--- title: "Night-onset Stroke Linked to Worse 3‑Month Outcomes After Reperfusion Therapy" id: "bmj-open-19-association-of-time-of-day-at-stroke-onset-with-functional-outcomes-after" canonical_url: "https://medichelpline.com/clinical-feed/bmj-open-19-association-of-time-of-day-at-stroke-onset-with-functional-outcomes-after" content_type: "clinical_feed_article" specialty: "Neurology" source_name: "BMJ Open" source_url: "http://bmjopen.bmj.com/cgi/content/short/16/9/e119656?rss=1" published_at: "2026-09-18T12:04:54.000Z" evidence_level: "Journal Feed" license: "CC-BY-NC-4.0 / Informational Use" --- # Night-onset Stroke Linked to Worse 3‑Month Outcomes After Reperfusion Therapy ## Provenance & Clinical Metadata - **Canonical URL:** https://medichelpline.com/clinical-feed/bmj-open-19-association-of-time-of-day-at-stroke-onset-with-functional-outcomes-after - **Specialty:** [Neurology](https://medichelpline.com/clinical-feed/neurology.md) - **Primary Source:** BMJ Open - **Source URL:** [Original Journal Publication](http://bmjopen.bmj.com/cgi/content/short/16/9/e119656?rss=1) - **Published At:** 2026-09-18T12:04:54.000Z - **Evidence Rating:** Journal Feed ## Executive GIST (TL;DR) - This retrospective cohort study examined 712 Chinese patients with acute ischaemic stroke who received **reperfusion therapy** (intravenous thrombolysis or combined endovascular therapy) between October 2018 and March 2022. - Patients were grouped by time of symptom onset: **day-onset (06:00–18:00)** and **night-onset (18:00–06:00)**; an additional analysis divided onset into six 4-hour intervals. - The primary outcome was 3-month functional status measured by the **modified Rankin Scale (mRS)**; mRS 0–2 defined favourable outcome, 3–6 unfavourable. - Unfavourable outcomes occurred in 148/286 (51.7%) of night-onset patients versus 182/426 (42.7%) of day-onset patients. - Night-onset onset was associated with higher odds of unfavourable outcome: unadjusted OR 1.44 (95% CI 1.06–1.94), p=0.018. - The association persisted after multiple adjustments and weighting methods: PSM OR 1.45 (95% CI 1.01–2.08), p=0.044; IPTW OR 1.42 (95% CI 1.02–1.96), p=0.036; OW OR 1.42 (95% CI 1.03–1.96), p=0.032; and multivariable adjusted OR 1.55 (95% CI 1.07–2.22), p=0.019. - A specific night interval, 22:00–02:00, showed a stronger adjusted association with unfavourable outcome (adjusted OR 2.44, 95% CI 1.34–4.43, p=0.003). - Authors conclude that **night-onset stroke** was associated with poorer 3-month functional outcomes after reperfusion therapy and recommend multicentre prospective studies to validate these findings. - Trial registration: Chinese Clinical Trial Registry Identifier ChiCTR2500101844. ## Clinical Analysis & Structured Key Points 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. 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