Interactions between remote ischemic conditioning and post-stroke sleep regulation

doi:10.1007/s11684-021-0887-9

Front. Med.

2021, Vol. 15

Issue (6) : 867-876 https://doi.org/10.1007/s11684-021-0887-9

REVIEW

Interactions between remote ischemic conditioning and post-stroke sleep regulation

Xian Wang¹, Xunming Ji^1,²(

)

¹. Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100069, China
². Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine, Beijing 100069, China

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Abstract

Sleep disturbances are common in patients with stroke, and sleep quality has a critical role in the onset and outcome of stroke. Poor sleep exacerbates neurological injury, impedes nerve regeneration, and elicits serious complications. Thus, exploring a therapy suitable for patients with stroke and sleep disturbances is imperative. As a multi-targeted nonpharmacological intervention, remote ischemic conditioning can reduce the ischemic size of the brain, improve the functional outcome of stroke, and increase sleep duration. Preclinical/clinical evidence showed that this method can inhibit the inflammatory response, mediate the signal transductions of adenosine, activate the efferents of the vagal nerve, and reset the circadian clocks, all of which are involved in sleep regulation. In particular, cytokines tumor necrosis factor α (TNFα) and adenosine are sleep factors, and electrical vagal nerve stimulation can improve insomnia. On the basis of the common mechanisms of remote ischemic conditioning and sleep regulation, a causal relationship was proposed between remote ischemic conditioning and post-stroke sleep quality.

Keywords remote ischemic conditioning sleep regulation stroke

Corresponding Author(s): Xunming Ji

Just Accepted Date: 29 October 2021 Online First Date: 19 November 2021 Issue Date: 27 December 2021

Cite this article:

Xian Wang,Xunming Ji. Interactions between remote ischemic conditioning and post-stroke sleep regulation[J]. Front. Med., 2021, 15(6): 867-876.

URL:

https://academic.hep.com.cn/fmd/EN/10.1007/s11684-021-0887-9
https://academic.hep.com.cn/fmd/EN/Y2021/V15/I6/867

Fig.1 Evidence that links stroke, remote ischemic conditioning (RIC) and sleep. Stroke and sleep disturbances have mutually adverse effects. Stress, brain edema, severity, comorbidities, and lesion location that are resulted from stroke induce sleep disturbances, while poor sleep facilitates atherogenesis, endothelial dysfunction, extended edema, and infarct region. RIC and good sleep have similarly neuroprotective effects, such as reducing ischemia/reperfusion (I/R) injury, increasing neurogenesis, axonal sprouting, and cerebral perfusion. Furthermore, RIC involves in sleep regulation, by impacting melatonin, sleep homeostasis, and circadian system, as well as by the shared mechanisms of sleep deprivation (SD) preconditioning.

Fig.2 Putative pathways linking remote ischemic conditioning to sleep regulation (sleep homeostasis and circadian system). RIC increases sleep propensity by the pre-activating immune system, mimicking/strengthening the effects of the adenosine system and vagal activity. It reduces sleep fragmentation by inhibiting the hyperactivation of inflammatory response and sympathetic activity. In addition, RIC plays a regulatory role in the circadian system, through increasing HIF1α, balancing neural activities, and decreasing ischemia/reperfusion (I/R) injury.

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