Enhanced external counterpulsation reverses acute sleep deprivation–induced gray matter hypoperfusion: A prospective randomized controlled study

Acute sleep deprivation not only affects brain function and subjective perception, but also negatively impacts brain perfusion, hindering nerve repair. Effective intervention methods for acute sleep deprivation are currently lacking. This study explored whether enhanced external counterpulsation (EECP) can create a favorable internal environment for neurological function recovery by restoring gray matter cerebral blood flow. In total, 42 healthy adults were randomly assigned to EECP (n = 21) and sham (n = 21) groups. All participants underwent 30 hours of total acute sleep deprivation. The EECP group received 1 hour of EECP, whereas the sham group received sham treatment of equal duration. cerebral blood flow was measured using arterial spin labeling magnetic resonance imaging, and subjective fatigue and sleepiness were assessed using clinical scales at three time points: before sleep deprivation, after sleep deprivation (and before the intervention), and after the intervention. After sleep deprivation, both groups showed significantly increased subjective fatigue and sleepiness, decreased gray matter cerebral blood flow, and increased white matter cerebral blood flow. After the intervention, both groups reported subjective improvement, but only the EECP group showed significant recovery of gray matter cerebral blood flow, which was negatively correlated with fatigue reduction but positively correlated with increased sleepiness. Regional cerebral blood flow analysis indicated that EECP modulated perfusion in specific brain regions (e.g., R42 and R112 in the anatomical automatic labeling atlas). Recovery of gray matter cerebral blood flow was associated with reduced fatigue but increased sleepiness, suggesting that EECP may regulate fatigue and sleepiness through distinct mechanisms. In addition, EECP not only induced non-specific placebo effects but also specifically reversed gray matter hypoperfusion caused by sleep deprivation, indicating that it has potential to improve the internal environment for neural repair.