Key result
Night-onset stroke linked to ~44% higher risk of poor 3-month functional outcome vs day-onset.
Why the study?
The association between time of day of stroke onset and functional outcomes after reperfusion therapy in acute ischaemic stroke was unclear.
Does night-onset stroke increase the risk of unfavourable functional outcomes at 3 months in patients with acute ischaemic stroke receiving reperfusion therapy compared to day-onset stroke?
Cohort (n=712)
Single-blind
No
Does night-onset stroke increase the risk of unfavourable functional outcomes at 3 months in patients with acute ischaemic stroke receiving reperfusion therapy compared to day-onset stroke?
Nighttime onset of acute ischemic stroke is associated with larger ischemic core volumes and significantly worse 3-month functional outcomes following reperfusion therapy, suggesting circadian mechanisms influence stroke severity and tolerance.
Answers are grounded in this paper and cite their sources.
Night-onset stroke was associated with worse 3-month outcomes after reperfusion; leaves open whether circadian timing should inform risk stratification or future trials.
OBJECTIVES: To investigate the association between the time of day of stroke onset and functional outcomes among patients with acute ischaemic stroke who received reperfusion therapy. DESIGN: Retrospective cohort study. SETTING: Patients with acute ischaemic stroke who received reperfusion therapy (intravenous thrombolysis or combined endovascular therapy) between October 2018 and March 2022 in China were included. PARTICIPANTS: A total of 712 patients with acute ischaemic stroke receiving reperfusion therapy were included. Patients were categorised into two groups (day-onset (06:00-18:00) and night-onset (18:00-06:00)) and into six groups by 4-hour intervals. OUTCOME MEASURES: The primary outcome was the 3-month functional status, evaluated using the modified Rankin Scale, with scores of 0-2 classified as favourable and scores of 3-6 as unfavourable outcomes. Propensity score matching (PSM), inverse probability of treatment weighting (IPTW) and overlap weighting (OW) were used for analyses. RESULTS: 148 out of 286 patients (51.7%) in the night-onset group and 182 out of 426 patients (42.7%) in the day-onset group experienced unfavourable outcomes at 3 months. Night-onset stroke was associated with a significantly higher risk of unfavourable outcome compared with day-onset stroke (OR 1.44 (95% CI 1.06 to 1.94), p=0.018). This association remained significant after adjustment using PSM (OR 1.45 (95% CI 1.01 to 2.08), p=0.044), and was further confirmed in analyses using IPTW (OR 1.42 (95% CI 1.02 to 1.96), p=0.036), OW (OR 1.42 (95% CI 1.03 to 1.96), p=0.032) and multivariable adjustment (adjusted OR 1.55 (95% CI 1.07 to 2.22), p=0.019). Night-onset stroke during 22:00-02:00 (adjusted OR 2.44 (95% CI 1.34 to 4.43), p=0.003) was significantly associated with a higher likelihood of unfavourable outcome in adjusted analysis. CONCLUSIONS: Night-onset stroke was associated with poorer functional outcomes at 3 months among patients receiving reperfusion therapy. Further multicentre prospective studies are warranted to validate these findings. TRIAL REGISTRATION NUMBER: Chinese Clinical Trial Registry Identifier: ChiCTR2500101844.
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Wang et al. (2026) conducted a cohort in Acute ischaemic stroke (n=712). Night-onset stroke (18:00-06:00) vs. Day-onset stroke (06:00-18:00) was evaluated on Unfavourable functional outcome at 3 months (modified Rankin Scale score 3-6) (OR 1.44, 95% CI 1.06 to 1.94, p=0.018). Night-onset stroke was associated with a significantly higher risk of unfavourable functional outcomes at 3 months compared to day-onset stroke (OR 1.44) among patients receiving reperfusion therapy.
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