonsmokers were more likely to have aSAH in the morning than smokers (P = 0.043, OR = 3.10, 95% CI = 1.33–7.23).

Conclusions  

aSAH occur in a diurnal, morning prevalent pattern regardless of traditional aSAH risk factors. The association of these risk factors with existing onset patterns should be investigated in future studies.

• Content Type Journal Article
• Category Original Article
• Pages 1-5
• DOI 10.1007/s12028-011-9640-6
• Authors
  • Richard E. Temes, Divison of Cerebrovascular Disease and Neurocritical Care, Rush University Medical Center, 1725 W. Harrison Street Suite 1121, Chicago, IL 60612, USA
  • Thomas Bleck, Divison of Cerebrovascular Disease and Neurocritical Care, Rush University Medical Center, 1725 W. Harrison Street Suite 1121, Chicago, IL 60612, USA
  • Siddharth Dugar, Divison of Cerebrovascular Disease and Neurocritical Care, Rush University Medical Center, 1725 W. Harrison Street Suite 1121, Chicago, IL 60612, USA
  • Bichun Ouyang, Divison of Cerebrovascular Disease and Neurocritical Care, Rush University Medical Center, 1725 W. Harrison Street Suite 1121, Chicago, IL 60612, USA
  • Yousef Mohammad, Divison of Cerebrovascular Disease and Neurocritical Care, Rush University Medical Center, 1725 W. Harrison Street Suite 1121, Chicago, IL 60612, USA
  • Sayona John, Divison of Cerebrovascular Disease and Neurocritical Care, Rush University Medical Center, 1725 W. Harrison Street Suite 1121, Chicago, IL 60612, USA
  • Pratik Patel, Divison of Cerebrovascular Disease and Neurocritical Care, Rush University Medical Center, 1725 W. Harrison Street Suite 1121, Chicago, IL 60612, USA
  • Vivien Lee, Divison of Cerebrovascular Disease and Neurocritical Care, Rush University Medical Center, 1725 W. Harrison Street Suite 1121, Chicago, IL 60612, USA
  • Shyam Prabhakaran, Divison of Cerebrovascular Disease and Neurocritical Care, Rush University Medical Center, 1725 W. Harrison Street Suite 1121, Chicago, IL 60612, USA
  • Mark Quigg, Department of Neurology, University of Virginia, Charlottesville, VA, USA

• Journal Neurocritical Care
• Online ISSN 1556-0961
• Print ISSN 1541-6933

http://www.springerlink.com/content/r5151x12845677mt/

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