Associations of rest-activity rhythm disturbances with stroke risk and post-stroke adverse outcomes

Jun 9, 2023medRxiv : the preprint server for health sciences

Disturbed daily activity patterns linked to stroke risk and worse outcomes after stroke

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Abstract

Suppressed 24-hour rest-activity rhythm is associated with a 62% increased risk of stroke in individuals in the lowest quartile compared to those in the top quartile.

Lower activity during the most active 10 hours and higher activity during the least active 5 hours may indicate a greater stroke risk.
Participants with a midpoint timing of activity between 14:00-15:26 experienced a higher stroke risk compared to those active from 12:17-13:10.
Fragmentation of the rest-activity rhythm is linked to a 27% increased risk of stroke when comparing the lowest to the highest quartiles.
Suppressed rest-activity rhythm is also associated with a higher likelihood of adverse outcomes post-stroke, with a 78% increased risk in the lowest quartile.
All observed associations remained significant after adjusting for various demographic and health factors.

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BACKGROUND: Almost all biological and disease processes are influenced by circadian clocks and display ∼24-hour rhythms. Disruption of these rhythms may be an important novel risk factor for stroke. We evaluated the association between 24-h rest-activity rhythm measures, stroke risk, and major post-stroke adverse outcomes.

METHODS: In this cohort study, we examined ∼100,000 participants in the UK Biobank (44-79 years old; ∼57% females) who underwent an actigraphy (6-7 days) and 5-year median follow-up. We derived: (1) most active 10 hours activity counts () across the 24-h cycle and the timing of its midpoint (); (2) the least active 5 hours counts () and its midpoint timing (); (3) relative amplitude () - (M10-L5)/(M10+L5); (4)(IS): stability and (5)(IV), fragmentation of the rhythm. Cox proportional hazard models were constructed for time to (i) incident stroke (n=1,652); and (ii) post-stroke adverse outcomes (dementia, depression, disability, or death). M10M10 midpoint L5L5 midpoint RA interdaily stability intradaily variability

RESULTS: Suppressed RA (lower M10 and higher L5) was associated with stroke risk after adjusting for demographics; the risk was highest in the lowest quartile [Q1] for RA (HR=1.62; 95% CI:1.36-1.93,<0.001) compared to the top quartile [Q4]. Participants withM10 midpoint timing (14:00-15:26, HR=1.26, CI:1.07-1.49,=0.007) also had a higher risk for stroke than(12:17-13:10) participants. A fragmented rhythm (IV) was also associated with a higher risk for stroke (Q4 vs. Q1; HR=1.27; CI:1.06-1.50,=0.008), but differences in the stability of rhythms (IS) were not. Suppressed RA was associated with an increased risk of unfavorable post-stroke outcomes (Q1 vs. Q4; 1.78 [1.29-2.47];<0.001). All the associations were independent of age, sex, race, obesity, sleep disorders, cardiovascular diseases or risks, and other morbidity burdens. p later p earlier p p

CONCLUSION: Suppressed 24-h rest-activity rhythm may be a risk factor for stroke and an early indicator of major post-stroke adverse outcomes.

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Associations of rest-activity rhythm disturbances with stroke risk and post-stroke adverse outcomes

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