The Cosmology of Stroke: A Systematic Review and Meta-analysis of the Lunar Influence on Cerebrovascular Disorders.

INTRODUCTION: Measurable changes in blood pressure, coagulation, neurophysiological activity, and autonomic regulation were observed in relation to the lunar cycle. A few studies evaluated the circalunar rhythm of stroke in relation to synodic moon phases. Stroke represents an ongoing strain on the global economy as a leading cause of mortality and physical disability. This systematic review analyzed studies on the influence of the lunar cycle on cerebrovascular disorders.

METHODS: A systematic analysis of studies on the effects of various moon phases on stroke was conducted using both quantitative meta-analysis and qualitative appraisal of observational studies, following the Joanna Briggs Institute format for systematic reviews of prevalence studies, to ensure a comprehensive and rigorous evaluation of the existing evidence.

RESULTS: A total of 130556 patients from five studies were analyzed using qualitative and quantitative meta-analyses across all stroke types. Quantitative meta-analysis showed no association of the lunar cycle with ischemic or hemorrhagic strokes. However, the qualitative analyses yielded mixed and inconclusive results regarding the association between moon phase and the rates of ischemic or hemorrhagic stroke.

DISCUSSION: The current body of studies on lunar chronobiology in stroke is confined to smallscale, predominantly single-center, retrospective studies. The diversity of populations, the lack of uniform adjustments for comorbidities or medications, and substantial methodological heterogeneity preclude firm conclusions. The ancillary evidence of circalunar rhythm in blood pressure, autonomic regulation, platelet functions, and coagulation parameters suggests a lunar effect and warrants validation in large-scale studies.

CONCLUSION: The limited evidence about the associations between stroke rates and the lunar cycle is mixed and inconclusive. Controlled studies spanning diverse geographic regions across the equator and multiple time zones are required to investigate the hypothetical moon effect on stroke rates. Identifying a lunar influence on stroke rates will guide critical econometric and chronotherapeutic strategies, such as dynamic dosing or drug titration, to address the circalunar biological rhythms for stroke prevention. The occult lunar rhythm on human tides may far exceed that of ocean tides, both biologically and economically.