Abstract Body: Background: Accumulating evidence suggests that circadian biology modulates the cerebral response to ischemia. Each individual’s endogenous circadian system influences their tendency to express an earlier or later behavioral sleep/wake schedule, i.e., to be more of a morning type of evening type, respectively. Since chronotype is reflective of the influence of the underlying circadian system, determining its relationship with stroke occurrence and severity may help in predicting interindividual differences in stroke susceptibility and evolution.
Objective: Characterize the association of chronotype with presentation, course, and outcome of acute ischemic stroke in adults and children 6 years old and older.
Design: International, observational, prospective, multicenter study at 10 centers in the United States, Europe, and Asia. Most data will be abstracted from routine clinical documentation in patient medical records. Patients and/or families/caregivers will be asked to answer two questions about the sleep episode prior to stroke onset, one question about any recent travel involving time zone change, and the six questions from the Ultra-Short Munich ChronoType Questionnaire, which includes recent shift-work history.
Population: Up to 1000 adult patients and 100 pediatric patients (6-17 years old) will be included. Consecutive patients with acute ongoing cerebral ischemia who present within 24 hours of last known well are eligible. Ongoing acute cerebral ischemia is defined as presence of neurologic deficits due to cerebral ischemia at the time of hospital presentation. Patients with resolution of symptoms prior to hospital arrival and final diagnosis of TIA; onset of acute cerebral ischemia during hospital admission; or discharge diagnosis of a stroke mimicking condition are excluded.
Intervention: None
Outcome Measures: Discharge modified Rankin Scale (mRS) score. Presenting National Institutes of Health Stroke Scale (NIHSS) score and Alberta Stroke Program Early Computed Tomography Score (ASPECTS). Ischemic stroke etiologic subtype, response to thrombolysis, and response to thrombectomy.
Analysis: Chronotype will be calculated using the Ultra-Short Munich ChronoType Questionnaire and is a continuous variable of a time between 0 and 24. Questionnaire responses also will be used to calculate social jet lag (SJL). As this is a registry study, all analyses will be considered exploratory.