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ORIGINAL RESEARCH ARTICLE

Sleep-induced limb vasodilation in individuals confined to bed for 24 h

Edoardo Casiglia1* ,  Valérie Tikhonoff2
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1 Department of Medicine, Studium Patavinum, University of Padua, Padua, Italy
2 2 Department of Medicine, Unit of Nutrition, University of Padua, Padua, Italy
Brain & Heart 2024, 2(1), 1886 https://doi.org/10.36922/bh.1886
Submitted: 21 September 2023 | Accepted: 11 December 2023 | Published: 15 February 2024
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

The sleep/wake rhythm in limbs has been scarcely studied, especially due to the difficulty associated with continuous monitoring of arterial flow to the forearm and leg for a 24-h period. Addressing this constraint, we employed indium-gallium-in-silicone strain-gauge venous-occlusion plethysmography, an automated method facilitating the measurement of 24-h limb arterial flow in bed-confined subjects without disturbing their natural sleep. This article presents the state of the art in this field. Our examination of 60 healthy normotensive individuals revealed a distinctive sleep/wake rhythm in limb arterial flow, characterized by elevated values during sleep (32.7% in the forearm, P < 0.0001; 39.1% in the leg, P < 0.0001). Correspondingly, limb resistance mirrored the trend of flow (-32.7%, P < 0.0001; -33.5%, P < 0.0001), with these variations attributed to sleep-induced limb vasodilation. Sleep-associated vasodilation was also evident in 21 hypertensive individuals (leg resistance: -33.1%, P < 0.0001) and 13 heart transplant recipients lacking vagal and sympathetic cardiac innervation (resistance: -33.6%, P < 0.0001). On the contrary, among 11 subjects with an interrupted spinal cord, we observed forearm vasodilation (resistance: -36.6%, P < 0.0001) but observed no leg vasodilation if the spinal lesion was under T2 (innervating the leg). Furthermore, a loss of sleep-induced vasodilation occurred in both the forearm and leg if the injury was above C7 (innervating both forearm and leg). Our conclusion posits the existence of sleep-induced limb vasodilation, a phenomenon attributed to signals traveling along the spinal cord, with the heart playing no discernible role in this rhythmic process, and arterial hypertension deemed irrelevant. Comprehensive further studies are imperative to elucidate the precise triggers of limb vasodilation during sleep.

Keywords
Arterial flow
Peripheral resistance
Sleep-induced vasodilation
Strain-gauge plethysmography
24-h continuous monitoring
Circadian
Spinal cord injury
Heart transplant
Funding
None.
Conflict of interest
The authors declare that they have no competing interests.
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