A neural regulation mechanism of head electroacupuncture on brain network of patients with stroke related sleep disorders

doi:10.19852/j.cnki.jtcm.2024.06.011

Abstract

Abstract:

OBJECTIVE: To analyze part of the mechanism of electroacupuncture on Sishencong (EX-HN1) for stroke-related sleep disorders (SSD) and post-stroke cognitive impairment (PSCI).

METHODS: Using a randomized controlled trial (RCT) design, 72 patients were assigned to the electro-acupuncture (EA) group or the sham acupuncture (SA) group. A healthy control (HC) group was also included. Both groups were given routine rehabilitation treatment. Then, patients in the EA group were given additional electroacupuncture at Sishencong (EX_HN1). Meanwhile, patients in the SA group were given a flat-head needle sham/placebo treatment placed at the bilateral Jianyu (LI15) and Binao (LI14) line midpoints and the Jianyu (LI15) and Jianzhen (SI9) line midpoints. Before and after treatment, scales were collected and analyzed. In the second phase of the study, some subjects from the EA group were selected for functional magnetic resonance imaging (fMRI) data acquisition and comparative analysis with the HC group using a non-RCT design.

RESULTS: The EA group performed better than the SA group on the Pittsburgh sleep quality index (PSQI), Montreal cognitive assessment basic (MoCA_B), self-rating anxiety scale (SAS), and self-rating depression scale (SDS). Analysis of the fMRI showed that low-frequency (2 Hz) electroacupuncture stimulation at Sishencong (EX_HN1) can restrain frontal sup medial right (SFGmed.R), precuneus right (PCUN.R), and posterior cingulate cortex right (PCC.R) and enhance angular left (ANG.L), parietal inf left (IPL.L) and occipital mid left (MOG.L). The functional connectivity (FC) of SFGmed.R was positively correlated with PSQI. Electroacupuncture stimulation at Sishencong (EX_HN1) can reduce the side efficiency of the whole brain connection with the Thalamus.L, Hippocampus.L, and Occipital.Mid.L.

CONCLUSIONS: Low frequency (2 Hz) electroacupuncture stimulation at Sishencong (EX_HN1) can simultaneously improve sleep quality, negative emotions, and cognitive functions, the first two of which may be related to SFGmed.R restraint. Electroacupuncture can make some brain areas approach the physiological bias state, which is characterized by dominant hemispheric enhancement and non-dominant hemispheric weakening. The reduced whole brain connection side efficiency with some key nodes of the brain net may relate to sleep quality improvements in SSD patients.

Key words: electroacupuncture, brain network, neural regulation, sleep disorder

ZHANG Boyang, ZHOU Yang, FENG Liyuan, SUI Dan, HE Lei, TONG Dan, WANG Ruoyu, SUI Xue, SONG Jing, WANG Dongyan. A neural regulation mechanism of head electroacupuncture on brain network of patients with stroke related sleep disorders[J]. Journal of Traditional Chinese Medicine, 2024, 44(6): 1268-1276.

Figures/Tables 7

Table 1 Scale scores comparing EA and SA groups before treatment ($\bar{x}±s$)

Scale	SA group (n = 33)	EA group (n = 34)	F value	P value
PSQI	13.7±2.0	14.6±2.7	2.87	0.095
MoCA_B	19.5±4.3	19.6±4.0	0.02	0.897
SAS	48.6±6.6	48.1±5.7	0.09	0.759
SDS	53.2±7.6	52.4±7.8	0.16	0.690

Table 2 Scale scores comparing EA and SA groups after treatment

Scale	SA group (n = 33)		EA group (n = 34)		F value	P value
Scale	$\bar{x}±s$	MD	$\bar{x}±s$	MD	F value	P value
PSQI	12.2±1.5	－1.42	7.1±2.4	－7.59	109.98	<0.001
MoCA_B	21.9±2.8	2.36	26.1±2.2	6.41	45.79	<0.001
SAS	45.2±5.3	－3.37	40.0±5.1	－8.14	16.79	<0.001
SDS	50.0±6.4	－3.19	43.8±5.8	－8.60	17.09	<0.001

Table 3 Scale scores comparing pre- and post-treatment within EA and SA groups

Scales	Time	SA group (n = 33)			EA group (n = 34)
Scales	Time	$\bar{x}±s$	F value	P value	$\bar{x}±s$	F value	P value
PSQI	Pre	13.7±2.0	10.66	0.002	14.6±2.7	311.67	<0.001
	Post	12.2±1.5	10.66	0.002	7.1±2.4	311.67	<0.001
MoCA_B	Pre	19.5±4.3	26.88	<0.001	19.6±4.0	203.77	<0.001
	Post	21.9±2.8	26.88	<0.001	26.1±2.2	203.77	<0.001
SAS	Pre	48.6±6.6	13.42	0.001	48.1±5.7	80.58	<0.001
	Post	45.2±5.3	13.42	0.001	40.0±5.1	80.58	<0.001
SDS	Pre	53.2±7.6	11.67	0.001	52.4±7.8	87.45	<0.001
	Post	50.0±6.4	11.67	0.001	43.8 ± 5.8	87.45	<0.001

Figure 1 Main FC enhanced areas of DMN in the EA group before treatment FC: functional connectivity; DMN: default mode network; EA: electroacupuncture group.

Figure 2 Main FC weakened areas of DMN in the EA group after treatment FC: functional connectivity; DMN: default mode network; EA: electroacupuncture group.

Figure 3 Main FC enhanced areas of CCN in the EA group after treatment FC: functional connectivity; CCN: cognitive control network EA: electroacupuncture group.

Figure 4 Plane visualization of the significant results of continuous edges analysis in the EA group after treatment EA: electroacupuncture group. The Thalamus.L, Hippocampus.L, and Occipital.mid.L were the key nodes.

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