INTRODUCTION Poststroke sleep disturbances are common and can affect stroke outcomes, but the clinical studies mainly focus on breathing-related sleep disorders, while the bidirectional impact of circadian rhythm dysfunction in ischemic stroke remains unknown. This study observed the characteristics of melatonin secretion in acute ischemic stroke patients and evaluated whether melatonin rhythm impacts the prognosis after stroke by assessing the neurological function, cognition, emotion, and quality of life 3 months after stroke. METHODS Acute ischemic stroke patients were selected from the Department of Neurology Inpatients of the Second Hospital affiliated with Soochow University from October 2019 to July 2021. Healthy control subjects were recruited at the same time. Demographic and clinical data were collected, and relevant scale scores (including neurological function, cognition, emotion, and sleep) were assessed within 2 weeks of onset and followed up 3 months later. All participants collected salivary melatonin samples on the 4th day of hospitalization and dim light melatonin onset (DLMO) was calculated according to melatonin concentration. Stroke patients were then divided into three groups based on their DLMO values. RESULTS A total of 74 stroke patients and 33 control subjects were included in this analysis. Compared with healthy controls, stroke patients exhibited a delayed melatonin rhythm during the acute phase of stroke (21:36 vs. 20:38, p = 0.004). Stroke patients were then divided into three groups, namely normal (n = 36), delayed (n = 28), or advanced DLMO (n = 10), based on their DLMO values. A χ2 test showed that there were significant differences in the rate of poor prognosis (p = 0.011) and depression tendency (p = 0.028) among the three groups. A further pairwise comparison revealed that stroke patients with delayed DLMO were more likely to experience poor short-term outcomes than normal DLMO group (p = 0.003). The average melatonin concentration of stroke patients at 5 time points was significantly lower than that of the control group (3.145 vs. 7.065 pg/mL, p < 0.001). Accordingly, we split stroke patients into three groups, namely low melatonin level (n = 14), normal melatonin level (n = 54), or high melatonin level (n = 6). Unfortunately, there were no great differences in the clinical characteristics, cognition, emotion, sleep quality, and short-term outcome among groups. CONCLUSIONS This is a preliminary study, and our results indicate that changes in melatonin secretion phase of stroke patients may have effect on their short-term prognosis.

中文翻译：

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急性缺血性中风患者的昼夜节律紊乱及其对预后的影响。

引言中风后睡眠障碍很常见，可以影响中风结局，但临床研究主要集中于呼吸相关的睡眠障碍，而昼夜节律功能障碍对缺血性中风的双向影响仍不清楚。本研究观察急性缺血性脑卒中患者褪黑激素分泌的特点，并通过评估脑卒中后3个月的神经功能、认知、情绪和生活质量来评估褪黑激素节律是否影响脑卒中后的预后。方法选取2019年10月至2021年7月苏州大学附属第二医院神经内科住院患者的急性缺血性脑卒中患者，同时纳入健康对照者。收集了人口统计和临床数据，发病后2周内评估相关量表评分（包括神经功能、认知、情绪和睡眠），并于3个月后进行随访。所有参与者在住院第4天采集唾液褪黑激素样本，根据褪黑激素浓度计算弱光褪黑激素起始时间（DLMO）。然后根据 DLMO 值将中风患者分为三组。结果 本次分析总共包括 74 名中风患者和 33 名对照受试者。与健康对照者相比，中风患者在中风急性期表现出褪黑激素节律延迟（21:36 vs. 20:38，p = 0.004）。然后根据 DLMO 值将中风患者分为三组，即正常组 (n = 36)、延迟组 (n = 28) 或晚期 DLMO (n = 10)。χ2检验显示，三组间不良预后率（p = 0.011）和抑郁倾向率（p = 0.028）差异有统计学意义。进一步的成对比较显示，延迟 DLMO 的中风患者比正常 DLMO 组更有可能经历不良的短期结果 (p = 0.003)。脑卒中患者5个时间点的平均褪黑激素浓度显着低于对照组（3.145 vs. 7.065 pg/mL，p < 0.001）。因此，我们将中风患者分为三组，即褪黑激素水平低（n = 14）、褪黑激素水平正常（n = 54）或褪黑激素水平高（n = 6）。不幸的是，各组之间的临床特征、认知、情绪、睡眠质量和短期结果没有太大差异。结论 这是一项初步研究，