Circadian variations in the occurrence of cardiac arrests - Initial and repeat episodes
Circadian variations in the occurrence of cardiac arrests - Initial and repeat episodes
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DOI：
10.1161/01.cir.98.1.31
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发表时间：
1998-07-07
期刊：
影响因子：
37.8
通讯作者：
Hallstrom, AP
中科院分区：
文献类型：
--
作者：
Peckova, M;Fahrenbruch, CE;Hallstrom, AP
背景-心脏骤停的时间变异模式对于理解导致急性心血管疾病发生的机制可能很重要。以往的研究报道了心脏骤停发作的昼夜变化，早晚发生率高，一周内缺乏日变化，并有一些季节性变化。方法和结果：我们研究了由西雅图消防局参加的6603例院外心脏骤停患者的时间变化。数据显示出日变化，夜间发病率较低，两个大小大致相同的高峰(上午8点至11点和下午4点至7点)。晚间高峰主要归因于室颤患者，而显示其他节律的停搏主要表现为上午高峰。与存活相关的心脏骤停比没有存活的心脏骤停有更明显的日变化。在对节奏进行调整后，这种差异仍然存在。对于至少有两次不同心脏骤停的597名患者，我们发现在一天中反复发生心脏骤停的时间之间没有总体联系。然而，对于女性来说，第一次和第二次心脏骤停的时间比人们预期的更接近，如果时间完全无关的话。结论-心脏骤停不是在一天中随机发生的，而是遵循一定的周期模式。这些模式可能与日常活动的模式有关。心脏骤停是由一个人的活动而不是由他或她的疾病的一些潜在特征触发的假设得到了支持，因为在反复发生心脏骤停的患者中，第一次和第二次心脏骤停的时间之间缺乏相关性。
Background-Patterns of temporal variation of cardiac arrests may be important for understanding mechanisms leading to the onset of acute cardiovascular disorders. Previous studies reported diurnal variation of the onset of cardiac arrests, with high incidence in the morning and in the evening, lack of daily variation during the week, and some seasonal variation. The association between the time of day and recurrent cardiac arrests has not been previously examined.Methods and Results-We explored temporal variation in 6603 out-of-hospital cardiac arrests attended by the Seattle Fire Department. The data exhibit diurnal variation, with a low incidence at night and two peaks of approximately the same size (at 8 to 11 AM and 4 to 7 PM). The evening peak is attributed primarily to the patients found in ventricular fibrillation, whereas arrests that show other rhythms exhibit mainly a morning peak. Cardiac arrests associated with survival have more pronounced diurnal variation than episodes in which survival did not occur. This difference persists after adjustment for rhythm. For 597 patients who had at least two separate cardiac arrests, we found no overall association between the times of day of the recurrent arrests. For women, however, the times of day of the first and second arrests were closer to each other than one would expect if the times were entirely unrelated.Conclusions-Cardiac arrests do not occur randomly during the day, but rather follow certain periodic patterns. These patterns are probably associated with patterns of daily activities. The hypothesis that cardiac arrests are triggered by a person's activity rather than by some underlying characteristics of his or her disease is supported by the lack of association between the times of the first and second arrests in the patients with recurrent arrests.