DOI: 10.4103/bc.bc_69_26 ISSN: 2394-8108

Effects of remote ischemic conditioning on multidimensional recovery in stroke patients with obstructive sleep apnea: Preliminary findings from a secondary post hoc analysis of the RIC-PS trial

Yunqian Luo, Xiaokang Shi, Changming Xu, Chen Chen, Pingping Wang, Dandan Hao, Sydni Rosenfeld, Zhen Chen
Show PDF Cite

Abstract:

BACKGROUND:

Obstructive sleep apnea (OSA) involves intermittent hypoxia and sleep fragmentation and is associated with adverse outcomes. Remote ischemic conditioning (RIC), a noninvasive intervention with vascular protective effects, modulates mechanisms shared by OSA and ischemic injury, including oxidative stress, inflammation, endothelial dysfunction, and autonomic imbalance. Its efficacy in OSA populations remains insufficiently studied.

METHODS:

This post hoc analysis of the RIC-PS trial included stroke patients with OSA (Apnea-Hypopnea Index ≥ 5). We compared pre-to-post changes between the original RIC and sham-RIC groups. Outcomes covered sleep (Pittsburgh Sleep Quality Index [PSQI], Insomnia Severity Index [ISI]), wearable parameters, HRV, psychology (Self-rating Anxiety Scale [SAS]/Self-rating Depression Scale [SDS]), and ICF-based function. Effect sizes (Cohen’s d ), Spearman correlations, and subgroup analyses (within RIC group) were performed to compare the effects of RIC versus sham on multidimensional recovery.

RESULTS:

Among 60 screened participants, 45 met OSA criteria (mean age 69 years; 25 male and 20 female). RIC ( n = 24) versus sham ( n = 21) showed significant medium-to-large effects on ISI ( d = 0.807), SAS ( d = 0.834), SDS ( d = 0.870), and ICF-based functional scale ( d = 1.111). Subjective sleep quality (PSQI) favored RIC ( d = 0.547, nonsignificant). Objective sleep parameters showed small, inconsistent effects. Improvements in sleep quality (PSQI) were positively correlated with reductions in anxiety (SAS, r = 0.518) and depression (SDS, r = 0.482). Greater benefits were observed in ischemic stroke (ISI improvement: r = −0.453) and subacute patients (sleep efficiency: r = −0.511), with trends toward stronger effects in those with ≥ 2 comorbidities.

CONCLUSIONS:

RIC may serve as a promising adjunctive therapy for improving sleep-related, psychological, and functional outcomes in stroke patients with OSA. The observed inter-domain associations and subgroup variability suggest integrated therapeutic effects and highlight the potential value of patient stratification in poststroke rehabilitation. However, given the modest sample size and the exploratory, post hoc nature of this analysis, these findings should be interpreted with caution. Larger prospective studies are warranted.

TRIAL REGISTRATION:

www.chictr.org.cn (identifier: ChiCTR2600128371).

More from our Archive