Effects of heat load and hypobaric hypoxia on cognitive performance: a combined stressor approach.

This study investigates how cognitive performance is affected by the combination of two stressors that are operationally relevant for helicopter pilots: heat load and hypobaric hypoxia. Fifteen participants were exposed to (1) no stressors, (2) heat load, (3) hypobaric hypoxia, and (4) combined heat load and hypobaric hypoxia. Hypobaric hypoxia (13,000 ft) was achieved in a hypobaric chamber. Heat load was induced by increasing ambient temperature to ∼28 °C. Cognitive performance was measured using two multitasks, and a vigilance task. Subjective and physiological data (oxygen saturation, heart rate, core- and skin temperature) were also collected. Mainly heat load caused cognitive performance decline. This can be explained by high subjective heat load and increased skin temperature, which takes away cognitive resources from the tasks. Only the arithmetic subtask was sensitive to hypobaric hypoxia, whereby hypobaric hypoxia caused a further performance decline in addition to the decline caused by heat load.Practitioner summary: Little is known about how multiple environmental stressors interact. This study investigates the combined effects of heat load and hypobaric hypoxia on cognitive performance. An additive effect of heat load and hypobaric hypoxia was found on a arithmetic task, which may be attributed to independent underlying mechanisms.

No Effects of Successful Bidirectional SMR Feedback Training on Objective and Subjective Sleep in Healthy Subjects.

There is a growing interest in the application of psychophysiological signals in more applied settings. Unidirectional sensory motor rhythm-training (SMR) has demonstrated consistent effects on sleep. In this study the main aim was to analyze to what extent participants could gain voluntary control over sleep-related parameters and secondarily to assess possible influences of this training on sleep metrics. Bidirectional training of SMR as well as heart rate variability (HRV) was used to assess the feasibility of training these parameters as possible brain computer interfaces (BCI) signals, and assess effects normally associated with unidirectional SMR training such as the influence on objective and subjective sleep parameters. Participants (n = 26) received between 11 and 21 training sessions during 7 weeks in which they received feedback on their personalized threshold for either SMR or HRV activity, for both up- and down regulation. During a pre- and post-test a sleep log was kept and participants used a wrist actigraph. Participants were asked to take an afternoon nap on the first day at the testing facility. During napping, sleep spindles were assessed as well as self-reported sleep measures of the nap. Although the training demonstrated successful learning to increase and decrease SMR and HRV activity, no effects were found of bidirectional training on sleep spindles, actigraphy, sleep diaries, and self-reported sleep quality. As such it is concluded that bidirectional SMR and HRV training can be safely used as a BCI and participants were able to improve their control over physiological signals with bidirectional training, whereas the application of bidirectional SMR and HRV training did not lead to significant changes of sleep quality in this healthy population.

Examining the Relationship Between Mental, Physical, and Organizational Factors Associated With Attrition During Maritime Forces Training.

For infantry units of the Dutch Ministry of Defence, high attrition rates (varying from 42 to 68%) during initial training are a persisting problem. The reasons for this attrition are diverse. Having better insight into the causes of attrition is a prerequisite for implementing preventive measures. To achieve this, a monitoring assessment system was developed that integrated the effects of physical, mental, and organizational determinants on operational readiness. The aim of this study was to implement the monitoring tools and to establish the set of determinants that best predicted attrition during infantry training of new recruits. Eighty-five recruits were monitored over a 24-week infantry training course. Before the training, recruits were screened for medical, psychological, and physical wellness. During the monitoring phase, mental, physiological, and organizational indicants were obtained using an array of tools such as questionnaires, chest belt monitors (for heart rate, acceleration, and skin temperature measurements), and computerized tests (e.g., vigilance, long-term memory). Survival analyses were used to tease out the determinants of individual and grouped predictors of attrition. Nearly half the recruits (47%) failed the training. Attrition was predicted by both physiological and mental determinants. However, the organizational determinant "trainers' judgment" on the "recruits' military quality" dominated the physiological and mental determinants. It was concluded that the monitoring system was successfully implemented during infantry training, and that the survival analysis method emphasized on single effects and interactions between the different determinants. Based on the current findings, we recommend several steps to successfully implement a monitoring method in settings with high demands.

Helicopter Pilot Performance and Workload in a Following Task in a Degraded Visual Environment.

BACKGROUND: In this study, we investigated the impact of a loss of horizon due to atmospheric conditions on flight performance and workload of helicopter pilots during a low-altitude, dynamic flight task in windy conditions at sea. We also examined the potential benefits of a helmet-mounted display (HMD) for this specific task.METHODS: In a fixed-based helicopter simulator, 16 military helicopter pilots were asked to follow a maneuvering go-fast vessel in a good visual environment (GVE) and in a degraded visual environment (DVE). DVE was simulated by fog, obscuring the horizon and reducing contrast. Both visual conditions were performed once with and once without an HMD, which was simulated by projecting head-slaved symbology in the outside visuals. Objective measures included flight performance, control inputs, gaze direction, and relative positioning. Subjective measures included self-ratings on performance, situation awareness, and workload.RESULTS: The results showed that in DVE the pilots perceived higher workload and were flying closer to the go-fast vessel than in GVE. Consequently, they responded with larger control inputs to maneuvers of the vessel. The availability of an HMD hardly improved flight performance but did allow the pilots to focus their attention more outside, significantly improving their situation awareness and reducing workload. These benefits were found in DVE as well as GVE conditions.DISCUSSION: DVE negatively affects workload and flight performance of helicopter pilots in a dynamic, low-altitude following task. An HMD can help improve situation awareness and lower the workload during such a task, irrespective of the visual conditions.Ledegang WD, van der Burg E, Valk PJL, Houben MMJ, Groen EL. Helicopter pilot performance and workload in a following task in a degraded visual environment. Aerosp Med Hum Perform. 2024; 95(1):16-24.

Sleep and alertness in North Sea helicopter operations.

INTRODUCTION: Dutch North Sea helicopter operations are characterized by multiple sector flights to offshore platforms under difficult environmental conditions. In the context of a Ministry of Transport program to improve safety levels of helicopter operations, we assessed effects of pre-duty sleep, pre-duty travel time, and workload factors on the alertness and vigilance of pilots. METHOD: Data of 24 pilots comprising 224 duty days were analyzed. Pilots performed 10-min test sessions after wake up, pre-duty, halfway-duty, end-duty, and at bedtime during normal duty rosters. Test sessions included completion of a vigilance task, vigor and sleepiness ratings, and questions on sleep and operational characteristics. Pilots wore an actometer to objectify sleep data. RESULTS: Vigor scores were high and sleepiness levels were low during the entire flight duty periods (FDPs), while vigilance was impaired only 6.8% in the course of the FDPs. Pre-duty sleep before morning duties was 1.5 h shorter than sleep before duties starting after midday. Longer pre-duty travel time was correlated with shorter pre-duty sleep and lower vigilance levels during duty. CONCLUSION: During the FDPs, pilots maintained alertness and vigilance levels that may be considered safe in terms of alertness-related flight safety. This favorable outcome may be attributed to reasonable length of FDPs, favorable circadian start and end times of duties, sufficient opportunities for restorative pre-duty sleep, and relatively good weather conditions. Appropriate FDP scheduling is an important measure to optimize alertness of helicopter pilots who have to cope with adverse environmental conditions and limited landing and air traffic control facilities.

Sleep monitoring: a comparison between three wearable instruments.

During military operations soldiers often encounter extreme environmental circumstances like heat, cold, prolonged physical exercise, and disturbed sleep, which hamper their performance. Monitoring changes in physiological parameters may assist with adequate interventions to prevent the negative consequences and support recovery. The current study was employed to reduce the number of measurement instruments to monitor physiological variables, especially with respect to adequate sleep prediction. We compared three instruments with respect to their effectiveness in predicting sleep; the Equivital, Sensewear, and Actiwatch. Additionally, we investigated the added value of cardio-respiratory to accelerometer signals to estimate sleep duration. The Equivital model (based on acceleration data) and Sensewear predict sleep and wake as accurate as the commonly used Actiwatch model, and the cardio-respiratory Equivital data further improve accuracy and specificity. In sum, the current study provides an indication that the Equivital system (or any other chestband that measures 3-dimensional acceleration plus other physiological variables) might be interchanged with an Actiwatch for sleep prediction.

Self-Assessed Preferred Retraining Intervals of Helicopter Underwater Egress Training (HUET).

BACKGROUND: Royal Netherlands Air Force (RNLAF) helicopter aircrew get Helicopter Underwater Egress Training (HUET) using a Modular Egress Training Simulator (METS™) in order to be prepared for escaping the aircraft when ditching into water. In the current situation the retraining intervals are only chosen on an arbitrary basis for different backgrounds of the crew (maritime and regular flight crew). The frequency of refresher training depends on the expected degree of retention, but evidence-based research on required intervals between refresher courses is scarce. Ideally, training should be based on the amount of retention of acquired competencies.METHODS: Retrospective questionnaires were filled in by 132 helicopter aircrew who followed the HUET course(s) at the Survival Evasion Resistance and Escape (SERE) school in Gilze-Rijen (Netherlands). They assessed themselves on competencies and gave their opinion on the preferred interval.RESULTS: Maritime crew report increasing competence levels with the number of refresher courses followed. According to the opinion of all aircrew, retraining intervals may take longer than 18 (first refresher) to 30 mo (fourth refresher). Maritime and regular flight crew differ in preferred retraining intervals (up to 22 mo and up to 33 mo, respectively).DISCUSSION: This study provides indications to reconsider the retraining interval and to differentiate between maritime and regular flight crew based on aircrew's opinions and self-assessments. As competence levels still increase with the number of courses followed, it is recommended to reconsider the current fixed intervals of once a year or once every 3 yr for maritime and regular flight crew, respectively.Bottenheft C, Oprins EAPB, Houben MMJ, Meeuwsen T, Valk PJL. Self-assessed preferred retraining intervals of Helicopter Underwater Egress Training (HUET). Aerosp Med Hum Perform. 2019; 90(9):800-806.

Sustained operations in confined-space military vehicles.

This paper reports 2 baseline studies and one experiment performed in a confined-space military vehicle concerning the effects on fitness and performance of time in a sitting posture and workstation characteristics. On average physical fitness decreased by slightly more than 10% per hour, the observation performance decreased by 30% per hour, and the technical performance (of gunners) showed a relatively small decrease, i.e., less than 5% per hour. So-called active breaks (changing sitting into standing and walking) led to a significant reduction in the decrease of physical fitness, almost reducing it to zero. Furthermore, the level of confinement was shown to affect physical fitness.

Usefulness of temazepam and zaleplon to induce afternoon sleep.

UNLABELLED: Insufficient daytime sleep may result in reduction of effectiveness and safety during overnight military missions. The usefulness of temazepam and zaleplon to optimize afternoon sleep and their effects on performance and alertness during a subsequent night shift were studied. METHOD: In a randomized double-blind within-subjects design, 11 subjects took 20 mg of temazepam, 10 mg of zaleplon, or placebo before a 5:30-10:00 p.m. sleep period. Sleep length and quality were measured. Subjects were kept awake throughout the night while alertness, cognitive performance, and muscle power were repeatedly measured. RESULTS: Temazepam provided significantly longer and qualitatively better sleep than zaleplon or placebo. During the night, sleepiness increased and muscle power was impaired in all conditions. Better sleep was correlated with less sleepiness during the night. CONCLUSION: Temazepam is useful to optimize a 4.5-hour afternoon sleep before overnight missions. Irrespective of hypnotic treatment, sleepiness and fatigue increased during the night shift.

Cognitive Performance Effects of Bilastine 20 mg During 6 Hours at 8000 ft Cabin Altitude.

INTRODUCTION: Bilastine is a new oral, second generation antihistamine used in the symptomatic treatment of allergic rhinoconjunctivitis and urticaria. It is considered a nonsedating antihistamine and might be recommended for use in pilots, pending research on the effects on flying-related performance under hypobaric conditions that prevail in an airliner. We assessed the effects of a single dose of bilastine 20 mg on alertness and complex task performance of healthy volunteers in a hypobaric chamber at 75.2 kPa (8000 ft/2438 m cabin altitude). METHODS: In a randomized, double-blind, crossover study, 24 volunteers received a single dose of bilastine 20 mg, hydroxyzine 50 mg (active control), and placebo. Using the Vigilance and Tracking Task, Multi-Attribute Task Battery, and Stanford Sleepiness Scale, assessments were made before and up to 6 h after intake of the study medication. RESULTS: Bilastine 20 mg had no impairing effects on sleepiness levels, vigilance, or complex task performance for up to 6 h post-dose. Hydroxyzine 50 mg (active control) was associated with significant sleepiness and impaired performance across this time period, confirming the sensitivity of the tests. CONCLUSION: Bilastine 20 mg did not cause sleepiness or impaired performance on tasks related to flying. It is anticipated that a single dose of bilastine 20 mg will not affect flying performance. Bilastine may provide a safe therapeutic alternative for pilots suffering from allergic rhinitis or urticaria. Our findings might also have implications for the treatment of allergic disorders of personnel involved in other safety-sensitive jobs. Valk PJL, Simons R, Jetten AM, Valiente R, Labeaga L. Cognitive performance effects of bilastine 20 mg during 6 hours at 8000 ft cabin altitude. Aerosp Med Hum Perform. 2016; 87(7):622-627.

Malaria prophylaxis for aircrew: safety of atovaquone/proguanil in healthy volunteers under aircraft cabin pressure conditions.

BACKGROUND: Because malaria in endemic areas presents a serious threat to the health of aircrew, optimal prevention is important. An effective and safe prophylactic antimalarial drug is needed. The combination of 250 mg atovaquone with 100 mg proguanil HCl (atovaquone/proguanil, or A/P) has shown good prophylactic efficacy and tolerance for prevention of falciparum malaria. However, medication for use by aircrew on duty is subject to approval by national and international aviation authorities, who require convincing evidence that the treatment has no negative effects on the flight performance of crews. The purpose of the present study was to evaluate the risk of detrimental effects of atovaquone/proguanil on flight-related performance and alertness in healthy subjects under conditions of aircraft cabin pressure. METHODS: A randomized, double-blind crossover study was conducted in which 24 subjects were enrolled to use A/P and placebo, each in a 14-day prophylactic dosing regimen with a 21-day washout phase. Vigilance, alertness, complex information processing, and sleepiness were assessed in a hypobaric chamber at 75.2 kPa, which equals the lower limit of commercial aircraft cabin pressure. Furthermore, duration and quality of sleep at home were recorded during the 14 days of drug administration. RESULTS: Twenty-two subjects completed the study. No significant differences were found between the effects of placebo and A/P on vigilance, alertness, complex information processing, sleep duration and quality, and the occurrence of adverse effects. CONCLUSIONS: In-flight performance and alertness of aircrew will not be affected by the prophylactic use of A/P during a period of 14 days.

Desloratadine shows no effect on performance during 6 h at 8,000 ft simulated cabin altitude.

INTRODUCTION: Sustained vigilance is required by pilots and crew during flight; therefore, the use of antihistamines with sedating properties is widely prohibited. The purpose of this study was to determine the effects of desloratadine, a long-acting, nonsedating antihistamine, on healthy volunteers placed under conditions of simulated cabin pressure. METHODS: In a double-blind crossover study, 21 subjects randomly received single doses of desloratadine 5 mg, diphenhydramine 50 mg (active control), and placebo on different days separated by washout periods of 7 d. On test days, predose levels of alertness and fatigue were determined, as were post-dose levels at 1, 2, 3, 5, and 6 h. Measurements included vigilance and tracking, a multi-attribute task battery, the Stanford Sleepiness Scale, and pulse oximetry. RESULTS: Desloratadine had no detrimental effects on sleepiness or performance of tasks associated with flying ability. Conversely, diphenhydramine (active control) caused significantly more sleepiness than did the placebo [F (2,40) = 6.52, p < 0.01], as well as impaired performance (tracking performance p < 0.05 at 3 h post dose), and an increased percentage of omissions (p < 0.05 at 2 h post dose). CONCLUSION: A single dose of desloratadine 5 mg did not cause sleepiness and did not impair the performance of tasks associated with flying ability.