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. 2015 Jan 12;5:287.
doi: 10.3389/fneur.2014.00287. eCollection 2014.

Changes in Chronotype After Stroke: A Pilot Study

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Free PMC article

Changes in Chronotype After Stroke: A Pilot Study

Thomas Kantermann et al. Front Neurol. .
Free PMC article

Abstract

This study aimed to elucidate associations between stroke onset and severity as well as chronotype (phase of entrainment) and internal time of stroke. Fifty-six first-ever ischemic stroke patients participated in a cross-sectional study assessing chronotype (mid-sleep on work-free days corrected for sleep deficit on workdays; MSFsc) by applying the Munich ChronoType Questionnaire (MCTQ). The MCTQ was completed twice, on average 68 ± 24 (SD) days post stroke and retrospectively for the time before stroke. To assess the impact of stroke in relation to internal time, InTstroke was calculated as MSFsc minus local time of stroke. Stroke severity was assessed via the standard clinical National Institute Health Stroke Scale (NIHSS) and modified Ranking Scale (mRS), both at hospital admission and discharge. Overall, most strokes occurred between noon and midnight. There was no significant association between MSFsc and stroke onset. MSFsc changed significantly after stroke, especially in patients with more severe strokes. Changes in MSFsc varied with InTstroke - the earlier the internal time of a stroke relative to MSFsc-before-stroke, the more MSFsc advanced after stroke. In addition, we provide first evidence that MSFsc changes varied between stroke locations. Larger trials are needed to confirm these findings.

Keywords: NIHSS; chronotype; internal time; mRS; sleep; stroke; stroke location.

Figures

Figure 1
Figure 1
Study flow chart of patient enrollment and data analysis.
Figure 2
Figure 2
Distribution of the number of strokes by time of day in 35 (13 female) stroke patients. Most strokes per hour were observed at 07:00 and 20:00 h.
Figure 3
Figure 3
Correlation between Intstroke (MSFsc-before-stroke − local time point of stroke) (x-axis) and the difference in MSFsc after stroke (MSFsc-after stroke − MSFsc-before stroke) (y-axis) in 35 stroke patients (13 female) (Spearman correlation, R = 0.421, p = 0.015). The correlation shows that the closer the time point of a stroke is to an individual’s MSFsc, the larger the advance (expressed as positive values on the y-axis) in chronotype (MSFsc) after the stroke.
Figure 4
Figure 4
Significant difference in MSFsc changes (MSFsc-after stroke − MSFsc-before stroke) between strokes within the anterior circulation (middle, anterior and posterior cerebral artery and anterior choroidal artery; providing blood to the cerebrum) and strokes within the posterior circulation (ventrobasilar and vertebrobasilar artery; proving blood to the cerebellum and brain stem) (*p = 0.016, Mann–Whitney U test). Positive values on y-axis indicate MSFsc advances. See also Table 1 for stroke locations.

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