How Sleep Research in Extreme Environments Can Inform the Military: Advocating for a Transactional Model of Sleep Adaptation.

PURPOSE OF REVIEW: We review the literature on sleep in extreme environments. Accordingly, we present a model that identifies the need for mitigating interventions to preserve sleep quality for military deployments. RECENT FINDINGS: Situational factors that affect sleep in extreme environments include cold temperatures, isolated and confined areas, fluctuating seasonality, photoperiodicity, and extreme latitudes and altitudes. Results vary across studies, but general effects include decreased total sleep time, poor sleep efficiency, and non-specific phase delays or phase advances in sleep onset and sleep architecture. Considering habitability measures (e.g., light or temperature control) and individual differences such as variable stress responses or sleep need can mitigate these effects to improve mood, cognition, and operational performance. Although the situational demands during military missions inevitably reduce total sleep time and sleep efficiency, mitigating factors can attenuate sleep-related impairments, hence allowing for optimal mission success and personnel safety.

Impact of long-term daylight deprivation on retinal light sensitivity, circadian rhythms and sleep during the Antarctic winter.

Long-term daylight deprivation such as during the Antarctic winter has been shown to lead to delayed sleep timing and sleep fragmentation. We aimed at testing whether retinal sensitivity, sleep and circadian rest-activity will change during long-term daylight deprivation on two Antarctic bases (Concordia and Halley VI) in a total of 25 healthy crew members (mean age: 34 ± 11y; 7f). The pupil responses to different light stimuli were used to assess retinal sensitivity changes. Rest-activity cycles were continuously monitored by activity watches. Overall, our data showed increased pupil responses under scotopic (mainly rod-dependent), photopic (mainly L-/M-cone dependent) as well as bright-blue light (mainly melanopsin-dependent) conditions during the time without direct sunlight. Circadian rhythm analysis revealed a significant decay of intra-daily stability, indicating more fragmented rest-activity rhythms during the dark period. Sleep and wake times (as assessed from rest-activity recordings) were significantly delayed after the first month without sunlight (p < 0.05). Our results suggest that during long-term daylight deprivation, retinal sensitivity to blue light increases, whereas circadian rhythm stability decreases and sleep-wake timing is delayed.

Acute cocoa flavanols intake improves cerebral hemodynamics while maintaining brain activity and cognitive performance in moderate hypoxia.

INTRODUCTION: Acute cocoa flavanols (CF) intake has been suggested to modulate cognitive function and neurovascular coupling (NVC). Whether increased NVC is solely driven by improved vascular responsiveness or also by neuronal activity remains unknown. This study investigated the effects of acute CF intake on cognitive performance, NVC, and neuronal activity in healthy subjects in normoxia and hypoxia (4000 m simulated altitude; 12.7% O2). METHODS: Twenty healthy subjects (age 23.2 ± 4.3 years) performed four trials. Participants performed a Stroop task and "cognition" battery 2 h after acute CF (530 mg CF, 100 mg epicatechin) or placebo intake, and 30 min after initial exposure to hypoxia or normoxia. Electroencephalogram and functional near-infrared spectroscopy were used to analyze hemodynamic changes and neuronal activity. RESULTS: CF enhanced NVC in the right prefrontal cortex during several tasks (risk decision making, visual tracking, complex scanning, spatial orientation), while neuronal activity was not affected. CF improved abstract thinking in normoxia, but not in hypoxia and did not improve other cognitive performances. Hypoxia decreased accuracy on the Stroop task, but performance on other cognitive tasks was preserved. NVC and neuronal activity during cognitive tasks were similar in hypoxia vs. normoxia, with the exception of increased ß activity in the primary motor cortex during abstract thinking. CONCLUSIONS: Acute CF intake improved NVC, but did not affect neuronal activity and cognitive performance in both normoxia and hypoxia. Most cognitive functions, as well as NVC and neuronal activity, did not decline by acute exposure to moderate hypoxia in healthy subjects.

BDNF, IGF-I, Glucose and Insulin during Continuous and Interval Exercise in Type 1 Diabetes.

Type 1 diabetes (T1D) can have a significant impact on brain function, mostly ascribed to episodes of hypoglycemia and chronic hyperglycemia. Exercise has positive effects on acute and chronic glycemic control in T1D, and has beneficial effects on cognitive function by increasing neurotrophins such as BDNF and IGF-I in non-diabetic humans. The present study examines the effects of different types of exercise intensities on neurotrophins in T1D. 10 participants with type 1 diabetes were evaluated in 3 sessions: high-intensity exercise (10×[60 s 90%Wmax, 60 s 50 W]), continuous exercise (22 min, 70% VO2 max) and a control session. Blood glucose, serum free insulin, serum BDNF and IGF-I were assessed pre/post all the trials and after recovery. Blood glucose significantly decreased after both exercise intensities and BDNF levels increased, with a dose-response effect for exercise intensity on BDNF. IGF-I changed over time, but without a difference between the different exercise protocols. Both exercise intensities change neurotrophins in T1D, but also exhibit a dose response effect for BDNF. The intensity-dependent findings may aid in designing exercise prescriptions for maintaining or improving neurological health in T1D, but both types of exercise can be implemented.

Evaluation of the effects of anti-motion sickness drugs on subjective sleepiness and cognitive performance of healthy males.

This study aimed to investigate the clinical and cognitive side effects of baclofen (10 mg), meclizine (25 mg), dimenhydrinate (40 mg) plus cinnarizine (25 mg) and promethazine (25 mg) plus d-amphetamine (10 mg). The study had a double-blind, placebo controlled, repeated measures design and was conducted on healthy male volunteers. The psychomotor vigilance test, the Sternberg working memory task, the implicit memory test and the automated Operation Span (Ospan) task were performed. The Stanford, the Karolinska and the Epworth Sleepiness scale determined the degree of sleepiness. The Profile of Mood States (POMS) evaluated mood states and adverse effects were reported on a 22-item questionnaire. Letter recalls and time for solving mathematical problems, recorded during the Ospan task, were impaired by baclofen and dimenhydrinate-cinnarizine respectively, suggesting an influence of these drugs on the working memory. Significant side effects for baclofen were: sleepiness, tiredness, blurred vision, concentration problems and dizziness whereas for dimenhydrinate-cinnarizine only sleepiness and blurred vision were reported. Meclizine decreased the accuracy on the Sternberg working memory task and thus seemed to affect short-term memory. A reported side effect was increased sleepiness. Promethazine plus d-amphetamine did not affect any of the tested cognitive functions. However, many side effects such as sleepiness, dry mouth, dizziness, vertigo, confusion, insomnia and tremors were reported. The results show that meclizine and dimenhydrinate combined with cinnarizine were the two drugs with the most acceptable combination of side effects.

Cardiovascular changes in parabolic flights assessed by ballistocardiography.

This paper presents a comparison of the cardiovascular changes observed in microgravity as compared to ground based measurements. The ballistocardiogram (BCG), the electrocardiogram (ECG) and the transthoracic impedance cardiogram (ICG) were recorded on five healthy subjects during the 57th-European Space Agency (ESA) parabolic flight campaign. BCG is analyzed though its most characteristic wave, the IJ wave complex that can be identified along the longitudinal component of BCG and which has been demonstrated to be linked to cardiac ejection. The timings between the contraction of the heart and the ejection of blood in the aorta are analyzed via the time delay between the R-wave of the ECG and the I and J-waves of BCG (RI and RJ intervals respectively). Our results show that the IJ complex presents a larger amplitude in weightlessness and suggest that stroke volume (SV) increases in microgravity. We assume that ballistocardiography is an efficient method to assess the ventricular performance.

Estimating the center of mass of a free-floating body in microgravity.

This paper addresses the issue of estimating the position of the center of mass (CoM) of a free-floating object of unknown mass distribution in microgravity using a stereoscopic imaging system. The method presented here is applied to an object of known mass distribution for validation purposes. In the context of a study of 3-dimensional ballistocardiography in microgravity, and the elaboration of a physical model of the cardiovascular adaptation to weightlessness, the hypothesis that the fluid shift towards the head of astronauts induces a significant shift of their CoM needs to be tested. The experiments were conducted during the 57th parabolic flight campaign of the European Space Agency (ESA). At the beginning of the microgravity phase, the object was given an initial translational and rotational velocity. A 3D point cloud corresponding to the object was then generated, to which a motion-based method inspired by rigid body physics was applied. Through simulations, the effects of the centroid-to-CoM distance and the number of frames of the sequence are investigated. In experimental conditions, considering the important residual accelerations of the airplane during the microgravity phases, CoM estimation errors (16 to 76 mm) were consistent with simulations. Overall, our results suggest that the method has a good potential for its later generalization to a free-floating human body in a weightless environment.

3D-ballistocardiography in microgravity: comparison with ground based recordings.

3D-Ballistocardiograms ECG and Impedancecardiograms (ICG) were recorded on 5 healthy volunteers participating to the European Space Agency (ESA) 57(th) parabolic flights campaigns. Comparisons are made between the baseline recordings performed on the ground and the recordings made during the microgravity phases of a parabolic flight. The spatial curves of the displacement, velocity and acceleration vectors, instead of their individual components are used to compute the magnitude of the force vector, kinetic energy and work during the cardiac cycle. Our hypothesis is that the 3D-BCG provides parameters correlated with the timings of ejection (PEP, LVET). Although our subject population is limited (N=5), this is the first study of BCG to be performed with N>1. Our results suggest that microgravity decrease the complexity of the 3D displacement curve and that peaks in curvature are consistently present in microgravity and on the ground. However they do not seem to be perfectly related to the classical cardiac ejection timings from ICG.

Timing and source of the maximum of the transthoracic impedance cardiogram (dZ/dt) in relation to the H-I-J complex of the longitudinal ballistocardiogram under gravity and microgravity conditions.

The transthoracic impedance cardiogram (ICG) and the acceleration ballistocardiogram (BCG) measured close to the center of mass of the human body are generated by changes of blood distribution. The transthoracic ICG is an integrated signal covering the whole thorax and spatial resolution is poor. Comparison between both signals can be used to elucidate the source of the ICG signal. We recorded the ECG, ICG, and BCG simultaneously in healthy subjects under resting and microgravity conditions during parabolic flights. The time interval between the R-peak of the ECG and the maximum of the ICG (R-dZ/dtmax) and the time interval between the R-peak of the ECG and the I-peak in the BCG (R-I) differed significantly (p<0.0001). The I-peak in the BCG always occurred earlier during systole than dZ/dtmax. The delay of dZ/dtmax ranged between 23 and 28 ms at rest and was lowest under microgravity conditions (12 ± 4 ms, p<0.02). Our results suggest that both signals have different sources. Combination of modern imaging techniques with classical non invasive approaches to detect changes of blood distribution may provide new insights into the complex interaction between blood flow and mechanocardiographic signals like the BCG.

Validation of centrifugation as a countermeasure for otolith deconditioning during spaceflight: preliminary data of the ESA SPIN study.

In the framework of further space exploration, countermeasures to combat the drawbacks of human space flights are essential. The present study focuses on the influence of microgravity on the otolith-ocular reflex and aims to test the hypothesis of artificial gravity being an adequate countermeasure for the deconditioning of the aforementioned reflex. The so-called SPIN study, commissioned by the European Space Agency, can be considered as a control experiment in the broad sense for the Neurolab mission (STS-90) during which 4 crewmembers of the space shuttle were subjected to in-flight centrifugation on the visual and vestibular investigation system (VVIS). After their nearly 16-day mission, they did not suffer from orthostatic intolerance and spatial disorientation. In addition, the relevant parameters of the otolith-ocular interaction remained unaffected. For this study cosmonauts from a long duration stay in the International Space Station that were not centrifuged in-flight were tested on the VVIS (1 g centripetal interaural acceleration) on 6 different days. Three measurements were taken about 1.5-2 months prior to launch and 3 were taken at 1, 4 and 9 days after return from space. Ocular counter-rolling was measured before, during and after rotation on the VVIS using infrared video goggles and compared pair wise using Friedman tests. The perception of verticality was monitored using an ultrasound system for perceptual evaluation. The preliminary results of 4 cosmonauts showed a surprisingly large inter-individual variability of the measurements. Although OCR and perception of verticality appeared to be influenced overall by the exposure to microgravity, the wide variability among the cosmonauts obscured any statistical significance, in particular due to one cosmonauts being inconsistent with the other 3. Despite the specificity of the tests under normal conditions, the diverse response to spaceflight of our subjects exposes the complexity of the peripheral and central neural adaptive processes.

Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular risk factors: recommendations from the EACPR. Part II.

In a previous paper, as the first of a series of three on the importance of characteristics and modalities of physical activity (PA) and exercise in the management of cardiovascular health within the general population, we concluded that, in the population at large, PA and aerobic exercise capacity clearly are inversely associated with increased cardiovascular disease risk and all-cause and cardiovascular mortality and that a dose­response curve on cardiovascular outcome has been demonstrated in most studies. More and more evidence is accumulated that engaging in regular PA and exercise interventions are essential components for reducing the severity of cardiovascular risk factors, such as obesity and abdominal fat, high BP, metabolic risk factors, and systemic inflammation. However, it is less clear whether and which type of PA and exercise intervention (aerobic exercise, dynamic resistive exercise, or both) or characteristic of exercise (frequency, intensity, time or duration, and volume) would yield more benefit for each separate risk factor. The present paper, therefore, will review and make recommendations for PA and exercise training in the management of cardiovascular health in individuals with cardiovascular risk factors. The guidance offered in this series of papers is aimed at medical doctors, health practitioners, kinesiologists, physiotherapists and exercise physiologists, politicians, public health policy makers, and individual members of the public. Based on previous and the current literature overviews, recommendations from the European Association on Cardiovascular Prevention and Rehabilitation are formulated regarding type, volume, and intensity of PA and regarding appropriate risk evaluation during exercise in individuals with cardiovascular risk factors.

Three dimensional ballisto- and seismo-cardiography: HIJ wave amplitudes are poorly correlated to maximal systolic force vector.

Ballistocardiography was recorded in 3-D on a free floating astronaut in space as well as on healthy volunteers participating to the ESA 55(th) and DLR 19(th) parabolic flights campaigns. In this paper we demonstrate further the usefulness of recording and analyzing ballistocardiograms (BCG) in three dimensions. The spatial curves of the displacement, velocity and acceleration vectors are analyzed instead of their individual 2-D components. The maximum magnitude of the force vector is shown to be poorly correlated to the HI and IJ wave amplitude traditionally computed on the longitudinal (feet-to-head) component of acceleration (uni-dimensional BCG). We also suggest that kinetic energy and work are useful parameters to consider for a physiological interpretation of the 3D-BCG. The technique presented is invariant from the axis of representation and provides important novel physiological information. We stress further the need of 3D recordings and analysis techniques for Ballisto- and Seismo-cardiography.

Three-dimensional ballistocardiography in microgravity: a review of past research.

This paper gives a short review of research on ballistocardiography in microgravity and indicates the benefits from this research for the use of BCG as a terrestrial cardiac monitoring system. In the past, 3-D methods required large devices to decouple the subject from the terrestrial environment and hence, BCG on Earth is usually limited to unidirectional recordings of the motion in the head-to-foot direction. However, microgravity provides a suspension-free environment where accelerations can be measured in all directions without the influence of gravity. Microgravity research indicated that along with the acceleration in the head-to-foot direction, the accelerations in the lateral and dorso-ventral direction are important in understanding the physiological forces during a cardiac cycle. Further, lung volume has a large influence on the transmission of cardiac forces to the surface of the body. To date, only the three separate components of the acceleration vector have been analyzed in 3-D BCG studies. Using the true acceleration and displacement vector (orientation and magnitude), rather than the three separate components, may permit more accurate cardiac event detection.

Three dimensional ballistocardiography: methodology and results from microgravity and dry immersion.

Balistocardiography was recorded in 3-D on a free floating astronaut in space as well as on healthy volunteers participating to a dry immersion study in a terrestrial laboratory. We demonstrate a new technique suitable for the analysis of 3-D BCG. The spatial curve of the displacement vector is analyzed instead of the three components of acceleration. The technique presented is invariant from the axis of representation and provides important novel physiological information.

Comparison between EEMD, wavelet and FIR denoising: influence on event detection in impedance cardiography.

During thoracic impedance signal acquisition, noise is inherently introduced and hence, denoising is required to allow for accurate event detection. This paper investigates the effectiveness of Ensemble Emperical Mode Decomposition to filter random noise. The performance of the EEMD method is compared with an optimal FIR filter and wavelet denoising. The IMF selection for signal reconstruction in the EEMD denoising method is optimized using a sequential search. Denoising performance was evaluated by the SNR and the accuracy in event detection after filtering. When all criteria are taken into account, wavelet seems to outperform both EEMD and FIR denoising.