Modafinil Subjectively Does Not Impair Sleep in Aviators After a Period of Extended Wakefulness.

INTRODUCTION: Modafinil is used as a countermeasure to limit the effects of fatigue in military aviation. However, literature is conflicting about its negative effects on subsequent sleep.METHODS: This randomized placebo-controlled trial conducted by the Center of Man in Aviation of the Royal Netherlands Airforce is part of a larger study. It included 32 subjects (mean age 35 yr old, 84% male) who followed a normal daily routine and stayed awake the subsequent night. At midnight, all subjects received either 300 mg caffeine, 200 mg modafinil, or placebo. At the end of the test night, subjects were awake for a median period of 26 h. Afterwards, sleep questionnaires containing qualitative (Groningen Sleep Quality Scale) and quantitative parameters of sleep for the subsequent day (recovery sleep) and consecutive night (post-test sleep) were completed and statistically analyzed using Friedman and Wilcoxon signed rank tests.RESULTS: A statistically significant difference in the reported recovery sleep was observed. The modafinil group slept 30% shorter than placebo, but sleep efficiency was not statistically different. Quantitatively post-test sleep did not vary statistically significantly between the three groups. However, Groningen Sleep Quality Scale scores were lower post-test than pre-test in the modafinil group, while this was not the case in the caffeine and placebo group.DISCUSSION:This study found that modafinil subjectively does not negatively impact recovery sleep or subsequent nighttime sleep after an extended period of wakefulness and suggests it may decrease the need for recovery sleep compared to placebo or caffeine.Wingelaar-Jagt YQ, Wingelaar TT, Riedel WJ, Ramaekers JG. Modafinil subjectively does not impair sleep in aviators after a period of extended wakefulness. Aerosp Med Hum Perform. 2024; 95(6):290-296.

Daily Caffeine Intake and the Effect of Caffeine on Pilots' Performance After Extended Wakefulness.

INTRODUCTION: Fatigue is a major contributor to aviation accidents. Sufficient sleep may be difficult to achieve under operational conditions in military aviation. Countermeasures include caffeine, however, studies evaluating its effects often do not represent daily practice with regular caffeine consumption. This study aims to establish the effect of caffeine on psychomotor performance in a realistic scenario (i.e., after a limited period of extended wakefulness).METHODS: This randomized, double-blind, crossover, placebo-controlled trial included 30 aeromedically fit subjects. On trial days, subjects followed their normal routine till 17:00, after which caffeine intake was stopped. At midnight, subjects were given 300 mg of caffeine or placebo and performed the Psychomotor Vigilance Test, Vigilance and Tracking Test, and the Stanford Sleepiness Scale hourly up to 04:00 and again at 06:00 and 08:00. Four blood samples were collected. Statistical analyses included repeated-measures ANOVA or Friedman tests, marginal models, and Wilcoxon Signed Rank tests.RESULTS: Median time awake at midnight was 17 h (IQR 16.5-17.5 h). Performance decreased significantly less during the night in the caffeine condition versus placebo. Neither habitual intake nor daytime caffeine consumption affected this. No statistically significant correlation was identified between blood concentrations of caffeine and performance.DISCUSSION: A single dose of 300 mg of caffeine has beneficial effects on performance during the night in a realistic scenario for military aviation. Daytime caffeine consumption does not affect the effects of caffeine at night. These findings could be relevant for all industries in which optimal performance is required during nighttime after a limited period of extended wakefulness.Wingelaar-Jagt YQ, Wingelaar TT, de Vrijer L, Riedel WJ, Ramaekers JG. Daily caffeine intake and the effect of caffeine on pilots' performance after extended wakefulness. Aerosp Med Hum Perform. 2023; 94(10):750-760.

Acute tryptophan depletion slows gastric emptying in females.

Serotonin (5-HT) is an important neurotransmitter involved in the brain-gut axis. It is possible to lower the 5-HT level in the body by means of a nutritional intervention using an amino acid mixture; the acute tryptophan depletion (ATD) method. We studied the effect of ATD on gastric emptying in healthy females, who received both ATD and placebo in a random order. Gastric emptying was measured using the [(13)C]octanoic acid breath test. The present data demonstrate significant differences in both gastric emptying and lag phase (Tlag) between the ATD and placebo experiment. Eight out of ten subjects showed a delayed gastric emptying in the ATD experiment. Both the gastric half-emptying time (T1/2) and the Tlag were significantly higher in the ATD experiment. T1/2 in the ATD experiment was 137.2 (range 76.2-634.8) min; T1/2 for the placebo experiment was 98.5 (range 63.7-168.8) min (P=0.028). Tlag in the ATD experiment was 83.7 (range 45.1-356.2) min; Tlag for the placebo experiment was 56.9 (range 23.2-101.2) min (P=0.007). We conclude that lowering the 5-HT level in the body using the ATD method leads to a significantly delayed gastric emptying of a solid meal. Nutritional manipulation of the serotonergic system in healthy volunteers may lead to alterations in gastrointestinal motility.