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Rutter LA, Cope H, MacKay MJ, Herranz R, Das S, Ponomarev SA, Costes SV, Paul AM, Barker R, Taylor DM, Bezdan D, Szewczyk NJ, Muratani M, Mason CE, Giacomello S. Astronaut omics and the impact of space on the human body at scale. Nat Commun 2024; 15:4952. [PMID: 38862505 PMCID: PMC11166943 DOI: 10.1038/s41467-024-47237-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 03/22/2024] [Indexed: 06/13/2024] Open
Abstract
Future multi-year crewed planetary missions will motivate advances in aerospace nutrition and telehealth. On Earth, the Human Cell Atlas project aims to spatially map all cell types in the human body. Here, we propose that a parallel Human Cell Space Atlas could serve as an openly available, global resource for space life science research. As humanity becomes increasingly spacefaring, high-resolution omics on orbit could permit an advent of precision spaceflight healthcare. Alongside the scientific potential, we consider the complex ethical, cultural, and legal challenges intrinsic to the human space omics discipline, and how philosophical frameworks may benefit from international perspectives.
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Affiliation(s)
- Lindsay A Rutter
- Transborder Medical Research Center, University of Tsukuba, 305-8575, Tsukuba, Japan
- Department of Genome Biology, Institute of Medicine, University of Tsukuba, 305-8575, Tsukuba, Japan
- School of Chemistry, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Henry Cope
- School of Medicine, University of Nottingham, Derby, DE22 3DT, UK
| | - Matthew J MacKay
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, 10065, USA
- The HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY, 10021, USA
- The WorldQuant Initiative for Quantitative Prediction, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Raúl Herranz
- Centro de Investigaciones Biológicas "Margarita Salas" (CSIC), Ramiro de Maeztu 9, Madrid, 28040, Spain
| | - Saswati Das
- Department of Biochemistry, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Sergey A Ponomarev
- Department of Immunology and Microbiology, Institute for the Biomedical Problems, Russian Academy of Sciences, 123007, Moscow, Russia
| | - Sylvain V Costes
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA, 94035, USA
| | - Amber M Paul
- Embry-Riddle Aeronautical University, Department of Human Factors and Behavioral Neurobiology, Daytona Beach, FL, 32114, USA
| | - Richard Barker
- Department of Botany, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Deanne M Taylor
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Daniela Bezdan
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, 72076, Germany
- NGS Competence Center Tübingen (NCCT), University of Tübingen, Tübingen, 72076, Germany
- yuri GmbH, Meckenbeuren, 88074, Germany
| | - Nathaniel J Szewczyk
- School of Medicine, University of Nottingham, Derby, DE22 3DT, UK
- Ohio Musculoskeletal and Neurological Institute (OMNI), Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, 45701, USA
| | - Masafumi Muratani
- Transborder Medical Research Center, University of Tsukuba, 305-8575, Tsukuba, Japan
- Department of Genome Biology, Institute of Medicine, University of Tsukuba, 305-8575, Tsukuba, Japan
| | - Christopher E Mason
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, 10065, USA.
- The HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY, 10021, USA.
- The WorldQuant Initiative for Quantitative Prediction, Weill Cornell Medicine, New York, NY, 10065, USA.
- The Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, 10065, USA.
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2
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Koch E, Johnell K, Kauppi K. Longitudinal effects of using and discontinuing central nervous system medications on cognitive functioning. Pharmacoepidemiol Drug Saf 2023; 32:446-454. [PMID: 36357173 DOI: 10.1002/pds.5569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 09/23/2022] [Accepted: 11/05/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE To investigate the longitudinal effect of using and discontinuing central nervous system (CNS) medications on cognitive performance. METHODS Using longitudinal cognitive data from population representative adults aged 25-100 years (N = 2188) from four test waves 5 years apart, we investigated both the link between use of CNS medications (opioids, anxiolytics, hypnotics and sedatives) on cognitive task performance (episodic memory, semantic memory, visuospatial ability) across 15 years, and the effect of discontinuing these medications in linear mixed effects models. RESULTS We found that opioid use was associated with decline in visuospatial ability whereas using anxiolytics, hypnotics and sedatives was not associated with cognitive decline over 15 years. A link between drug discontinuation and cognitive improvement was seen for opioids as well as for anxiolytics, hypnotics and sedatives. CONCLUSIONS Although our results may be confounded by subjacent conditions, they suggest that long-term use of CNS medications may have domain-specific negative effects on cognitive performance over time, whereas the discontinuation of these medications may partly reverse these effects. These results open up for future studies that address subjacent conditions on cognition to develop a more complete understanding of the cognitive effects of CNS medications.
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Affiliation(s)
- Elise Koch
- Department of Integrative Medical Biology, Umeå University, Sweden
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Norway
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Karolina Kauppi
- Department of Integrative Medical Biology, Umeå University, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Tavares G, Kelmann G, Tustumi F, Tundisi CN, Silveira BRB, Barbosa BMAC, Winther DB, Boutros EC, Villar GDS, Brunocilla G, Lourenção GRC, Ferreira JGA, Bernardo WM. Cognitive and balance dysfunctions due to the use of zolpidem in the elderly: a systematic review. Dement Neuropsychol 2021; 15:396-404. [PMID: 34630929 PMCID: PMC8485645 DOI: 10.1590/1980-57642021dn15-030013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 04/10/2021] [Indexed: 11/22/2022] Open
Abstract
Zolpidem is one of the most widely prescribed hypnotic (non-benzodiazepine) agents for sleep disorder. Recently, an increase in the demand for this drug has been observed, mainly in the elderly population. Objective This study aims to analyze the acute effect of zolpidem on cognitive and balance dysfunctions in the elderly population. Methods A study was conducted by two independent researchers in four virtual scientific information bases and included randomized controlled trials. The studies evaluated elderly patients using zolpidem. Cognitive and balance dysfunctions were analyzed. Results Six articles were included. The mean age of the participants in the studies was 69 years. The following zolpidem dosages were evaluated: 5, 6.25, 10, and 12.5 mg. Comparing zolpidem and placebo, relating to the cognitive dysfunctions, there is no statistically significant difference between the groups. However, in relation to balance dysfunctions, there is a statistically significant difference between the intervention and the comparison, favoring placebo. Conclusions Zolpidem, even in usual doses (5 mg and 10 mg), has shown to increase the risk for balance dysfunctions. However, this does not occur in relation to cognitive changes.
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Affiliation(s)
- Guilherme Tavares
- Department of Evidence-Based Medicine, Centro Universitário Lusíada - Santos, SP, Brazil
| | - Gizela Kelmann
- Department of Evidence-Based Medicine, Centro Universitário Lusíada - Santos, SP, Brazil
| | - Francisco Tustumi
- Department of Evidence-Based Medicine, Centro Universitário Lusíada - Santos, SP, Brazil.,Department of Evidence-Based Medicine, Universidade de São Paulo - São Paulo, SP, Brazil.,Department of Surgery, Hospital Israelita Albert Einstein - São Paulo, SP, Brazil
| | | | | | | | - Diana Bragança Winther
- Department of Evidence-Based Medicine, Centro Universitário Lusíada - Santos, SP, Brazil
| | - Eduarda Conte Boutros
- Department of Evidence-Based Medicine, Centro Universitário Lusíada - Santos, SP, Brazil
| | | | - Giovanna Brunocilla
- Department of Evidence-Based Medicine, Centro Universitário Lusíada - Santos, SP, Brazil
| | | | | | - Wanderley Marques Bernardo
- Department of Evidence-Based Medicine, Centro Universitário Lusíada - Santos, SP, Brazil.,Department of Evidence-Based Medicine, Universidade de São Paulo - São Paulo, SP, Brazil
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Wingelaar-Jagt YQ, Wingelaar TT, Riedel WJ, Ramaekers JG. Fatigue in Aviation: Safety Risks, Preventive Strategies and Pharmacological Interventions. Front Physiol 2021; 12:712628. [PMID: 34552504 PMCID: PMC8451537 DOI: 10.3389/fphys.2021.712628] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/06/2021] [Indexed: 01/22/2023] Open
Abstract
Fatigue poses an important safety risk to civil and military aviation. In addition to decreasing performance in-flight (chronic) fatigue has negative long-term health effects. Possible causes of fatigue include sleep loss, extended time awake, circadian phase irregularities and work load. Despite regulations limiting flight time and enabling optimal rostering, fatigue cannot be prevented completely. Especially in military operations, where limits may be extended due to operational necessities, it is impossible to rely solely on regulations to prevent fatigue. Fatigue management, consisting of preventive strategies and operational countermeasures, such as pre-flight naps and pharmaceuticals that either promote adequate sleep (hypnotics or chronobiotics) or enhance performance (stimulants), may be required to mitigate fatigue in challenging (military) aviation operations. This review describes the pathophysiology, epidemiology and effects of fatigue and its impact on aviation, as well as several aspects of fatigue management and recommendations for future research in this field.
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Affiliation(s)
- Yara Q Wingelaar-Jagt
- Center for Man in Aviation, Royal Netherlands Air Force, Soesterberg, Netherlands.,Department of of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Thijs T Wingelaar
- Diving Medical Center, Royal Netherlands Navy, Den Helder, Netherlands
| | - Wim J Riedel
- Department of of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Johannes G Ramaekers
- Department of of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
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Sides MB, Johnston SL, Sirek A, Lee PH, Blue RS, Antonsen EL, Basner M, Douglas GL, Epstein A, Flynn-Evans EE, Gallagher MB, Hayes J, Lee SMC, Lockley SW, Monseur B, Nelson NG, Sargsyan A, Smith SM, Stenger MB, Stepanek J, Zwart SR. Bellagio II Report: Terrestrial Applications of Space Medicine Research. Aerosp Med Hum Perform 2021; 92:650-669. [PMID: 34503618 DOI: 10.3357/amhp.5843.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AbstractINTRODUCTION: For over 50 yr, investigators have studied the physiological adaptations of the human system during short- and long-duration spaceflight exposures. Much of the knowledge gained in developing health countermeasures for astronauts onboard the International Space Station demonstrate terrestrial applications. To date, a systematic process for translating these space applications to terrestrial human health has yet to be defined.METHODS: In the summer of 2017, a team of 38 international scientists launched the Bellagio ll Summit Initiative. The goals of the Summit were: 1) To identify space medicine findings and countermeasures with highest probability for future terrestrial applications; and 2) To develop a roadmap for translation of these countermeasures to future terrestrial application. The team reviewed public domain literature, NASA databases, and evidence books within the framework of the five-stage National Institutes of Health (NIH) translation science model, and the NASA two-stage translation model. Teams then analyzed and discussed interdisciplinary findings to determine the most significant evidence-based countermeasures sufficiently developed for terrestrial application.RESULTS: Teams identified published human spaceflight research and applied translational science models to define mature products for terrestrial clinical practice.CONCLUSIONS: The Bellagio ll Summit identified a snapshot of space medicine research and mature science with the highest probability of translation and developed a Roadmap of terrestrial application from space medicine-derived countermeasures. These evidence-based findings can provide guidance regarding the terrestrial applications of best practices, countermeasures, and clinical protocols currently used in spaceflight.Sides MB, Johnston SL III, Sirek A, Lee PH, Blue RS, Antonsen EL, Basner M, Douglas GL, Epstein A, Flynn-Evans EE, Gallagher MB, Hayes J, Lee SMC, Lockley SW, Monseur B, Nelson NG, Sargsyan A, Smith SM, Stenger MB, Stepanek J, Zwart SR; Bellagio II Team. Bellagio II report: terrestrial applications of space medicine research. Aerosp Med Hum Perform. 2021; 92(8):650669.
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Neylan TC, Richards A, Metzler TJ, Ruoff LM, Varbel J, O’Donovan A, Sivasubramanian M, Motraghi T, Hlavin J, Batki SL, Inslicht SS, Samuelson K, Morairty SR, Kilduff TS. Acute cognitive effects of the hypocretin receptor antagonist almorexant relative to zolpidem and placebo: a randomized clinical trial. Sleep 2020; 43:zsaa080. [PMID: 32303763 PMCID: PMC7551303 DOI: 10.1093/sleep/zsaa080] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/06/2020] [Indexed: 12/18/2022] Open
Abstract
STUDY OBJECTIVES Hypnotic medications can adversely affect behavior during unanticipated awakenings during the night. Animals treated with the hypocretin (Hcrt) receptor antagonist almorexant (ALM) have less acute cognitive impairment compared to the GABAA receptor modulator zolpidem (ZOL). This study aimed to determine whether ALM produces less acute cognitive impairment than ZOL in human subjects. METHODS Healthy, young adult, unmedicated male and female subjects participated in a controlled trial of a single dose of ALM 100 mg (N = 48), ALM 200 mg (N = 53), ZOL 10 mg (N = 49), and placebo (PBO, N = 52). RESULTS ZOL and both doses of ALM produced similar levels of subjective sleepiness and impaired the ability of subjects to remain awake in a dark, low-stimulus setting relative to PBO. For most cognitive measures, performance under ZOL was significantly worse than ALM or PBO. For tasks involving verbal memory or visual-motor coordination, ZOL impaired performance, whereas the two doses of ALM were no different than PBO. For tasks involving higher-order executive function, ZOL produced impairment in processing speed and inhibitory control, whereas the two doses of ALM were no different than PBO. Performance decrements for ALM were less than ZOL but greater than PBO for some reaction time measures. CONCLUSIONS The data provide support for the hypothesis that Hcrt receptor antagonists produce less functional impairment than a benzodiazepine receptor agonist (BzRA). These observations are particularly relevant to patients treated with sedative-hypnotics who are at elevated risk for falls and other untoward events during the intended hours for sleep.
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Affiliation(s)
- Thomas C Neylan
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
- Sierra-Pacific Mental Illness Research Educational and Clinical Center, Department of Veterans Affairs, Palo Alto, CA
- Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Anne Richards
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
- Sierra-Pacific Mental Illness Research Educational and Clinical Center, Department of Veterans Affairs, Palo Alto, CA
| | - Thomas J Metzler
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
- Sierra-Pacific Mental Illness Research Educational and Clinical Center, Department of Veterans Affairs, Palo Alto, CA
| | - Leslie M Ruoff
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
- Sierra-Pacific Mental Illness Research Educational and Clinical Center, Department of Veterans Affairs, Palo Alto, CA
| | - Jonathan Varbel
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
- Sierra-Pacific Mental Illness Research Educational and Clinical Center, Department of Veterans Affairs, Palo Alto, CA
| | - Aoife O’Donovan
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
- Sierra-Pacific Mental Illness Research Educational and Clinical Center, Department of Veterans Affairs, Palo Alto, CA
| | - Melinda Sivasubramanian
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
- Sierra-Pacific Mental Illness Research Educational and Clinical Center, Department of Veterans Affairs, Palo Alto, CA
| | - Terri Motraghi
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
- Sierra-Pacific Mental Illness Research Educational and Clinical Center, Department of Veterans Affairs, Palo Alto, CA
| | - Jennifer Hlavin
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
- Sierra-Pacific Mental Illness Research Educational and Clinical Center, Department of Veterans Affairs, Palo Alto, CA
| | - Steven L Batki
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
- Sierra-Pacific Mental Illness Research Educational and Clinical Center, Department of Veterans Affairs, Palo Alto, CA
| | - Sabra S Inslicht
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
- Sierra-Pacific Mental Illness Research Educational and Clinical Center, Department of Veterans Affairs, Palo Alto, CA
| | - Kristin Samuelson
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
- Sierra-Pacific Mental Illness Research Educational and Clinical Center, Department of Veterans Affairs, Palo Alto, CA
- Department of Psychology, University of Colorado, Colorado Springs, CO
| | - Stephen R Morairty
- Center for Neuroscience, Biosciences Division, SRI International, Menlo Park, CA
| | - Thomas S Kilduff
- Center for Neuroscience, Biosciences Division, SRI International, Menlo Park, CA
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Regan MD, Flynn-Evans EE, Griko YV, Kilduff TS, Rittenberger JC, Ruskin KJ, Buck CL. Shallow metabolic depression and human spaceflight: a feasible first step. J Appl Physiol (1985) 2020; 128:637-647. [PMID: 31999524 DOI: 10.1152/japplphysiol.00725.2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Synthetic torpor is an induced state of deep metabolic depression (MD) in an organism that does not naturally employ regulated and reversible MD. If applied to spaceflight crewmembers, this metabolic state may theoretically mitigate numerous biological and logistical challenges of human spaceflight. These benefits have been the focus of numerous recent articles where, invariably, they are discussed in the context of hypothetical deep MD states in which the metabolism of crewmembers is profoundly depressed relative to basal rates. However, inducing these deep MD states in humans, particularly humans aboard spacecraft, is currently impossible. Here, we discuss shallow MD as a feasible first step toward synthetic torpor during spaceflight and summarize perspectives following a recent NASA-hosted workshop. We discuss methods to safely induce shallow MD (e.g., sleep and slow wave enhancement via acoustic and photoperiod stimulation; moderate sedation via dexmedetomidine), which we define as an ~20% depression of metabolic rate relative to basal levels. We also discuss different modes of shallow MD application (e.g., habitual versus targeted, whereby shallow MD is induced routinely throughout a mission or only under certain circumstances, respectively) and different spaceflight scenarios that would benefit from its use. Finally, we propose a multistep development plan toward the application of synthetic torpor to human spaceflight, highlighting shallow MD's role. As space agencies develop missions to send humans further into space than ever before, shallow MD has the potential to confer health benefits for crewmembers, reduce demands on spacecraft capacities, and serve as a testbed for deeper MD technologies.
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Affiliation(s)
- Matthew D Regan
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, Wisconsin
| | - Erin E Flynn-Evans
- Fatigue Countermeasures Laboratory, Human Systems Integration Division, NASA Ames Research Center, Moffett Field, California
| | - Yuri V Griko
- Countermeasure Development Laboratory, Space Biosciences Division, NASA Ames Research Center, Moffett Field, California
| | - Thomas S Kilduff
- Biosciences Division, Center for Neuroscience, SRI International, Menlo Park, California
| | - Jon C Rittenberger
- Guthrie Robert Packer Hospital Emergency Medicine Program, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Keith J Ruskin
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
| | - C Loren Buck
- Department of Biological Sciences, Northern Arizona University, Flagstaff, Arizona
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8
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Good CH, Brager AJ, Capaldi VF, Mysliwiec V. Sleep in the United States Military. Neuropsychopharmacology 2020; 45:176-191. [PMID: 31185484 PMCID: PMC6879759 DOI: 10.1038/s41386-019-0431-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/23/2019] [Accepted: 05/31/2019] [Indexed: 02/07/2023]
Abstract
The military lifestyle often includes continuous operations whether in training or deployed environments. These stressful environments present unique challenges for service members attempting to achieve consolidated, restorative sleep. The significant mental and physical derangements caused by degraded metabolic, cardiovascular, skeletomuscular, and cognitive health often result from insufficient sleep and/or circadian misalignment. Insufficient sleep and resulting fatigue compromises personal safety, mission success, and even national security. In the long-term, chronic insufficient sleep and circadian rhythm disorders have been associated with other sleep disorders (e.g., insomnia, obstructive sleep apnea, and parasomnias). Other physiologic and psychologic diagnoses such as post-traumatic stress disorder, cardiovascular disease, and dementia have also been associated with chronic, insufficient sleep. Increased co-morbidity and mortality are compounded by traumatic brain injury resulting from blunt trauma, blast exposure, and highly physically demanding tasks under load. We present the current state of science in human and animal models specific to service members during- and post-military career. We focus on mission requirements of night shift work, sustained operations, and rapid re-entrainment to time zones. We then propose targeted pharmacological and non-pharmacological countermeasures to optimize performance that are mission- and symptom-specific. We recognize a critical gap in research involving service members, but provide tailored interventions for military health care providers based on the large body of research in health care and public service workers.
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Affiliation(s)
- Cameron H. Good
- 0000 0001 2151 958Xgrid.420282.ePhysical Scientist, US Army Research Laboratory, Aberdeen Proving Ground, MD, 21005 USA
| | - Allison J. Brager
- 0000 0001 0036 4726grid.420210.5Sleep Research Center, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD 20910 USA
| | - Vincent F. Capaldi
- 0000 0001 0036 4726grid.420210.5Department of Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Silver Spring, MD 20910 USA
| | - Vincent Mysliwiec
- 0000 0004 0467 8038grid.461685.8San Antonio Military Health System, Department of Sleep Medicine, JBSA, Lackland, TX 78234 USA
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