A Preliminary Investigation of the Association of Sleep With Inflammation and Oxidative Stress Biomarkers and Functional Outcomes After Stroke Rehabilitation

Ting-Ting Yeh,Chia-Ling Chen,Ching-Yi Wu,Yu-Wei Hsieh,Jong-Shyan Wang,Keh-Chung Lin

doi:10.1038/s41598-017-08931-w

Abstract

This study examined the association of sleep with inflammation and oxidative stress biomarkers, and with functional outcomes, after stroke rehabilitation. The rehabilitation effects on biomarkers and functional outcomes were also evaluated. Twenty subacute stroke survivors received 4 weeks of upper limb rehabilitation. Baseline inflammatory (i.e., soluble intercellular adhesion molecule-1, sICAM-1) and oxidative stress biomarkers (i.e., glutathione peroxidase, GPx and malondialdehyde, MDA) were assessed, as were sleep outcomes. Positive correlations were observed between baseline level of sICAM-1 and number of awakenings at post-treatment (ρ = 0.51, p < 0.05) as well as between baseline level of MDA and post-performance time of the Wolf Motor Function Test (WMFT-time) (ρ = 0.46, p < 0.05). In addition, MDA levels were significantly decreased, and functional outcomes of the modified Rankin Scale (mRS), functional ability scale of the WMFT, and Stroke Impact Scale (SIS-total, and SIS-physical function) were improved after the rehabilitation. This pilot study emphasizes the relationship among biomarkers, sleep, and functional outcomes after stroke rehabilitation. Oxidative stress markers may be useful predictors of functional outcomes in subacute stroke survivors.

Highlights

Lower functional ability, as measured by the Functional Independence Measure (FIM), than did those without sleep apnea[7]
Examining the associations among level of inflammation, level of oxidative stress, and sleep outcomes is relevant after stroke, given that changes in any one of these factors are proposed to be related to functional prognosis and the effectiveness of rehabilitation treatment post-stroke[20, 21]
The results of the study showed that the levels of C-Reactive protein (CRP) and total antioxidant capacity (TAC) were positively correlated with the oxyhemoglobin desaturation index; the TAC levels were negatively correlated with mean arterial oxygen saturation in stroke survivors with severe OSA22

Summary

Introduction

Lower functional ability, as measured by the Functional Independence Measure (FIM), than did those without sleep apnea[7]. A meta-analysis of 51 studies found that, compared to control subjects, patients with obstructive sleep apnea (OSA) have higher levels of inflammatory markers such as C-Reactive protein (CRP), tumor necrosis factor alpha (TNF-α), and intercellular adhesion molecule (ICAM)[10] These levels are positively correlated to the level of OSA severity[10]. Examining the associations among level of inflammation, level of oxidative stress, and sleep outcomes is relevant after stroke, given that changes in any one of these factors are proposed to be related to functional prognosis and the effectiveness of rehabilitation treatment post-stroke[20, 21]. The pilot study aimed to: (1) characterize the relationships among baseline biomarkers (i.e., inflammation and oxidative stress), sleep, and functional and health-related outcomes at post-treatment in subacute stroke patients, and (2) investigate the changes in levels of biomarkers, sleep, and functional and health-related outcomes after 4 weeks of rehabilitation intervention. We hypothesized that (1) higher levels of inflammation and oxidative stress at baseline would be associated with poor sleep quality and functional and health-related outcomes post-treatment, and (2) the levels of inflammation and oxidative stress would decrease, and the functional and health-related outcomes would improve, after the intervention

Objectives

Methods

Results

Conclusion