J Korean Neurosurg Soc.  2019 Sep;62(5):519-525. 10.3340/jkns.2019.0061.

Relationship between Circadian Variation in Ictus of Aneurysmal Subarachnoid Hemorrhage and Physical Activity

• Lee JM
• Jung NY
• Kim MS
• Park ES
• Park JB
• Sim HB
• Lyo IU
• Kwon SC

• KMID: 2457941
• DOI: http://doi.org/10.3340/jkns.2019.0061

Abstract

OBJECTIVE
The circadian pattern of the onset time of aneurysmal subarachnoid hemorrhage (aSAH) has been reported by various authors. However, the effect of the degree of physical exertion on the circadian pattern has not been studied in detail. Therefore, we conducted this study to investigate the effect of physical exertion on the circadian pattern of aSAH.
METHODS
Of the 335 patients presenting with aSAH from January 2012 to December 2017, 234 patients with identifiable onset time and metabolic equivalent (MET) values were enrolled. The onset time of aSAH was divided into 4-hour intervals. The patient's physical exertion was then assessed on a scale between 1 and 8 METs using generally accepted MET values, and categorized into two groups"”light exertion (1 to 4 METs) and moderate to heavy exertion (5 to 8 METs)"”to determine the effect of the degree of physical exertion on the onset time distribution of aSAH. Multivariate analysis was used to calculate the odds ratio (OR) between the two groups to determine the effect of the degree of physical exertion on each set of time periods.
RESULTS
There was a definite bimodal onset pattern that peaked at 08:00-12:00 hours followed by 16:00-20:00 hours (p <0.001). MET values at all time intervals were found to be significantly higher than the night time (00:00-04:00 hours) values (p<0.031). The MET value distribution showed a unimodal pattern that slightly differed from the bimodal distribution of the onset time of aSAH. There were no significant differences in the ORs of each time interval according to the degree of the MET value.
CONCLUSION
This study reaffirmed that aSAH occurs in a bimodal pattern, especially showing the highest prevalence in the morning. Although aSAH could be related to daily activity, there were no significant changes in diurnal variations affected by the degree of physical exertion.

Keyword

Subarachnoid hemorrhage; Epidemiology; Physical exertion; Risk factors

MeSH Terms

Aneurysm*
Epidemiology
Humans
Metabolic Equivalent
Motor Activity*
Multivariate Analysis
Odds Ratio
Physical Exertion
Prevalence
Risk Factors
Subarachnoid Hemorrhage*

Figure

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  Fig. 1. Distribution of number of the observed cases with aneurysmal subarachnoid hemorrhage according to the rupture time. Bar graph showing distribution of number of the observed cases with aneurysmal subarachnoid hemorrhage with known times of onset. Null hypothesis of uniformity is rejected (χ2 =68.94, df=5, p<0.001).

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  Fig. 2. Differences in metabolic equivalent (MET) scores in relation to time intervals. The mean value of MET scores shows a peak at 08:00–12:00 hours followed by 12:00–16:00 hours. Post-hoc analysis demonstrates that MET score at 00:00–04:00 is significant lower when compared to that for all other time intervals. *p=0.031.

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