Time-of-day significantly influences the severity and incidence of stroke. Evidence has emerged not only for circadian governance over stroke risk factors, but also for important determinants of clinical outcome. In this review, we provide a comprehensive overview of the interplay between chronobiology and cerebrovascular disease. We discuss circadian regulation of pathophysiological mechanisms underlying stroke onset or tolerance as well as in vascular dementia. This includes cell death mechanisms, metabolism, mitochondrial function, and inflammation/immunity. Furthermore, we present clinical evidence supporting the link between disrupted circadian rhythms and increased susceptibility to stroke and dementia. We propose that circadian regulation of biochemical and physiological pathways in the brain increase susceptibility to damage after stroke in sleep and attenuate treatment effectiveness during the active phase. This review underscores the importance of considering circadian biology for understanding the pathology and treatment choice for stroke and vascular dementia and speculates that considering a patient’s chronotype may be an important factor in developing precision treatment following stroke.

中文翻译：

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昼夜节律医学时代的中风

一天中的时间显着影响中风的严重程度和发病率。证据不仅表明昼夜节律管理对中风危险因素的影响，而且也表明临床结果的重要决定因素。在这篇综述中，我们全面概述了时间生物学和脑血管疾病之间的相互作用。我们讨论中风发作或耐受以及血管性痴呆的病理生理机制的昼夜节律调节。这包括细胞死亡机制、新陈代谢、线粒体功能和炎症/免疫。此外，我们提供的临床证据支持昼夜节律紊乱与中风和痴呆症易感性增加之间的联系。我们认为，大脑中生化和生理通路的昼夜节律调节会增加中风后睡眠中损伤的易感性，并削弱活动期的治疗效果。本综述强调了考虑昼夜节律生物学对于理解中风和血管性痴呆的病理学和治疗选择的重要性，并推测考虑患者的生物钟可能是中风后制定精准治疗的重要因素。