Due to sample size and lack of correction for waking time, no definite conclusions could be reached from those observations. A suggestion was made, however, that one of the mechanisms by which adrenergic blocking agents may protect from ischemic cardiac events is by suppressing or blunting the effects of the catecholamine surge associated with the arousal phenomenon. The absence of a circadian rhythm on weekends may reflect differences in the collective habits of a population and the importance of exogenous daily rhythms in modulating the hemodynamic response associated with waking.
The circadian variability in the incidence of sudden cardiac death is virtually identical to the periodicity seen in transient myocardial ischemia and acute myocardial infarction. On the other hand, in accordance with several previous reports that indicate a low incidence of sudden cardiac death during sleep (average 12 percent), Muller and associates also established a trough in the incidence of sudden cardiac death from 11 pm to 6 am. ventolin inhaler
Assuming that ischemia is the common pathophysiologic denominator linking these cardiovascular disorders, it is clear that the physiologic events that constitute the arousal phenomenon (waking/arising) increase the risk of ischemia-induced myocardial damage. The lack of differences related to age, gender, and known risk factors in the different populations involved in these three major studies indicates that the multiple cardiovascular changes occurring during the transition from sleep to an aroused, active state constitute a universal physiologic adaptation to the return to mental and physical activity.
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