Ville Kytö

Turku University Hospital · Heart Center

Background Statins are essential for secondary prevention after ischaemic stroke (IS). However, statin intensity recommendations differ, and there is a concern about intracerebral haemorrhage (ICH). We studied the long-term impacts of initial statin intensity following IS. Methods Consecutive patients using high-intensity, moderate-intensity or lo...

Purpose: To investigate national trends of surgical treatment for benign prostatic obstruction (BPO). Methods: The Care Register for Healthcare in Finland was used to investigate the annual numbers and types of surgical procedures, operation incidence and duration of hospital stay between 2004 and 2018 in Finland. Procedures were classified using t...

Background and aims There is a paucity of data on later healthcare visits and retreatments after primary treatment of spontaneous pneumothorax. The main purpose of this study was to describe retreatment rates up to 5 years after primary spontaneous pneumothorax treated with either surgery or tube thoracostomy (TT) at index hospitalization in Finlan...

Background and study aims Upper gastrointestinal endoscopy (EGD) is one of the most common diagnostic procedures done to examine the foregut, but it can also be used for therapeutic interventions. The main objectives of this study were to investigate trends in EGD utilization and mortality related to it in a national low-threshold healthcare system...

We aimed to investigate the national trends in the incidence and management of slipped capital femoral epiphysis (SCFE) and to report the need for reoperations. We included all <19-year-old patients hospitalised for SCFE in 2004-2014 in mainland Finland (n=159). Data from the Finnish Care Register for Health Care, Statistics Finland, and Turku Univ...

Background Patients with Parkinson's disease (PD) may have an increased risk of mortality, but robust estimates are lacking. Objective To compare mortality rates nationally between patients with PD and controls. Methods The case‐fatality rates of Finnish PD patients diagnosed in 2004–2018 (n = 23,688; 57% male, mean age at diagnosis = 71 years) a...

BACKGROUND AND OBJECTIVES The use of medications commonly prescribed after traumatic brain injury (TBI) has been little studied before TBI. This study examined the association between the use of medications that affect the central nervous system (CNS) and the occurrence and short-term mortality of TBI. METHODS Mandatory Finnish registries were use...

Cerebral venous sinus thrombosis (CVST) is a rare neurological emergency condition with non-specific symptoms. Imaging options to rule out CVST are computed tomography (CT) and magnetic resonance imaging (MRI). This study aimed to determine the imaging outcomes of emergency MRI as a first-line imaging method in patients with suspected CVST. In this...

Objective: The phenotype of patients who suffer fatal traumatic brain injury (TBI) is poorly characterized. The authors examined the external causes, contributing diseases, and preinjury medication in adult patients with fatal TBI in a nationwide Finnish cohort. Methods: Deaths caused by TBIs in Finland were examined among decedents aged ≥ 16 ye...

Background Transurethral resection of the prostate (TURP) is the standard surgical treatment for benign prostate enlargement (BPE). Photoselective vaporization of the prostate (PVP) is an alternative, but there is limited real-life evidence of PVP risks. Objective To compare short- and long-term risks of PVP to those of TURP in the treatment of BP...

Background Childhood exposure to dyslipidemia is associated with adult atherosclerosis, but it is unclear whether the long‐term risk associated with dyslipidemia is attenuated on its resolution by adulthood. We aimed to address this question by examining the links between childhood and adult dyslipidemia on carotid atherosclerotic plaques in adulth...

Background: Statin treatment is effective at preventing adverse vascular events after ischemic stroke (IS). However, many patients fail to use statins after IS. We studied the impact of not using statins after IS on adverse outcomes. Methods: IS patients (n=59 588) admitted to 20 Finnish hospitals were retrospectively studied. Study data were co...

Background and purpose: We aimed to assess the incidence of anterior cruciate ligament reconstruction (ACLR) and concomitant procedures in Finland. Patients and methods: We identified all the patients who underwent ACLR between 2004 and 2018 in Finland using national registry data. Patients with an ICD-10 diagnosis code S83.5 and the NOMESCO ope...

In press info about our recent paper entitled "Adult-onset epilepsy and risk of traumatic brain injury: a nationwide cohort study" published in Journal of Neurology, Neurosurgery, and Psychiatry (DOI: 10.1136/jnnp-2022-330150)

Background: A knowledge gap exists regarding the risk of traumatic brain injury (TBI) in patients with epilepsy. Methods: Patients with adult-onset epilepsy during 2005–2018 in Finland were studied using retrospective longitudinal national registry-linkage design. Patients with epilepsy (n=35 686; 51% men; mean age 56.6 years) were 1:1 matched to n...

The CHA2DS2-VASc score is a reliable tool used to estimate the risk of ischemic stroke (IS) in patients with atrial fibrillation (AF). Few tools exist for the prediction of new-onset AF (NOAF) after myocardial infarction (MI) and its relation to IS. We studied the usefulness of CHA2DS2-VASc in predicting NOAF and IS in a long-term follow-up after M...

Background: Little controlled evidence exists on road traffic accident (RTA) risk among patients diagnosed with cancer, while clinicians are often requested to comment their ability to drive. The aim of this study was to evaluate RTA risk in a population-based cohort of cancer patients living in Southwest Finland. Patients: All adult patients di...

Aims Effective statin therapy is a cornerstone of secondary prevention after myocardial infarction (MI). Real-life statin dosing is nevertheless suboptimal and largely determined early after MI. We studied long-term outcome impact of initial statin dose after MI. Methods and Results Consecutive MI patients treated in Finland who used statins early...

Background To explore long-term cardiovascular prognosis after myocardial infarction (MI) among patients with type 1 diabetes. Methods Patients with type 1 diabetes surviving 90 days after MI (n = 1508; 60% male, mean age = 62.1 years) or without any type of diabetes (n = 62,785) in Finland during 2005–2018 were retrospectively studied using multi...

Purpose To investigate postoperative mortality rates and risk factors for mortality after surgical treatment of benign prostate hyperplasia (BPH). Methods All patients who underwent partial prostate excision/resection from 2004 to 2014 in Finland were retrospectively assessed for eligibility using a nationwide registry. Procedures were classified...

Objective: Usage of oral anticoagulants (OAC) or adenosine diphosphate inhibitors (ADPi) is known to increase the risk of bleeding. We aimed to investigate the impact of OAC and ADPi therapies on short-term outcomes after traumatic brain injury (TBI). Methods: All adult patients hospitalized for TBI in Finland during 2005-2018 were retrospective...

OBJECTIVE Type 1 diabetes is a risk factor for myocardial infarction (MI). We aimed to evaluate the case fatality in patients with type 1 diabetes after MI. RESEARCH DESIGN AND METHODS Consecutive patients experiencing MI with type 1 diabetes (n = 1,935; 41% female; mean age 62.5 years) and without diabetes (n = 74,671) admitted to 20 hospitals in...

Objectives. To study the long-term outcomes of mitral valve replacement with mechanical or biological valve prostheses in native mitral valve infective endocarditis patients. Desing. We conducted a retrospective, nationwide, multicenter cohort study with patients aged ≤70 years who were treated with mitral valve replacement for native mitral valve...

Background and aims Statin therapy is a cornerstone of secondary prevention after myocardial infarction (MI). However, many patients do not use statins. We studied the association of not using statin early after MI with adverse outcomes. Methods Consecutive MI patients admitted to 20 Finnish hospitals (n = 64,401; median age 71) were retrospective...

Chronic subdural hematoma (cSDH), previously considered fairly benign and easy to treat, is now viewed a possible sign of incipient clinical decline. We investigated case-fatality, excess fatality and need for reoperations following operated cSDH in a nationwide setting focusing on patient-related characteristics. Finnish nationwide databases were...

Digoxin is used for rate control in atrial fibrillation (AF), but evidence for its efficacy and safety after myocardial infarction (MI) is scarce and mixed. We studied post‐MI digoxin use effects on AF patient outcomes in a nationwide registry follow‐up study in Finland. Digoxin was used by 18.6% of patients after MI, with a decreasing usage trend...

Background: Recent studies from Finland have highlighted an increase in the incidence of traumatic brain injuries (TBI) in older age groups and high overall mortality. We performed a comprehensive study on the changing epidemiology of TBI focusing on the acute events in the Finnish working-age population. Methods: Nationwide databases were searche...

Background Female sex has previously been associated with poorer outcomes after myocardial infarction (MI), although evidence is scarce among young patients. Aim We studied sex differences in cardiovascular outcomes after MI in young patients <55 years old. Methods Consecutive young (18–54 years) all-comer patients with out-of-hospital MI admitte...

Background Patients with schizophrenia spectrum disorder have increased risk of coronary artery disease. AimsTo investigate long-term outcomes of patients with schizophrenia spectrum disorder and coronary artery disease after coronary artery bypass grafting surgery (CABG). Method Data from patients with schizophrenia spectrum disorder (n = 126) wer...

Importance The incidence of Zenker diverticulum has been established; previous estimates have been extrapolated from small institutional cohorts. Objective To describe the population-wide incidence of Zenker diverticulum over a 20-year period and characterize management strategies across specialties and treatment settings. Design, Setting, and Pa...

Background Evidence on the impact of sex on prognoses after myocardial infarction (MI) among older adults is limited. We evaluated sex differences in long‐term cardiovascular outcomes after MI in older adults. Methods and Results All patients with MI ≥70 years admitted to 20 Finnish hospitals during a 10‐year period and discharged alive were studi...

Background Substantial variation in health care costs for malignant pleural mesothelioma (MPM) has previously been identified. Materials and Methods We analyzed the changes in health care costs in MPM in Finland during 2002–2012. Finland has low-threshold public health care and a mandatory Workers' Compensation scheme that covers all occupational-...

Infective endocarditis (IE) is a life-threatening condition with high mortality and morbidity [1, 2]. Surgical valve replacement is the cornerstone of treatment in the presence of severe valvular destruction, uncontrolled infection, or large vegetation [1, 3]. The prosthetic valve choice, however, is not easy. Current guidelines recommend biologica...

Infective endocarditis (IE) is associated with high mortality. However, data on factors associated with length of stay (LOS) in hospital due to IE are scarce. In addition, long-term mortality of more than 1 year is inadequately known. In this large population-based study we investigated age and sex differences, temporal trends, and factors affectin...

Patients with rheumatoid arthritis (RA) have increased risk of developing cardiovascular disease and events. Little is, however, known about the influence of RA to the outcomes after surgical aortic valve replacement (SAVR). Methods: In a retrospective, nationwide, multicenter cohort study, RA patients (n = 109) were compared to patients without RA...

Background Case-fatality of Intracerebral hemorrhage (ICH) has been reported to have improved in some areas recently. Previous reports have shown that in Finland ICH survival has improved already from the 1980s. We aimed to investigate if this trend has continued and to assess possible predictors for death. Methods All patients hospitalized for IC...

Objective There are no evidence-based guidelines for operative neurosurgical treatment of older patients with traumatic brain injuries (TBI) and there are no population-based results of current practices. The objective of the study was to investigate rates of trauma craniotomy operations and later mortality in older adults with TBI in Finland. Met...

Background The female sex is associated with poorer outcomes after myocardial infarction (MI), although current evidence in older patients is limited and mixed. We sought to evaluate sex-based differences in outcome after MI in older patients. Methods Consecutive older (≥ 70 years) all-comer patients with out-of-hospital MI admitted to 20 hospital...

We investigated the association between the widening of a nationwide restaurant smoking ban, enacted on 1 June 2007, and stroke admissions. All acute stroke admissions between 1 May 2005 and 30 June 2009 were retrieved from a mandatory registry covering mainland Finland. Patients aged ≥18 years were included. One annual admission per patient was in...

Background: We investigated the long-term outcomes of mitral valve replacement (MVR) in native mitral valve infective endocarditis (IE). Methods: Multicentre, population-based cohort register study consisted of 1233 consecutive adult patients treated with first-time MVR in Finland. Mitral valve IE was diagnosed in 170 of these patients. Propensi...

Introduction: There is minimal existing available information on nationwide seasonal peaks in traumatic brain injuries (TBIs). This lack of information is an impediment to the effective development of prevention programs, societal policies, and hinders the resourcing of medical emergency services. Our current aim is to study nationwide population-...

Objective: To investigate the long-term outcomes of patients with rheumatoid arthritis (RA) after myocardial infarction (MI). Methods: All-comer, real-life MI patients with RA (n = 1614, mean age 74 years) were retrospectively compared to propensity score (1:5) matched MI patients without RA (n = 8070) in a multicenter, nationwide, cohort regist...

OBJECTIVES Surgery is the standard treatment in early-stage non-small-cell lung cancer and select cases of small-cell lung cancer, but gender differences in its use and outcome are poorly known. Gender differences in surgical resection rates and long-term survival after lung cancer surgery were therefore investigated. METHODS In Finland, 3524 pati...

Background Sex is suggested to influence outcomes after coronary artery bypass grafting (CABG) although evidence on long-term mortality is controversial and cardiovascular outcome data is lacking. We studied sex differences in outcomes after isolated CABG. Methods Consecutive patients with first-time isolated CABG for stable coronary artery diseas...

Objective To investigate the long-term outcomes of coronary artery bypass grafting surgery (CABG) in patients with rheumatoid arthritis (RA). Methods Patients with RA (n = 378) were retrospectively compared to patients without RA (n = 7560), all treated with CABG in a multicentre, population-based cohort register study in Finland. The outcomes wer...

Background We wanted to investigate the influence of native‐valve infective endocarditis (IE) on long‐term outcomes of surgical aortic valve replacement (SAVR). Methods Native‐valve patients with IE (n = 191) were compared to propensity score‐matched patients without IE (n = 191), all treated with SAVR, in a multicentre, population‐based cohort re...

BACKGROUND AND PURPOSE: Epidemiology of cerebral venous thrombosis (CVT) has been reported to be changing. Because long-term nationwide data are needed to confirm this, we studied CVT occurrence between 2005 and 2014 in Finland. METHODS: All acute CVT admissions were retrieved from a mandatory registry covering mainland Finland. Patients aged ≥18 y...

Objectives Previous data on the trends of surgical treatment of vesicoureteral reflux outside USA are scarce. The aim of this study was to clarify the national trends of operative treatment of vesicoureteral reflux (VUR) in Finland. Methods We analyzed national data from Finnish Care Register for Health Care on children (<16 years of age) surgical...

Objective: To investigate the epidemiology and prognosis of Unverricht–Lundborg disease (EPM1) in a nationwide, population-based setting. Methods: Data from multiple registries were combined and analyzed. Clinical data was obtained from medical records. All patients treated for EPM1 in Finland between January 1, 1998 and December 31, 2016 were inc...

Objective To study the long-term outcome differences between acute myocardial infarction (MI) and stable coronary artery disease (CAD) patients treated with coronary artery bypass grafting (CABG). Methods We studied retrospectively patients with MI (n = 1882) or stable CAD (n = 13117) treated with isolated CABG between 2004 and 2014. Inverse prope...

The objectives of this study were to investigate the outcome differences between ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) patients treated with coronary artery bypass grafting surgery (CABG). We conducted a multicenter, retrospective cohort follow-up study of consecutive patients...

Background Data on the epidemiology and prognosis of Wilson's disease are scarce, and no clinical data are available from Finland. Methods All persons diagnosed and treated for Wilson's disease in Finnish hospitals in 1998 to 2017 were identified. Data were collected from national registries and patient charts. Results The point prevalence was 0....

Rationale: Currently available imaging techniques have limited specificity for the detection of active myocardial inflammation. Aluminum fluoride-18-labeled 1,4,7-triazacyclononane-N,N',N″-triacetic acid conjugated folate (18F-FOL) is a positron emission tomography (PET) tracer targeting folate receptor β (FR-β) that is expressed on activated macro...

Background A person's sex is suggested to impact their outcome after acute coronary syndrome (ACS) and cardiac surgery, although evidence in controversial. This study examined sex differences in outcomes of ACS patients treated with coronary artery bypass grafting (CABG). Methods Patients aged ≥18 year with ACS and treated with first-time isolated...

Purpose Use of oral antiplatelets (OAPs) is essential for preventing thrombotic events in patients with acute coronary syndrome (ACS). Effects of clopidogrel, prasugrel, and ticagrelor may be enhanced due to pharmacodynamic interactions, but as CYP substrates, they are prone to pharmacokinetic interactions too. The aim was to study polypharmacy in...

Objectives: Postpericardiotomy syndrome (PPS) is a relatively common complication after cardiac surgery. However, long-term follow-up data on the adverse events and mortality of PPS patients requiring invasive interventions are scarce. Methods: We sought to assess the occurrence of mortality, new-onset atrial fibrillation (AF), cerebrovascular e...

Background: We investigated trends of traumatic brain injury (TBI)-related hospitalisations, deaths, acute neurosurgical operations (ANO), and lengths of hospital stay (LOS) in patients aged ≥70 years in Finland using a population-based cohort. Methods: Nationwide databases were searched for all admissions with a TBI diagnosis as well as later deat...

Coronary artery disease is a common co-morbidity of aortic stenosis. When needed, adding coronary artery bypass grafting (CABG) to surgical aortic valve replacement (SAVR) is the standard treatment method, but the impact of concomitant CABG on long-term outcomes is uncertain. We compared long-term outcomes of SAVR patients with and without CABG. Ho...

Background: Infective endocarditis (IE) is a serious mainly bacterial infection associated with high mortality. Epidemiology of fatal IE is however largely unknown. We studied occurrence and trends of fatal IE in a population-based setting. Methods: All adults (≥18 years of age) who deceased due to IE in Finland during 2004-2016 were studied. Da...

Objectives The occurrence and mortality of vasospastic angina pectoris (VAP) is largely unknown in western countries. Our objective was to clarify the occurrence, gender-distribution and mortality of VAP in Finland using a population-based hospital registry. Methods We studied consecutive patients aged ≥18 years hospitalized with VAP as the primar...

Background: Usage of biological prosthesis is increasing in surgical aortic valve replacement (SAVR). Recent U.S. guidelines recommend either biological or mechanical prosthesis for SAVR in patients aged 50-70 years. We set out to study long-term outcomes of mechanical vs. biological prosthetic valves in this patient group. Methods: All patients...

Objectives. To investigate nationwide changes in procedure rates, patient selection, and prognosis after all surgical aortic valve replacements. Design. Patients undergoing primary surgical aortic valve replacement between 2001 and 2016 were identified from three nationwide registers with compulsory reporting to examine trends in aortic valve surge...

Objectives: Women are considered to have poorer prognoses after cardiac surgery, although evidence is scarce. The authors studied sex differences and long-term outcomes after surgical aortic valve replacement (SAVR). Design: Nationwide retrospective cohort study. Setting: Six public hospitals and 2 private hospitals. Participants: All first-...

Freely available until December 8 via: https://authors.elsevier.com/a/1ZwMM,WmRDBvE Hospital admission trends in Myasthenia Gravis are largely unknown, so they were here investigated in Finlandbetween 2004 and 2014 using national mandatory registry data. There were 2989 hospital admissions (59.7%for women) for 861 individuals (median 2 admissions/...

We investigated the trends of traumatic brain injury (TBI)-related hospitalizations, deaths, acute neurosurgical operations (ANO) and lengths of hospital stay (LOS) in patients aged ≥70 years in Finland during 2004–2014 using a population-based cohort. Nationwide databases were searched for all admissions with a TBI diagnosis for patients ≥70 year...

Objectives: Few population-based studies reporting trends in oesophageal cancer surgery exist. The aim of this study was to assess the incidence of oesophageal cancer, changes in resection rates, patient demographics and short- and long-term outcomes of oesophagectomy at the population level in Finland. Methods: All Finnish patients diagnosed wi...

Objectives: Population-based studies comparing long-term survival after minimally invasive and open surgery for lung cancer are lacking. The aim of this study was to compare long-term survival rates between minimally invasive [video-assisted thoracoscopic surgery (VATS)] and open surgery for lung cancer in an unselected nationwide setting. Method...

Background The population‐based incidence of anastomotic stricture after minimally invasive oesophagectomy (MIO) and open oesophagectomy (OO) is not known. The aim of this study was to compare rates of anastomotic stricture requiring dilatation after the two approaches in an unselected cohort using nationwide data from Finland and Sweden. Methods...

Background. Magnetic resonance imaging (MRI) with Gadolinium 1,4,7,10-tetraazacy-clododecane-N 0 ,N 00 ,N 000 ,N 0000-tetraacetic acid (Gd-DOTA) enables assessment of myocardial perfusion during first-pass of the contrast agent, while increased retention can signify areas of myocardial infarction (MI). We studied whether Gallium-68-labeled analog,...

Background Magnetic resonance imaging (MRI) with Gadolinium 1,4,7,10-tetraazacyclododecane-N′,N″,N′′′,N″″-tetraacetic acid (Gd-DOTA) enables assessment of myocardial perfusion during first-pass of the contrast agent, while increased retention can signify areas of myocardial infarction (MI). We studied whether Gallium-68-labeled analog, ⁶⁸Ga-DOTA, c...

Objectives: The optimal choice of valve prosthesis in surgical aortic valve replacement for infective endocarditis (IE) is controversial. We studied outcomes after mechanical versus biological prosthetic valve surgical aortic valve replacement in IE patients. Methods: All patients with native-valve IE aged 16-70 years undergoing mechanical or bi...

Background Despite currently available treatments, the burden of myocardial infarction (MI) morbidity and mortality remains prominent. The aim of this was to investigate the risk of developing subsequent cardiovascular events in MI patients. Methods This was an observational, retrospective cohort database linkage study using patient level data fro...

Background: Biologic prostheses are preferred for surgical aortic valve replacement (SAVR) in patients more than 70 years of age in clinical practice. This study investigated differences in long-term outcomes between SAVR-treated patients more than 70 years of age who received mechanical or biologic prosthetic valves. Methods: All patients (excl...

We sought to investigate how increases in alcohol taxation and changes in alcohol consumption were associated with the incidence rate of fatal traumatic brain injuries (TBI) in Finland during the years 2004–2016. Nationwide, mandatory cause of death database covering all deaths in Finland was searched for all deaths related to TBIs (ICD-10: S06.X)...

Objectives Infective endocarditis (IE) is a life-threatening disease associated with significant mortality. We studied recent temporal trends and age and sex differences in the occurrence and short-term mortality of IE. Design Population based retrospective cohort study. Setting Data of IE hospital admissions in patients aged ≥18 years in Finland...

Population-based studies examining whether preoperative esophageal stenting influences the short-term outcomes after esophagectomy for esophageal cancer are lacking. This nationwide cohort combining data from Finland and Sweden was conducted to cover this gap. Patients with locally advanced esophageal cancer (T ≥ 3 and/or N ≥ 1, M0) who underwent e...

Objective To investigate if progressive multifocal leucoencephalopathy (PML) incidence has increased in Finland like in the neighbouring Sweden. Methods National administrative registries were searched for all PML admissions aged 16 years or more in 2004–2014 on all neurological and internal medicine wards in Finland. The mortality data of the pat...

Background Activation of glucagon-like peptide-1 receptor (GLP-1R) signaling protects against cardiac dysfunction and remodeling after myocardial infarction (MI). The aim of the study was to evaluate ⁶⁸Ga-NODAGA-exendin-4 positron emission tomography (PET) for assessment of GLP-1R expression after MI in rats. Methods and Results Rats were studied...

Background We aimed to investigate the trends in occurrence and the treatment approaches of appendicitis in Finnish children. Material and methods All patients aged <16 y hospitalized for appendicitis in Finland in 2004-2014 were included. Data were retrospectively collected from the Finnish Care Register for Health Care and Statistics Finland. R...

Background: Studies of long-term survival after minimally invasive and open esophagectomy are needed. The aim of this study was to compare long-term outcomes following minimally invasive and open esophagectomy for esophageal cancer at the population level. Methods: All patients undergoing minimally invasive (n = 159) or open transthoracic (n = 4...

Objective: To determine the incidence trends of progressive multifocal leukoencephalopathy (PML) in Finland (HD). Background: PML incidence has increased in Sweden from 2004 to 2014, coinciding with prior use of monoclonal antibody treatment. Use of immunosuppressive and -modulating treatments, including second-line treatments for multiple scleros...

Objective: A significant proportion of traumatic brain injuries (TBIs) occur under the influence of alcohol. In Finland, alcohol taxation has been tightened several times during the years 2004- 2016. We sought to investigate how increases in alcohol taxation and changes in alcohol consumption were associated with I. Incidence of fatal TBIs in Finl...

Background The age-standardized incidence of stroke has decreased globally but, for reasons unknown, conflicting results have been observed regarding trend in incidence of major stroke subtypes in young adults. We studied these trends among people of working age in a population-based setting in Finland, where cardiovascular risk factor profiles hav...

Stroke occurrence shows strong correlations with sleep disorders and even subtle sleep disturbances have been shown to affect ischemic stroke (IS) occurrence. Chronobiology also exerts effects, like the morning surge in IS occurrence. Lunar cycles have also been shown to affect sleep and other physiological processes, but studies on moon phases and...