Associations of Rest‐Activity Rhythm Disturbances With Stroke Risk and Poststroke Adverse Outcomes

🥉 Top 5% JournalSep 5, 2024Journal of the American Heart Association

Disturbed Daily Activity Patterns Linked to Stroke Risk and Worse Outcomes After Stroke

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Abstract

Suppressed relative amplitude of 24-hour rest-activity rhythms is associated with a 61% increased stroke risk.

Lower relative amplitude (in the lowest quartile) correlates with a higher risk of incident stroke.
A later midpoint timing of the most active 10-hour activity period is linked to increased stroke risk compared to earlier timing.
Increased intradaily variability, indicating a more fragmented rhythm, is associated with higher stroke risk.
Suppressed relative amplitude is also linked to a greater risk of adverse outcomes following a stroke, including dementia and disability.
All associations persist after adjusting for various demographic and health factors.

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BACKGROUND: Many disease processes are influenced by circadian clocks and display ~24-hour rhythms. Whether disruptions to these rhythms increase stroke risk is unclear. We evaluated the association between 24-hour rest-activity rhythms, stroke risk, and major poststroke adverse outcomes.

METHODS AND RESULTS: We examined ~100 000 participants from the UK Biobank (aged 44-79 years; ~57% women) assessed with actigraphy (6-7 days) and 5-year median follow-up. We derived (1) most active 10-hour activity counts across the 24-hour cycle and the timing of its midpoint timing; (2) the least active 5-hour count and its midpoint; (3) relative amplitude; (4) interdaily stability; and (5) intradaily variability, for stability and fragmentation of the rhythm. Cox proportional hazard models were constructed for time to (1) incident stroke (n=1652) and (2) poststroke adverse outcomes (dementia, depression, disability, or death). Suppressed relative amplitude (lowest quartile [quartile 1] versus the top quartile [quartile 4]) was associated with stroke risk (hazard ratio [HR], 1.61 [95% CI, 1.35-1.92];<0.001) after adjusting for demographics. Later most active 10-hour activity count midpoint timing (14:00-15:26; HR, 1.26 [95% CI, 1.07-1.49];=0.007) also had higher stroke risk than earlier (12:17-13:10) participants. A fragmented rhythm (intradaily variability) was also associated with higher stroke risk (quartile 4 versus quartile 1; HR, 1.26 [95% CI, 1.06-1.49];=0.008). Suppressed relative amplitude was associated with risk for poststroke adverse outcomes (quartile 1 versus quartile 4; HR, 2.02 [95% CI, 1.46-2.48];<0.001). All associations were independent of age, sex, race, obesity, sleep disorders, cardiovascular diseases or risks, and other comorbidity burdens. P P P P

CONCLUSIONS: Suppressed 24-hour rest-activity rhythm may be a risk factor for stroke and an early indicator of major poststroke adverse outcomes.

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