Sleep, Nutrition, and Injury Risk in Adolescent Athletes: A Narrative Review.

This narrative review explores the impact of sleep and nutrition on injury risk in adolescent athletes. Sleep is viewed as essential to the recuperation process and is distinguished as an active participant in recovery through its involvement in growth, repair, regeneration, and immunity. Furthermore, the literature has shown that the sleep of athletes impacts elements of athletic performance including both physical and cognitive performance, recovery, injury risk, and mental well-being. For sleep to have a restorative effect on the body, it must meet an individual's sleep needs whilst also lasting for an adequate duration and being of adequate quality, which is age-dependent. The literature has suggested that athletes have increased sleep needs compared to those of the general population and thus the standard recommendations may not be sufficient for athletic populations. Therefore, a more individualised approach accounting for overall sleep health may be more appropriate for addressing sleep needs in individuals including athletes. The literature has demonstrated that adolescent athletes achieve, on average, ~6.3 h of sleep, demonstrating a discrepancy between sleep recommendations (8-10 h) and actual sleep achieved. Sleep-wake cycles undergo development during adolescence whereby adaptation occurs in sleep regulation during this phase. These adaptations increase sleep pressure tolerance and are driven by the maturation of physiological, psychological, and cognitive functioning along with delays in circadian rhythmicity, thus creating an environment for inadequate sleep during adolescence. As such, the adolescent period is a phase of rapid growth and maturation that presents multiple challenges to both sleep and nutrition; consequently, this places a significant burden on an adolescent athletes' ability to recover, thus increasing the likelihood of injury. Therefore, this article aims to provide a comprehensive review of the available literature on the importance of sleep and nutrition interactions in injury risk in adolescent athletes. Furthermore, it provides foundations for informing further investigations exploring the relation of sleep and nutrition interactions to recovery during adolescence.

Sensitivity to Experiencing Alcohol Hangovers: Reconsideration of the 0.11% Blood Alcohol Concentration (BAC) Threshold for Having a Hangover.

The 2010 Alcohol Hangover Research Group consensus paper defined a cutoff blood alcohol concentration (BAC) of 0.11% as a toxicological threshold indicating that sufficient alcohol had been consumed to develop a hangover. The cutoff was based on previous research and applied mostly in studies comprising student samples. Previously, we showed that sensitivity to hangovers depends on (estimated) BAC during acute intoxication, with a greater percentage of drinkers reporting hangovers at higher BAC levels. However, a substantial number of participants also reported hangovers at comparatively lower BAC levels. This calls the suitability of the 0.11% threshold into question. Recent research has shown that subjective intoxication, i.e., the level of severity of reported drunkenness, and not BAC, is the most important determinant of hangover severity. Non-student samples often have a much lower alcohol intake compared to student samples, and overall BACs often remain below 0.11%. Despite these lower BACs, many non-student participants report having a hangover, especially when their subjective intoxication levels are high. This may be the case when alcohol consumption on the drinking occasion that results in a hangover significantly exceeds their "normal" drinking level, irrespective of whether they meet the 0.11% threshold in any of these conditions. Whereas consumers may have relative tolerance to the adverse effects at their "regular" drinking level, considerably higher alcohol intake-irrespective of the absolute amount-may consequentially result in a next-day hangover. Taken together, these findings suggest that the 0.11% threshold value as a criterion for having a hangover should be abandoned.

Correction: Van Lawick van Pabst, A.E. et al. Sex Differences in the Presence and Severity of Alcohol Hangover Symptoms. Journal of Clinical Medicine 2019, 8, 867.

The paper [...].

Cognitive performance and mood after a normal night of drinking: A naturalistic alcohol hangover study in a non-student sample.

AIMS: The alcohol hangover is typically investigated in student samples. However, alcohol hangovers are also reported by non-student drinkers, beyond the age and drinking behaviors of a student sample. The aim of this study was to investigate the effects of a normal night of alcohol consumption on next-day cognitive performance in a non-student sample. METHODS: Participants (N = 45) were recruited from a public drinking setting and participated in a naturalistic study comprising of a hangover test day and alcohol-free control day. On each test day, mood and hangover severity were assessed and participants completed a cognitive test battery consisting of a Stroop test, Eriksen's flanker test, spatial working memory test, free recall test, choice reaction time test, and intra-extra dimensional set shifting test. RESULTS: On the hangover day, significantly impaired performance was revealed on all tests, except the intra-extra dimensional set shifting test. On the hangover day, significantly lower mood scores were observed for alertness and tranquility. CONCLUSION: The current study in a non-student sample confirms previous findings in student samples that cognitive functioning and mood are significantly impaired during alcohol hangover.

Memory and attention during an alcohol hangover.

OBJECTIVE: This study aims to investigate attention, memory functioning, and mood in a natural setting with real-life alcohol consumption levels. METHODS: Seventy-four participants with a mean (SD) age of 24.5 (7.0) years old participated in a naturalistic study. A between subjects design was applied comparing a hangover group with an (alcohol-free) control group. Participants in the hangover group consumed a mean (SD) of 13.8 (10.2) alcoholic drinks the night before testing. Cognitive tests included the Stroop test, Eriksen's flanker test, a divided attention test, intradimensional-extradimensional set shifting test, spatial working memory test, and free word recall test. RESULTS: The hangover group had increased reaction times compared with the control group. Selective attention (Stroop and Eriksen's Flanker test performance) was significantly impaired during alcohol hangover. However, the number of errors did not differ significantly between the groups in any task. Mood assessments revealed that the hangover group reported significantly higher levels of drowsiness and clumsiness compared with the control group. CONCLUSION: Selective attention was significantly impaired during alcohol hangover. The differences between the hangover and control group did not reach significance for other forms of attention or memory.

Sex Differences in the Presence and Severity of Alcohol Hangover Symptoms.

Studies have demonstrated significant sex differences in alcohol intoxication effects. In contrast, the majority of studies on the alcohol hangover phase did not investigate sex differences. Therefore, the current study examined possible sex differences in the presence and severity of alcohol hangover symptoms. Data from n = 2446 Dutch students (male = 50.7%, female = 49.3%) were analyzed. They reported the presence and severity of 22 hangover symptoms experienced after their past month heaviest drinking occasion. Subjects were categorized according to their estimated peak blood alcohol concentration (eBAC) and presence and severity of the hangover symptoms were compared between men and women. In the lowest eBAC group (0% ≤ eBAC < 0.08%), no significant sex differences were found. In the subsequent eBAC group (0.08% ≤ eBAC < 0.11%), severity of nausea was significantly higher in women than in men. In the third eBAC group (0.11% ≤ eBAC < 0.2%), women reported higher severity scores on nausea, tiredness, weakness, and dizziness than men. Men reported the presence of confusion significantly more often than women, and women reported the presence of shivering significantly more often than men. In the fourth eBAC group (0.2% ≤ eBAC < 0.3%), women reported higher severity scores on nausea and tiredness than men. In the highest eBAC group (0.3% ≤ eBAC < 0.4%), no significant sex differences were found. In conclusion, across the eBAC groups, severity scores of nausea and tiredness were higher in women than in men. However, albeit statistically significant, the observed sex differences in presence and severity of hangover symptoms were of small magnitude, and therefore, have little clinical relevance.

Sleep after Heavy Alcohol Consumption and Physical Activity Levels during Alcohol Hangover.

Alcohol consumption can negatively affect sleep quality. The current study examined the impact of an evening of alcohol consumption on sleep, and next day activity levels and alcohol hangover. n = 25 healthy social drinkers participated in a naturalistic study, consisting of an alcohol and alcohol-free test day. On both days, a GENEactiv watch recorded sleep and wake, and corresponding activity levels. In addition, subjective assessments of sleep duration and quality were made, and hangover severity, and the amount of consumed alcoholic beverages were assessed. Alcohol consumption was also assessed in real-time during the drinking session, using smartphone technology. The results confirmed, by using both objective and subjective assessments, that consuming a large amount of alcohol has a negative impact on sleep, including a significant reduction in objective sleep efficiency and significantly lower self-reported sleep quality. Activity levels during the hangover day were significantly reduced compared to the alcohol-free control day. Of note, next-morning retrospective alcohol consumption assessments underestimated real-time beverage recordings. In conclusion, heavy alcohol consumption impairs sleep quality, which is associated with increased next day hangover severity and reduced activity levels. The outcome of this study underlines that, in addition to retrospectively reported data, real-time objective assessments are needed to fully understand the effects of heavy drinking.

The impact of expectancy on cognitive performance during alcohol hangover.

OBJECTIVE: Knowing the purpose of a clinical study may provoke expectancies among subjects that may influence the study outcome. For example, expectancies about a drug effect may cause subjects to put in more effort to counteract these effects on performance tasks, or cause stress or other mood alterations in anticipation of expected adverse effects. The objective of this study was to investigate to what extent expectancy effects will influence the magnitude of cognitive performance decrement in the alcohol hangover state. RESULTS: Forty subjects with a mean (SD) age of 24.0 (7.4) years old participated in a naturalistic study to examine the alcohol hangover effects on cognitive performance. Subjects in the expectancy group were informed of the purpose of the study. In the control group subjects were told that the purpose of the study was to investigate the effects of time of day on cognitive performance. Subjects consumed a mean (SD) of 12.9 (10.0) alcoholic drinks the night before testing. Cognitive tests included the Stroop test, Eriksen's flanker test, a divided attention test, intra-extra dimensional set shifting test, spatial working memory test, and free word recall test. Expectancy effects did not differentially affect cognitive performance in the alcohol hangover state.

Proceeding of the 9th Alcohol Hangover Research Group Meeting.

BACKGROUND: Alcohol hangover is a common occurrence among individuals who have experienced an episode of heavy alcohol consumption the previous night. Until now defined as the general feeling of misery that develops once the Blood Alcohol Concentration approaches zero. Despite its prevalence and several related adverse consequences, insufficient research has been conducted with regards to this matter and further understanding of the pathology of alcohol hangover is necessary. During the 9th Alcohol Hangover Research Group meeting, held on April 29th 2017, Utrecht, The Netherlands, numerous aspects of alcohol hangover were presented and many advances with regards to determinants, biological and cognitive consequences and potential treatment have been presented. CONCLUSION: Precisely, a definition of alcohol hangover has been established and wider understandings of biological and cognitive effects, alcohol metabolism, immune functioning and potential treatment of alcohol hangover were presented and discussed. Further research and development are necessary to attain a wider understanding of the pathology of alcohol hangover.

Written words supersede pictures in priming semantic access: a P300 study.

The dynamic interplay of semantic access during information integration across the verbal and nonverbal domains and sensory modalities is poorly understood. Here, we compared the priming effects of four types of meaningful stimuli (pictures, written words, spoken words, and environmental sounds) on picture and written word targets referring to the same concept in all cases. P3b event-related brain potentials indexed automatic access to semantic memory in the different modalities. As expected, P3b amplitudes were large in the repetition priming condition, but also for word-picture and picture-word visual stimulus pairs. Critically, written word primes resulted in the largest P3b amplitudes whether elicited by written word or picture targets, suggesting a semantic priming supremacy of written words.