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Kubala AG, Roma PG, Jameson JT, Sessoms PH, Chinoy ED, Rosado LR, Viboch TB, Schrom BJ, Rizeq HN, Gordy PS, Hirsch LDA, Biggs LAT, Russell DW, Markwald RR. Advancing a U.S. navy shipboard infrastructure for sleep monitoring with wearable technology. Appl Ergon 2024; 117:104225. [PMID: 38219375 DOI: 10.1016/j.apergo.2024.104225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/20/2023] [Accepted: 01/03/2024] [Indexed: 01/16/2024]
Abstract
Development of fatigue management solutions is critical to U.S. Navy populations. This study explored the operational feasibility and acceptability of commercial wearable devices (Oura Ring and ReadiBand) in a warship environment with 845 Sailors across five ship cohorts during at-sea operations ranging from 10 to 31 days. Participants were required to wear both devices and check-in daily with research staff. Both devices functioned as designed in the environment and reliably collected sleep-wake data. Over 10,000 person-days at-sea, overall prevalence of Oura and ReadiBand use was 69% and 71%, respectively. Individual use rates were 71 ± 38% of days underway for Oura and 59 ± 34% for ReadiBand. Analysis of individual factors showed increasing device use and less device interference with age, and more men than women found the devices comfortable. This study provides initial support that commercial wearables can contribute to infrastructures for operational fatigue management in naval environments.
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Affiliation(s)
- Andrew G Kubala
- Warfighter Performance Department, Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, CA, USA; Military and Veterans Health Solutions, Leidos Inc., San Diego, CA, USA
| | - Peter G Roma
- Warfighter Performance Department, Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, CA, USA; Military and Veterans Health Solutions, Leidos Inc., San Diego, CA, USA
| | - Jason T Jameson
- Warfighter Performance Department, Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, CA, USA; Military and Veterans Health Solutions, Leidos Inc., San Diego, CA, USA
| | - Pinata H Sessoms
- Warfighter Performance Department, Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, CA, USA
| | - Evan D Chinoy
- Warfighter Performance Department, Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, CA, USA
| | - Luis R Rosado
- Warfighter Performance Department, Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, CA, USA; Military and Veterans Health Solutions, Leidos Inc., San Diego, CA, USA
| | - Trevor B Viboch
- Warfighter Performance Department, Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, CA, USA; Military and Veterans Health Solutions, Leidos Inc., San Diego, CA, USA
| | - Brandon J Schrom
- Warfighter Performance Department, Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, CA, USA; Military and Veterans Health Solutions, Leidos Inc., San Diego, CA, USA
| | - Hedaya N Rizeq
- Warfighter Performance Department, Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, CA, USA; Military and Veterans Health Solutions, Leidos Inc., San Diego, CA, USA
| | - Prayag S Gordy
- Warfighter Performance Department, Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, CA, USA; Military and Veterans Health Solutions, Leidos Inc., San Diego, CA, USA
| | | | - Lcdr Adam T Biggs
- Psychological Health and Resilience Department, Military Population Health Directorate, Naval Health Research Center, San Diego, CA, USA
| | - Dale W Russell
- Commander Naval Surface Force, U.S. Pacific Fleet, San Diego, CA, USA; Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Rachel R Markwald
- Warfighter Performance Department, Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, CA, USA.
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2
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Cox RC, Blumenstein AB, Burke TM, Depner CM, Guerin MK, Hay-Arthur E, Higgins J, Knauer OA, Lanza SM, Markwald RR, Melanson EL, McHill AW, Morton SJ, Ritchie HK, Smith MR, Smits AN, Sprecher KE, Stothard ER, Withrow D, Wright KP. Distribution of dim light melatonin offset (DLMOff) and phase relationship to waketime in healthy adults and associations with chronotype. Sleep Health 2024; 10:S76-S83. [PMID: 37777359 DOI: 10.1016/j.sleh.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVES Dim light melatonin onset, or the rise in melatonin levels representing the beginning of the biological night, is the gold standard indicator of circadian phase. Considerably less is known about dim light melatonin offset, or the decrease in melatonin to low daytime levels representing the end of the biological night. In the context of insufficient sleep, morning circadian misalignment, or energy intake after waketime but before dim light melatonin offset, is linked to impaired insulin sensitivity, suggesting the need to characterize dim light melatonin offset and identify risk for morning circadian misalignment. METHODS We examined the distributions of dim light melatonin offset clock hour and the phase relationship between dim light melatonin offset and waketime, and associations between dim light melatonin offset, phase relationship, and chronotype in healthy adults (N = 62) who completed baseline protocols measuring components of the circadian melatonin rhythm and chronotype. RESULTS 74.4% demonstrated dim light melatonin offset after waketime, indicating most healthy adults wake up before the end of biological night. Later chronotype (morningness-eveningness, mid-sleep on free days corrected, and average mid-sleep) was associated with later dim light melatonin offset clock hour. Later chronotype was also associated with a larger, positive phase relationship between dim light melatonin offset and waketime, except for morningness-eveningness. CONCLUSIONS These findings suggest morning circadian misalignment risk among healthy adults, which would not be detected if only dim light melatonin onset were assessed. Chronotype measured by sleep timing may better predict this risk in healthy adults keeping a consistent sleep schedule than morningness-eveningness preferences. Additional research is needed to develop circadian biomarkers to predict dim light melatonin offset and evaluate appropriate dim light melatonin offset timing to promote health.
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Affiliation(s)
- Rebecca C Cox
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Alivia B Blumenstein
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Tina M Burke
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA; Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Christopher M Depner
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA; Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah, USA
| | - Molly K Guerin
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Emily Hay-Arthur
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Janine Higgins
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Oliver A Knauer
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Shannon M Lanza
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Rachel R Markwald
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA; Naval Health Research Center, San Diego, California, USA
| | - Edward L Melanson
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Andrew W McHill
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA; Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, Oregon, USA
| | - Sarah J Morton
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Hannah K Ritchie
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Mark R Smith
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Alexandra N Smits
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Kate E Sprecher
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Ellen R Stothard
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA; Colorado Sleep Institute, Boulder, Colorado, USA
| | - Dana Withrow
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Kenneth P Wright
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA; Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
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D'Souza EW, MacGregor AJ, Markwald RR, Elkins TA, Zouris JM. Investigating insomnia in United States deployed military forces: A topic modeling approach. Sleep Health 2024; 10:75-82. [PMID: 38071173 DOI: 10.1016/j.sleh.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 09/12/2023] [Accepted: 09/29/2023] [Indexed: 03/01/2024]
Abstract
STUDY OBJECTIVES This retrospective study analyzed free-text clinical notes from medical encounters for insomnia among a sample of deployed US military personnel. Topic modeling, a natural language processing technique, was used to identify thematic patterns in the clinical notes that were potentially related to insomnia diagnosis. METHODS Clinical notes of patient clinical encounters coded for insomnia from the US Department of Defense Military Health System Theater Medical Data Store were analyzed. Following preprocessing of the free text in the clinical notes, topic modeling was employed to identify relevant underlying topics or themes in 32,864 unique patients. The machine-learned topics were validated using human-coded potential insomnia etiological issues. RESULTS A 12-topic model was selected based on quantitative metrics, interpretability, and coherence of terms comprising topics. The topics were assigned the following labels: personal/family history, stimulants, stress, family/relationships, other sleep disorders, depression, schedule/environment, anxiety, other medication, headache/concussion, pain, and medication refill. Validation of these topics (excluding the two medication topics) against their corresponding human-coded potential etiological issues showed strong agreement for the assessed topics. CONCLUSIONS Analysis of free-text clinical notes using topic modeling resulted in the identification of thematic patterns that largely mirrored known correlates of insomnia. These findings reveal multiple potential etiologies for deployment-related insomnia. The identified topics may augment electronic health record diagnostic codes and provide valuable information for sleep researchers and providers. As both civilian and military healthcare systems implement electronic health records, topic modeling may be a valuable tool for analyzing free-text data to investigate health outcomes.
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Affiliation(s)
- Edwin W D'Souza
- Leidos, Inc., San Diego, California, USA; Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
| | - Andrew J MacGregor
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA.
| | - Rachel R Markwald
- Warfighter Performance Department, Naval Health Research Center, San Diego, California, USA
| | - Trevor A Elkins
- Leidos, Inc., San Diego, California, USA; Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
| | - James M Zouris
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
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LaGoy AD, Kubala AG, Seech TR, Jameson JT, Markwald RR, Russell DW. Steps toward developing a comprehensive fatigue monitoring and mitigation solution: perspectives from a cohort of United States Naval Surface Force officers. Sleep Adv 2024; 5:zpae008. [PMID: 38425454 PMCID: PMC10904103 DOI: 10.1093/sleepadvances/zpae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/12/2024] [Indexed: 03/02/2024]
Abstract
Study Objectives This study analyzed fatigue and its management in US Naval Surface Force warships, focusing on understanding current practices and barriers, and examining the influence of organizational and individual factors on managing chronic fatigue. Furthermore, this study explored the impact of organizational and individual factors on fatigue management. Methods As part of a larger study, 154 naval officers (mean ± standard deviation; 31.5 ± 7.0 years; 8.8 ± 6.8 years of service; 125 male, and 29 female) completed a fatigue survey. The survey addressed (1) self-reported fatigue, (2) fatigue observed in others, (3) fatigue monitoring strategies, (4) fatigue mitigation strategies, and (5) barriers to fatigue mitigation. Logistic and ordinal regressions were performed to examine the effect of individual (i.e. sleep quality and years in military service) and organizational (i.e. ship-class) factors on fatigue outcomes. Results Fatigue was frequently experienced and observed by 23% and 54% of officers, respectively. Of note, officers often monitored fatigue reactively (i.e. 65% observed others nodding off and 55% observed behavioral impairments). Still, officers did not frequently implement fatigue mitigation strategies, citing few operationally feasible mitigation strategies (62.3%), being too busy (61.7%), and not having clear thresholds for action (48.7%). Fatigue management varies across organizational factors, which must be considered when further developing fatigue management strategies. Conclusions Fatigue remains a critical concern aboard surface force ships and it may be better addressed through development of objective sleep and fatigue monitoring tools that could inform leadership decision-making.
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Affiliation(s)
- Alice D LaGoy
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
- Military and Veterans Health Solutions, Leidos, Inc., San Diego, CA, USA
| | - Andrew G Kubala
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
- Military and Veterans Health Solutions, Leidos, Inc., San Diego, CA, USA
| | - Todd R Seech
- Commander, Naval Surface Force, U.S. Pacific Fleet, Coronado, CA, USA
| | - Jason T Jameson
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
- Military and Veterans Health Solutions, Leidos, Inc., San Diego, CA, USA
| | - Rachel R Markwald
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
| | - Dale W Russell
- Commander, Naval Surface Force, U.S. Pacific Fleet, Coronado, CA, USA
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Mallett R, Jameson JT, Paller KA, Markwald RR, Russell DW. Clinical nightmare frequency and its association with reduced physical health during military operations. Sleep 2023; 46:zsad214. [PMID: 37632739 DOI: 10.1093/sleep/zsad214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Indexed: 08/28/2023] Open
Affiliation(s)
- Remington Mallett
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Jason T Jameson
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
- Leidos, Inc., San Diego, CA, USA
| | - Ken A Paller
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Rachel R Markwald
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
| | - Dale W Russell
- Commander, US Naval Surface Forces, Research, Assessment and Development Directorate, Coronado, CA, USA
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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6
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Anderson MS, Chinoy ED, Harrison EM, Myers CA, Markwald RR. Sleep, Immune Function, and Vaccinations in Military Personnel: Challenges and Future Directions. Mil Med 2023; 188:296-299. [PMID: 37104811 DOI: 10.1093/milmed/usad119] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/27/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
The U.S. military invests substantial resources to vaccinate all personnel, including recruits, against operationally important infectious disease threats. However, research suggests that vaccine immune response and, therefore, vaccine effectiveness may be inadvertently reduced because of chronic and/or acute sleep deficiency experienced by recipients around the time of vaccination. Because sleep deficiency is expected and even necessary in deployed and training contexts, research investigations of the impacts of sleep and related physiological systems such as circadian rhythms on vaccine effectiveness in military settings are needed. Specifically, research should be aimed at understanding the effects of sleep deficiency, as well as vaccine administration schedules, on response to vaccination and clinical protection. Furthermore, knowledge gaps among military medical leadership on sleep, vaccines, and immune health should be assessed. This area of research may benefit the health and readiness of service members while also decreasing health care utilization and associated costs from illness.
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Affiliation(s)
- Melissa S Anderson
- Operational Infectious Diseases, Naval Health Research Center, San Diego, CA 92106, USA
- General Dynamics Information Technology, San Diego, CA 92106, USA
| | - Evan D Chinoy
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA 92106, USA
- Leidos Inc., San Diego, CA 92106, USA
| | - Elizabeth M Harrison
- Leidos Inc., San Diego, CA 92106, USA
- Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, CA 92106, USA
| | - Christopher A Myers
- Operational Infectious Diseases, Naval Health Research Center, San Diego, CA 92106, USA
| | - Rachel R Markwald
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA 92106, USA
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Chabal S, Folstein JR, Chinoy ED, Markwald RR, Lieberman HR. Caffeine consumption and sleep in a submarine environment: An observational study. J Sleep Res 2023; 32:e13901. [PMID: 37020175 DOI: 10.1111/jsr.13901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/07/2023]
Abstract
Submariners face many environmental and operational challenges to maintaining good sleep, including suboptimal lighting, shift work, and frequent interruptions. Anecdotally, many Sailors consume caffeine to alleviate the effects of poor sleep on alertness, mood, and performance; however, caffeine itself may also degrade sleep quantity and/or quality. This study provides the first exploration of the potential relationship between caffeine use and sleep onboard submarines. Objective measures (wrist actigraphy, available from 45 participants), self-report sleep metrics, and self-reported caffeine consumption were collected from 58 US Navy Sailors before and during a routine submarine underway at sea lasting 30 days. Contrary to expectations, less caffeine was reportedly consumed at sea (232.8 ± 241.1 mg) than on land prior to the underway (M = 284.4 ± 251.7 mg; X2 (1) = 7.43, p = 0.006), positive rather than negative relationships were observed between caffeine consumption and sleep efficiency (F = 6.11, p = 0.02), and negative relationships were observed between caffeine consumption and wake after sleep onset (F = 9.36, p = 0.004) and sleep fragmentation (F = 24.73, p < 0.0001). However, in contrast, higher caffeine consumption was also negatively related to self-reported sleep duration while at sea (F = 4.73, p = 0.03). This observational study is the first to measure relationships between caffeine consumption and sleep quantity and/or quality in a submarine environment. We propose that the unique submarine environment and the unique caffeine consumption patterns of submariners should be considered in the development of potential countermeasures for sleepiness.
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Affiliation(s)
- Sarah Chabal
- Naval Submarine Medical Research Laboratory, Groton, Connecticut, USA
- Leidos, Inc., Reston, Virginia, USA
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, California, USA
| | - Jonathan R Folstein
- Naval Submarine Medical Research Laboratory, Groton, Connecticut, USA
- Leidos, Inc., Reston, Virginia, USA
| | - Evan D Chinoy
- Leidos, Inc., Reston, Virginia, USA
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, California, USA
| | - Rachel R Markwald
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, California, USA
| | - Harris R Lieberman
- US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
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Jensen AE, Bernards JR, Hamilton JA, Markwald RR, Kelly KR, Biggs AT. Don't Shoot Me: Potential Consequences of Force-on-Force Training Modulate the Human Stress Response. J Strength Cond Res 2023; 37:1761-1769. [PMID: 37235207 DOI: 10.1519/jsc.0000000000004481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
ABSTRACT Jensen, AE, Bernards, JR, Hamilton, JA, Markwald, RR, Kelly, KR, and Biggs, AT. Do not shoot me: potential consequences of force-on-force training modulate the human stress response. J Strength Cond Res 37(9): 1761-1769, 2023-Close-quarters combat (CQC) engagements trigger the "fight-or-flight" response, activating the sympathetic nervous system and hypothalamic-pituitary-adrenal axis in response to perceived threats. However, it has yet to be shown if a force-on-force (FoF) CQC training environment will lead to adaptations in the physiological stress response or performance. United States Marines and Army infantry personnel participated in a 15-day CQC training program. The CQC program focused heavily on FoF training with the use of nonlethal training ammunition (NLTA). Data collections occurred on training days 1 and 15, during a simulated FoF-hostage rescue (HR) scenario and photorealistic target drill. For the FoF-HR, subjects were instructed to clear the shoot house, rescue the hostage, and only shoot hostile threat(s) with NLTA. The photorealistic target drills were similar, but replaced the role players in the FoF-HR with paper targets. Salivary alpha-amylase (sAA) and salivary cortisol were obtained immediately before entering and exiting the shoot house. Time to completion significantly decreased, between days 1 and 15, for both the FoF-HR and the photorealistic drills by 67.7 and 54.4%, respectively ( p < 0.05). Analyses revealed that the change in sAA, nonsignificantly, doubled from day 1 to 15 during FoF-HR ( p > 0.05), whereas the change in sAA decreased during the photorealistic drills across days ( p < 0.05). Cortisol was significantly higher during the FoF-HR in comparison to the photorealistic drills ( p < 0.05). These data suggest that potential consequences of FoF training heighten the stress response in conjunction with enhanced performance.
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Affiliation(s)
- Andrew E Jensen
- Leidos, Inc., San Diego, California
- Naval Health Research Center, San Diego, California
| | - Jake R Bernards
- Leidos, Inc., San Diego, California
- Naval Health Research Center, San Diego, California
| | - Joseph A Hamilton
- Naval Health Research Center, San Diego, California
- Innovative Employee Solutions, San Diego, California
| | | | | | - Adam T Biggs
- Naval Medical Research Unit-Dayton, Dayton, Ohio; and
- Naval Special Warfare Command, Coronado, California
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LaGoy AD, Kubala AG, Deering S, Germain A, Markwald RR. Dawn of a New Dawn: Advances in Sleep Health to Optimize Performance. Sleep Med Clin 2023; 18:361-371. [PMID: 37532375 DOI: 10.1016/j.jsmc.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Optimal sleep health is a critical component to high-level performance. In populations such as the military, public service (eg, firefighters), and health care, achieving optimal sleep health is difficult and subsequently deficiencies in sleep health may lead to performance decrements. However, advances in sleep monitoring technologies and mitigation strategies for poor sleep health show promise for further ecological scientific investigation within these populations. The current review briefly outlines the relationship between sleep health and performance as well as current advances in behavioral and technological approaches to improving sleep health for performance.
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Affiliation(s)
- Alice D LaGoy
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, USA; Leidos, Inc., San Diego, CA, USA
| | - Andrew G Kubala
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, USA; Leidos, Inc., San Diego, CA, USA
| | - Sean Deering
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, USA; Leidos, Inc., San Diego, CA, USA
| | | | - Rachel R Markwald
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, USA.
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10
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Biggs AT, Hamilton JA, Thompson AG, Jensen A, Suss J, Kelly K, Markwald RR. Not according to plan: Cognitive failures in marksmanship due to effects of expertise, unknown environments, and the likelihood of shooting unintended targets. Appl Ergon 2023; 112:104058. [PMID: 37331030 DOI: 10.1016/j.apergo.2023.104058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 05/24/2023] [Accepted: 05/28/2023] [Indexed: 06/20/2023]
Abstract
Shooting errors have multi-faceted causes with contributing factors that include sensorimotor activity and cognitive failures. Empirical investigations often assess mental errors through threat identification, yet other cognitive failures could contribute to poor outcomes. The current study explored several possible sources of cognitive failures unrelated to threat identification with live fire exercises. Experiment 1 examined a national shooting competition to compare marksmanship accuracy, expertise, and planning in the likelihood of hitting no-shoot or unintended targets. Experts demonstrated an inverse speed/accuracy trade-off and fired upon fewer no-shoot targets than lesser skilled shooters, yet overall, greater opportunity to plan produced more no-shoot errors, thereby demonstrating an increase in cognitive errors. Experiment 2 replicated and extended this finding under conditions accounting for target type, location, and number. These findings further dissociate the roles of marksmanship and cognition in shooting errors while suggesting that marksmanship evaluations should be re-designed to better incorporate cognitive variables.
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Affiliation(s)
| | | | - Andrew G Thompson
- West Virginia University, United States; United States Army Training and Doctrine Command, United States
| | - Andrew Jensen
- Naval Health Research Center, United States; Leidos, United States
| | - Joel Suss
- Naval Health Research Center, United States; Leidos, United States; Wichita State University, United States
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11
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Chinoy ED, Cuellar JA, Jameson JT, Markwald RR. Daytime Sleep-Tracking Performance of Four Commercial Wearable Devices During Unrestricted Home Sleep. Nat Sci Sleep 2023; 15:151-164. [PMID: 37032817 PMCID: PMC10075216 DOI: 10.2147/nss.s395732] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/20/2023] [Indexed: 04/11/2023] Open
Abstract
Purpose Previous studies have found that many commercial wearable devices can accurately track sleep-wake patterns in laboratory or home settings. However, nearly all previous studies tested devices under conditions with fixed time in bed (TIB) and during nighttime sleep episodes only. Despite its relevance to shift workers and others with irregular sleep schedules, it is largely unknown how devices track daytime sleep. Therefore, we tested the sleep-tracking performance of four commercial wearable devices during unrestricted home daytime sleep. Participants and Methods Participants were 16 healthy young adults (6 men, 10 women; 26.6 ± 4.6 years, mean ± SD) with habitual daytime sleep schedules. Participants slept at home for 1 week under unrestricted conditions (ie, self-selecting TIB) using a set of four commercial wearable devices and completed reference sleep logs. Wearables included the Fatigue Science ReadiBand, Fitbit Inspire HR, Oura Ring, and Polar Vantage V Titan. Daytime sleep episode TIB biases and frequencies of missed and false-positive daytime sleep episodes were examined. Results TIB bias was low in general for all devices on most daytime sleep episodes, but some exhibited large biases (eg, >1 h). Total missed daytime sleep episodes were as follows: Fatigue Science: 3.6%; Fitbit: 4.8%; Oura: 6.0%; Polar: 37.3%. Missed episodes occurred most often when TIB was short (eg, naps <4 h). Conclusion When daytime sleep episodes were recorded, the devices generally exhibited similar performance for tracking TIB (ie, most episodes had low bias). However, the devices failed to detect some daytime episodes, which occurred most often when TIB was short, but varied across devices (especially Polar, which missed over one-third of episodes). Findings suggest that accurate daytime sleep tracking is largely achievable with commercial wearable devices. However, performance differences for missed recordings suggest that some devices vary in reliability (especially for naps), but improvements could likely be made with changes to algorithm sensitivities.
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Affiliation(s)
- Evan D Chinoy
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
- Leidos, Inc, San Diego, CA, USA
| | - Joseph A Cuellar
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
- Leidos, Inc, San Diego, CA, USA
| | - Jason T Jameson
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
- Leidos, Inc, San Diego, CA, USA
| | - Rachel R Markwald
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
- Correspondence: Rachel R Markwald, Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA, Tel +1 619 767 4494, Email
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12
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Chinoy ED, Carey FR, Kolaja CA, Jacobson IG, Cooper AD, Markwald RR. The bi-directional relationship between post-traumatic stress disorder and obstructive sleep apnea and/or insomnia in a large U.S. military cohort. Sleep Health 2022; 8:606-614. [PMID: 36163136 DOI: 10.1016/j.sleh.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 05/27/2022] [Accepted: 07/14/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Determine if a bi-directional relationship exists between the development of sleep disorders (obstructive sleep apnea [OSA] and/or insomnia) and existing post-traumatic stress disorder (PTSD), and vice versa; and examine military-related factors associated with these potential relationships. DESIGN Longitudinal analyses of a prospective representative U.S. military cohort. PARTICIPANTS Millennium Cohort Study responders in 2011-2013 (Time 1 [T1]) and 2014-2016 (Time 2 [T2]) without insomnia or OSA at T1 (N = 65,915) or without PTSD at T1 (N = 71,256). MEASUREMENTS Provider-diagnosed OSA, self-reported items for insomnia, provider-diagnosed PTSD, and current PTSD symptoms were assessed at T1 and T2. Adjusted multivariable models identified military-related factors associated with new-onset PTSD in those with OSA and/or insomnia, and vice versa. RESULTS Self-reported history of provider-diagnosed PTSD without current symptoms at T1 was associated with new-onset OSA only and comorbid OSA/insomnia at T2, while current PTSD symptoms and/or diagnosis was associated with new-onset insomnia only. OSA/insomnia at T1 was consistently associated with newly reported PTSD symptoms or diagnosis except that insomnia only was not associated with newly reported provider-diagnosed PTSD. Military-related risk factors significantly associated with the bi-directional relationship for new-onset PTSD or OSA/insomnia included prior deployment with higher combat exposure and recent separation from the military; being an officer was protective for both outcomes. CONCLUSIONS In this large military cohort, findings suggest that PTSD and OSA and/or insomnia are bi-directionally predictive for their development, which was sometimes revealed by health care utilization. Relevant military-related risk factors should be considered in efforts to prevent or treat PTSD and/or sleep disorders.
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Affiliation(s)
- Evan D Chinoy
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, California, USA; Leidos, Inc., San Diego, California, USA
| | - Felicia R Carey
- Leidos, Inc., San Diego, California, USA; Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
| | - Claire A Kolaja
- Leidos, Inc., San Diego, California, USA; Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
| | - Isabel G Jacobson
- Leidos, Inc., San Diego, California, USA; Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
| | - Adam D Cooper
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, California, USA; Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA; Innovative Employee Solutions, San Diego, California, USA
| | - Rachel R Markwald
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, California, USA.
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13
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Jameson JT, Markwald RR, Kubala AG, Roma PG, Biggs AT, Lai K, Russell DW. Sleep deficiency, operational fatigue and the interplay of compromising factors: Analysis to aid in fatigue management. J Sleep Res 2022; 32:e13788. [PMID: 36436505 DOI: 10.1111/jsr.13788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/25/2022] [Accepted: 11/03/2022] [Indexed: 11/29/2022]
Abstract
The United States Navy is a high-reliability organization that must maintain optimum performance under challenging conditions. One key challenge for sailors is obtaining sufficient sleep, which can lead to fatigue and other outcomes that compromise operational readiness. Identifying sleep issues and their causes is critical for military leaders to care for their personnel, and to make informed, risk-based operational decisions. Though previous studies in shipboard environments have implicated factors responsible for insufficient sleep (e.g. poor sleep environment and work demands), there has been less research into characterizing the complex interplay among such factors in relation to sleep and work-related fatigue outcomes. This study seeks to address this gap. Data were drawn from the Afloat Safety Climate Assessment Survey of 7617 sailors from 73 ships. The survey included demographic characteristics and measures of crew endurance (e.g. sleep, occupational impairment due to fatigue). Descriptive analyses characterized the presence and severity of sleep issues across subpopulations and operational settings (e.g. the type of ship); structural equation modelling techniques characterized and quantified the statistical associations among factors. The results indicate that sleep deficits are widespread, holding across subpopulations and operational settings. Though sleep deficits varied across subpopulations, no group obtained an average of more than 7 hr of sleep per night. Fatigue-induced occupational functional impairment was directly related to sleep deficiency, and sleep environment and job-related factors were contributors to sleep deficiency. Moreover, job-related factors emerged as potentially more consequential. Lastly, factors may exist aboard a ship that could help promote better sleep.
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Affiliation(s)
- Jason T Jameson
- Leidos, Inc., San Diego, California, USA.,Sleep, Tactical Effectiveness, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, California, USA
| | - Rachel R Markwald
- Sleep, Tactical Effectiveness, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, California, USA
| | - Andrew G Kubala
- Leidos, Inc., San Diego, California, USA.,Sleep, Tactical Effectiveness, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, California, USA
| | - Peter G Roma
- Leidos, Inc., San Diego, California, USA.,Sleep, Tactical Effectiveness, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, California, USA
| | - Adam T Biggs
- Commander, Naval Surface Force, US Pacific Fleet, Coronado, California, USA
| | - Kevin Lai
- Leidos, Inc., San Diego, California, USA.,Commander, Naval Surface Force, US Pacific Fleet, Coronado, California, USA
| | - Dale W Russell
- Commander, Naval Surface Force, US Pacific Fleet, Coronado, California, USA.,Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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14
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Viboch TB, Amescua MF, Jones DM, Nardulli PJ, Sessoms PH, Markwald RR, Russell DW, Cialdella-Kam LA. Pre-deployment Vitamin D And Nutritional Status In Us Navy Sailors. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000878872.27273.5a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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15
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Chinoy ED, Cuellar JA, Jameson JT, Markwald RR. Performance of Four Commercial Wearable Sleep-Tracking Devices Tested Under Unrestricted Conditions at Home in Healthy Young Adults. Nat Sci Sleep 2022; 14:493-516. [PMID: 35345630 PMCID: PMC8957400 DOI: 10.2147/nss.s348795] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/21/2022] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Commercial wearable sleep-tracking devices are growing in popularity and in recent studies have performed well against gold standard sleep measurement techniques. However, most studies were conducted in controlled laboratory conditions. We therefore aimed to test the performance of devices under naturalistic unrestricted home sleep conditions. PARTICIPANTS AND METHODS Healthy young adults (n = 21; 12 women, 9 men; 29.0 ± 5.0 years, mean ± SD) slept at home under unrestricted conditions for 1 week using a set of commercial wearable sleep-tracking devices and completed daily sleep diaries. Devices included the Fatigue Science Readiband, Fitbit Inspire HR, Oura ring, and Polar Vantage V Titan. Participants also wore a research-grade actigraphy watch (Philips Respironics Actiwatch 2) for comparison. To assess performance, all devices were compared with a high performing mobile sleep electroencephalography headband device (Dreem 2). Analyses included epoch-by-epoch and sleep summary agreement comparisons. RESULTS Devices accurately tracked sleep-wake summary metrics (ie, time in bed, total sleep time, sleep efficiency, sleep latency, wake after sleep onset) on most nights but performed best on nights with higher sleep efficiency. Epoch-by-epoch sensitivity (for sleep) and specificity (for wake), respectively, were as follows: Actiwatch (0.95, 0.35), Fatigue Science (0.94, 0.40), Fitbit (0.93, 0.45), Oura (0.94, 0.41), and Polar (0.96, 0.35). Sleep stage-tracking performance was mixed, with high variability. CONCLUSION As in previous studies, all devices were better at detecting sleep than wake, and most devices compared favorably to actigraphy in wake detection. Devices performed best on nights with more consolidated sleep patterns. Unrestricted sleep TIB differences were accurately tracked on most nights. High variability in sleep stage-tracking performance suggests that these devices, in their current form, are still best utilized for tracking sleep-wake outcomes and not sleep stages. Most commercial wearables exhibited promising performance for tracking sleep-wake in real-world conditions, further supporting their consideration as an alternative to actigraphy.
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Affiliation(s)
- Evan D Chinoy
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA.,Leidos, Inc., San Diego, CA, USA
| | - Joseph A Cuellar
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA.,Leidos, Inc., San Diego, CA, USA
| | - Jason T Jameson
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA.,Leidos, Inc., San Diego, CA, USA
| | - Rachel R Markwald
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
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16
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Mysliwiec V, Brock MS, Creamer JL, Espejo EP, Markwald RR, Matwiyoff GN, Peachey JT, O'Reilly BM, Shattuck NL, Taylor DJ, Troxel WM, Germain A. Leaning in to Address Sleep Disturbances and Sleep Disorders in Department of Defense and Defense Health Agency. Mil Med 2021; 187:155-157. [PMID: 34964474 DOI: 10.1093/milmed/usab529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/09/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Matthew S Brock
- San Antonio Military Health System Sleep Disorders Center, Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX 78236, USA
| | - Jennifer L Creamer
- United States Army Command and General Staff College, Fort Leavenworth, KS 66027, USA
| | | | - Rachel R Markwald
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA 92106, USA
| | | | - John T Peachey
- Mental Health Department, Naval Hospital Camp, Pendleton, CA 92055, USA
| | - Brian M O'Reilly
- Department of Pulmonary, Critical Care and Sleep Medicine, Madigan Army Medical Center, Tacoma, WA 98431, USA
| | - Nita L Shattuck
- Human Systems Integration Program, Operations Research Department, Naval Postgraduate School, Monterey, CA 93943, USA
| | - Daniel J Taylor
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
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17
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Markwald RR, Carey FR, Kolaja CA, Jacobson IG, Cooper AD, Chinoy ED. Prevalence and predictors of insomnia and sleep medication use in a large tri-service US military sample. Sleep Health 2021; 7:675-682. [PMID: 34690109 DOI: 10.1016/j.sleh.2021.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/13/2021] [Accepted: 08/02/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The presence of insomnia in the general military population is not well known. This study aimed to determine the prevalence of probable clinical insomnia and identify factors leading to new-onset insomnia and/or sleep medication use in a large military population. DESIGN Cross-sectional and longitudinal analyses of a prospective cohort study. PARTICIPANTS A tri-service US military and veteran cohort (sample range 99,383-137,114). MEASUREMENTS Participants were surveyed in 2013 (Time 1 [T1]) and 2016 (Time 2 [T2]) using the clinically validated Insomnia Severity Index. The prevalence of insomnia and sleep medication use was quantified at both times. Multivariable models identified military factors associated with new-onset insomnia and/or sleep medication use while adjusting for covariates. RESULTS The prevalence of insomnia at T1 and T2 was 16.3% and 11.2%, respectively. New-onset insomnia at T2 was reported by 6.0% of participants screening negative at T1; risk factors included Army service, combat deployment experience, and separation from military service. The prevalence of sleep medication use at T1 and T2 was 23.1% and 25.1%, respectively. Sleep medication use at T2 was newly-reported by 17.1% of participants not reporting sleep medication use at T1; risk factors included number of deployments and having a healthcare occupation. CONCLUSIONS The prevalence of probable clinical insomnia in this large general military population is within the range of previous reports in military and civilian populations. Certain military factors that predict new-onset insomnia and/or sleep medication use should be considered when designing and implementing sleep interventions in military populations.
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Affiliation(s)
- Rachel R Markwald
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, California, USA.
| | - Felicia R Carey
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA; Leidos, Inc., San Diego, California, USA
| | - Claire A Kolaja
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA; Leidos, Inc., San Diego, California, USA
| | - Isabel G Jacobson
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA; Leidos, Inc., San Diego, California, USA
| | - Adam D Cooper
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, California, USA; Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA; Innovative Employee Solutions, San Diego, California, USA
| | - Evan D Chinoy
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, California, USA; Leidos, Inc., San Diego, California, USA
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18
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Cogswell D, Bisesi P, Markwald RR, Cruickshank-Quinn C, Quinn K, McHill A, Melanson EL, Reisdorph N, Wright KP, Depner CM. Identification of a Preliminary Plasma Metabolome-based Biomarker for Circadian Phase in Humans. J Biol Rhythms 2021; 36:369-383. [PMID: 34182829 PMCID: PMC9134127 DOI: 10.1177/07487304211025402] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Measuring individual circadian phase is important to diagnose and treat circadian rhythm sleep-wake disorders and circadian misalignment, inform chronotherapy, and advance circadian science. Initial findings using blood transcriptomics to predict the circadian phase marker dim-light melatonin onset (DLMO) show promise. Alternatively, there are limited attempts using metabolomics to predict DLMO and no known omics-based biomarkers predict dim-light melatonin offset (DLMOff). We analyzed the human plasma metabolome during adequate and insufficient sleep to predict DLMO and DLMOff using one blood sample. Sixteen (8 male/8 female) healthy participants aged 22.4 ± 4.8 years (mean ± SD) completed an in-laboratory study with 3 baseline days (9 h sleep opportunity/night), followed by a randomized cross-over protocol with 9-h adequate sleep and 5-h insufficient sleep conditions, each lasting 5 days. Blood was collected hourly during the final 24 h of each condition to independently determine DLMO and DLMOff. Blood samples collected every 4 h were analyzed by untargeted metabolomics and were randomly split into training (68%) and test (32%) sets for biomarker analyses. DLMO and DLMOff biomarker models were developed using partial least squares regression in the training set followed by performance assessments using the test set. At baseline, the DLMOff model showed the highest performance (0.91 R2 and 1.1 ± 1.1 h median absolute error ± interquartile range [MdAE ± IQR]), with significantly (p < 0.01) lower prediction error versus the DLMO model. When all conditions (baseline, 9 h, and 5 h) were included in performance analyses, the DLMO (0.60 R2; 2.2 ± 2.8 h MdAE; 44% of the samples with an error under 2 h) and DLMOff (0.62 R2; 1.8 ± 2.6 h MdAE; 51% of the samples with an error under 2 h) models were not statistically different. These findings show promise for metabolomics-based biomarkers of circadian phase and highlight the need to test biomarkers that predict multiple circadian phase markers under different physiological conditions.
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Affiliation(s)
- D Cogswell
- Sleep and Chronobiology Laboratory, University of Colorado, Boulder, Boulder, Colorado
| | - P Bisesi
- Sleep and Chronobiology Laboratory, University of Colorado, Boulder, Boulder, Colorado
| | - R R Markwald
- Sleep and Chronobiology Laboratory, University of Colorado, Boulder, Boulder, Colorado
| | - C Cruickshank-Quinn
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - K Quinn
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - A McHill
- Sleep and Chronobiology Laboratory, University of Colorado, Boulder, Boulder, Colorado
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, Oregon
| | - E L Melanson
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Eastern Colorado Veterans Affairs Geriatric Research, Education, and Clinical Center, Denver, Colorado
| | - N Reisdorph
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - K P Wright
- Sleep and Chronobiology Laboratory, University of Colorado, Boulder, Boulder, Colorado
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - C M Depner
- Sleep and Chronobiology Laboratory, University of Colorado, Boulder, Boulder, Colorado
- Department of Health and Kinesiology, The University of Utah, Salt Lake City, Utah
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19
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Cooper AD, Kolaja CA, Markwald RR, Jacobson IG, Chinoy ED. Longitudinal associations of military-related factors on self-reported sleep among U.S. service members. Sleep 2021; 44:6314292. [PMID: 34216467 DOI: 10.1093/sleep/zsab168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 06/24/2021] [Indexed: 11/15/2022] Open
Abstract
STUDY OBJECTIVES Sleep loss is common in the military, which can negatively affect health and readiness; however, it is largely unknown how sleep varies over a military career. This study sought to examine the relationships between military-related factors and the new onset and reoccurrence of short sleep duration and insomnia symptoms. METHODS Millennium Cohort Study data were used to track U.S. military service members over time to examine longitudinal changes in sleep. Outcomes were self-reported average sleep duration (categorized as ≤5 hours, 6 hours, or 7-9 hours [recommended]) and/or insomnia symptoms (having trouble falling or staying asleep). Associations between military-related factors and the new onset and reoccurrence of these sleep characteristics were determined, after controlling for multiple health and behavioral factors. RESULTS Military-related factors consistently associated with an increased risk for new onset and/or reoccurrence of short sleep duration and insomnia symptoms included active duty component, Army or Marine Corps service, combat deployment, and longer than average deployment lengths. Military officers and noncombat deployers had decreased risk for either sleep characteristic. Time-in-service and separation from the military were complex factors; they lowered risk for ≤5 hours sleep but increased risk for insomnia symptoms. CONCLUSIONS Various military-related factors contribute to risk of short sleep duration and/or insomnia symptoms over time, although some factors affect these sleep characteristics differently. Also, even when these sleep characteristics remit, some military personnel have an increased risk of reoccurrence. Efforts to improve sleep prioritization and implement interventions targeting at-risk military populations, behaviors, and other significant factors are warranted.
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Affiliation(s)
- Adam D Cooper
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA.,Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA.,Innovative Employee Solutions, San Diego, CA, USA
| | - Claire A Kolaja
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA.,Leidos, Inc., San Diego, CA, USA
| | - Rachel R Markwald
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
| | - Isabel G Jacobson
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA.,Leidos, Inc., San Diego, CA, USA
| | - Evan D Chinoy
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA.,Leidos, Inc., San Diego, CA, USA
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20
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Russell DW, Markwald RR, Jameson JT. Self-reported sleep and sleep deficiency: Results from a large initiative of sailors attached to U.S. Navy warships. J Sleep Res 2021; 30:e13397. [PMID: 34187090 PMCID: PMC9285824 DOI: 10.1111/jsr.13397] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/21/2021] [Accepted: 05/07/2021] [Indexed: 11/29/2022]
Abstract
Chronic insufficient sleep is known to lead to a broad range of negative consequences (e.g. poor health and cognitive performance). While insufficient sleep and associated fatigue are present in many diverse populations, it is of special concern in high-risk military environments, where a mishap can result in catastrophic outcomes. Although many studies have been conducted to characterise sleep in general military populations, relatively few have been conducted using a large representative sample of sailors assigned to United States Naval warships. The present cross-sectional study characterises self-reported sleep parameters in sailors (N = 11,738) and explores the role of possible contributors to insufficient sleep. The results indicate that sailors, across a variety of different subgroups, do not obtain the amount of sleep that they report requiring for feeling well-rested. Of the many potential factors thwarting sleep, workload and an uncomfortable mattress are the most promising candidates to target for improvement.
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Affiliation(s)
- Dale W Russell
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Rachel R Markwald
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
| | - Jason T Jameson
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA.,Leidos, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
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21
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MacGregor AJ, Markwald RR, Dougherty AL, Seda G. The relationship between military occupation and diagnosed insomnia following combat deployment. J Clin Sleep Med 2021; 16:1125-1132. [PMID: 32248897 DOI: 10.5664/jcsm.8444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Our objective was to investigate the relationship between military occupation and diagnosed insomnia following combat deployment. METHODS This retrospective cohort study was conducted using existing electronic military databases. Eligible participants were military personnel with a deployment to Iraq, Afghanistan, or Kuwait between 2005 and 2009. A total of 66,869 U.S. Navy and U.S. Marine Corps service members constituted the study sample and were categorized by military occupation. Military medical databases were used to abstract information on insomnia diagnoses and prescription medications. RESULTS The overall prevalence of diagnosed insomnia was 3.4%. In multivariable logistic regression, personnel in law enforcement (odds ratio = 1.62; 95% confidence interval, 1.28-2.04), motor transport (odds ratio = 1.38; 95% confidence interval, 1.14-1.66), and health care occupations (odds ratio = 2.24; 95% confidence interval, 1.85-2.71) had significantly higher odds of an insomnia diagnosis following deployment than did those in infantry occupations. These results remained unchanged after excluding those who reported posttraumatic stress disorder symptoms. Nonbenzodiazepine sedative/hypnotics were prescribed for 44.2% of those with insomnia, and prescription patterns differed by occupation. CONCLUSIONS These results suggest that military occupation may play a primary role in the onset and management of insomnia. The findings provide a rationale for targeting individuals in insomnia-susceptible occupations with better methods to prevent and/or minimize sleep issues during and after combat deployment.
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Affiliation(s)
- Andrew J MacGregor
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California
| | - Rachel R Markwald
- Warfighter Performance Department, Naval Health Research Center, San Diego, California
| | - Amber L Dougherty
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California.,Leidos, Inc., San Diego, California
| | - Gilbert Seda
- Sleep Clinic, Pulmonary Medicine Department, Naval Medical Center, San Diego, California
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22
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Chinoy ED, Cuellar JA, Huwa KE, Jameson JT, Watson CH, Bessman SC, Hirsch DA, Cooper AD, Drummond SPA, Markwald RR. Performance of seven consumer sleep-tracking devices compared with polysomnography. Sleep 2021; 44:6055610. [PMID: 33378539 PMCID: PMC8120339 DOI: 10.1093/sleep/zsaa291] [Citation(s) in RCA: 126] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 12/02/2020] [Indexed: 01/22/2023] Open
Abstract
STUDY OBJECTIVES Consumer sleep-tracking devices are widely used and becoming more technologically advanced, creating strong interest from researchers and clinicians for their possible use as alternatives to standard actigraphy. We, therefore, tested the performance of many of the latest consumer sleep-tracking devices, alongside actigraphy, versus the gold-standard sleep assessment technique, polysomnography (PSG). METHODS In total, 34 healthy young adults (22 women; 28.1 ± 3.9 years, mean ± SD) were tested on three consecutive nights (including a disrupted sleep condition) in a sleep laboratory with PSG, along with actigraphy (Philips Respironics Actiwatch 2) and a subset of consumer sleep-tracking devices. Altogether, four wearable (Fatigue Science Readiband, Fitbit Alta HR, Garmin Fenix 5S, Garmin Vivosmart 3) and three nonwearable (EarlySense Live, ResMed S+, SleepScore Max) devices were tested. Sleep/wake summary and epoch-by-epoch agreement measures were compared with PSG. RESULTS Most devices (Fatigue Science Readiband, Fitbit Alta HR, EarlySense Live, ResMed S+, SleepScore Max) performed as well as or better than actigraphy on sleep/wake performance measures, while the Garmin devices performed worse. Overall, epoch-by-epoch sensitivity was high (all ≥0.93), specificity was low-to-medium (0.18-0.54), sleep stage comparisons were mixed, and devices tended to perform worse on nights with poorer/disrupted sleep. CONCLUSIONS Consumer sleep-tracking devices exhibited high performance in detecting sleep, and most performed equivalent to (or better than) actigraphy in detecting wake. Device sleep stage assessments were inconsistent. Findings indicate that many newer sleep-tracking devices demonstrate promising performance for tracking sleep and wake. Devices should be tested in different populations and settings to further examine their wider validity and utility.
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Affiliation(s)
- Evan D Chinoy
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA.,Leidos, Inc., San Diego, CA
| | - Joseph A Cuellar
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA.,Leidos, Inc., San Diego, CA
| | - Kirbie E Huwa
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA.,Leidos, Inc., San Diego, CA
| | - Jason T Jameson
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA.,Leidos, Inc., San Diego, CA
| | - Catherine H Watson
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA.,Innovative Employee Solutions, San Diego, CA
| | - Sara C Bessman
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA.,Eagle Applied Sciences, San Diego, CA
| | - Dale A Hirsch
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA
| | - Adam D Cooper
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA.,Innovative Employee Solutions, San Diego, CA
| | - Sean P A Drummond
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Rachel R Markwald
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA
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23
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MacGregor AJ, Joseph AR, Markwald RR, Dougherty AL. The Relationship Between Blast-related Hearing Threshold Shift and Insomnia in U.S. Military Personnel. Mil Med 2021; 186:844-849. [PMID: 33580669 DOI: 10.1093/milmed/usaa567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/01/2020] [Accepted: 01/04/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Hearing loss and insomnia emerged as preeminent sources of morbidity among military service members and veterans who served in the recent Iraq and Afghanistan conflicts. Significant threshold shift (STS), an early indicator of hearing loss, has not been studied in relation to insomnia. This study's objective was to examine the co-occurrence of STS and insomnia among U.S. military personnel with blast-related injury. MATERIALS AND METHODS A total of 652 service members who were blast-injured during military operations in Iraq or Afghanistan between 2004 and 2012 were identified from the Blast-Related Auditory Injury Database. Pre- and post-injury audiometric data were used to ascertain new-onset STS, defined as 30 dB or greater increase for the sum of thresholds at 2,000, 3,000, and 4,000 Hz for either ear. Insomnia diagnosed within 2 years post-injury was abstracted from electronic medical records. Multivariable logistic regression analysis examined the relationship between STS and insomnia, while adjusting for age, year of injury, occupation, injury severity, tinnitus and concussion diagnosed in-theater, and PTSD. RESULTS A majority of the study sample was aged 18-25 years (79.9%) and sustained mild-to-moderate injuries (92.2%). STS was present in 21.1% of service members. Cumulative incidence of diagnosed insomnia was 22.3% and 11.1% for those with and without STS, respectively. After adjusting for covariates, those with STS had nearly 2-times higher odds of insomnia (odds ratio (OR) = 1.91, 95% CI = 1.12-3.24) compared with those without STS. In multivariable modeling, the strongest association was between PTSD and insomnia (OR = 5.57, 95% CI = 3.35-9.26). A secondary finding of note was that military personnel with STS had a significantly higher frequency of PTSD compared with those without STS (28.1% vs. 15.2%). CONCLUSIONS Hearing threshold shift was associated with insomnia in military personnel with blast-related injury and could be used to identify service members at risk. Multidisciplinary care is needed to manage the co-occurrence of both conditions during the post-deployment rehabilitation phase. Future research should evaluate the specific mechanisms involved in this relationship and further explore the association between hearing threshold shift and PTSD.
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Affiliation(s)
- Andrew J MacGregor
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA 92106, USA
| | - Antony R Joseph
- Hearing Loss Prevention Laboratory, Communication Sciences and Disorders Department, Illinois State University, Normal, IL 61790, USA.,Leidos, Inc, San Diego, CA 92106, USA
| | - Rachel R Markwald
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA 92106, USA
| | - Amber L Dougherty
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA 92106, USA.,Leidos, Inc, San Diego, CA 92106, USA
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24
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Germain A, Markwald RR, King E, Bramoweth AD, Wolfson M, Seda G, Han T, Miggantz E, O’Reilly B, Hungerford L, Sitzer T, Mysliwiec V, Hout JJ, Wallace ML. Enhancing behavioral sleep care with digital technology: study protocol for a hybrid type 3 implementation-effectiveness randomized trial. Trials 2021; 22:46. [PMID: 33430955 PMCID: PMC7798254 DOI: 10.1186/s13063-020-04974-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/14/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Insomnia affects almost one in four military service members and veterans. The first-line recommended treatment for insomnia is cognitive-behavioral therapy for insomnia (CBTI). CBTI is typically delivered in-person or online over one-to-four sessions (brief versions) or five-to-eight sessions (standard versions) by a licensed doctoral or masters-level clinician with extensive training in behavioral sleep medicine. Despite its effectiveness, CBTI has limited scalability. Three main factors inhibit access to and delivery of CBTI including restricted availability of clinical expertise; rigid, resource-intensive treatment formats; and limited capacities for just-in-time monitoring and treatment personalization. Digital technologies offer a unique opportunity to overcome these challenges by providing scalable, personalized, resource-sensitive, adaptive, and cost-effective approaches for evidence-based insomnia treatment. METHODS This is a hybrid type 3 implementation-effectiveness randomized trial using a scalable evidence-based digital health software platform, NOCTEM™'s Clinician-Operated Assistive Sleep Technology (COAST™). COAST includes a clinician portal and a patient app, and it utilizes algorithms that facilitate detection of sleep disordered patterns, support clinical decision-making, and personalize sleep interventions. The first aim is to compare three clinician- and system-centered implementation strategies on the reach, adoption, and sustainability of the COAST digital platform by offering (1) COAST only, (2) COAST plus external facilitation (EF: assistance and consultation to providers by NOCTEM's sleep experts), or (3) COAST plus EF and internal facilitation (EF/IF: assistance/consultation to providers by NOCTEM's sleep experts and local champions). The second aim is to quantify improvements in insomnia among patients who receive behavioral sleep care via the COAST platform. We hypothesize that reach, adoption, and sustainability and the magnitude of improvements in insomnia will be superior in the EF and EF/IF groups relative to the COAST-only group. DISCUSSION Digital health technologies and machine learning-assisted clinical decision support tools have substantial potential for scaling access to insomnia treatment. This can augment the scalability and cost-effectiveness of CBTI without compromising patient outcomes. Engaging providers, stakeholders, patients, and decision-makers is key in identifying strategies to support the deployment of digital health technologies that can promote quality care and result in clinically meaningful sleep improvements, positive systemic change, and enhanced readiness and health among service members. TRIAL REGISTRATION ClinicalTrials.gov NCT04366284 . Registered on 28 April 2020.
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Affiliation(s)
- Anne Germain
- NOCTEM, LLC, 218 Oakland Avenue, Pittsburgh, PA 15213 USA
| | - Rachel R. Markwald
- Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Rd, San Diego, CA 92106 USA
| | - Erika King
- Mental Health Division, Air Force Medical Readiness Agency, 2261 Hughes Ave, Suite 153, JBSA Lackland AFB, TX 78236-9853 USA
| | - Adam D. Bramoweth
- VA Pittsburgh Healthcare System, Research Office Building (151RU), University Drive C, Pittsburgh, PA 15240 USA
| | - Megan Wolfson
- NOCTEM, LLC, 218 Oakland Avenue, Pittsburgh, PA 15213 USA
| | - Gilbert Seda
- Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 USA
| | - Tony Han
- Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 USA
| | - Erin Miggantz
- Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Rd, San Diego, CA 92106 USA
- Leidos, Inc., 4161 Campus Point Ct., San Diego, 92121 USA
| | - Brian O’Reilly
- Madigan Army Medical Center, 9040A Jackson Ave, Joint Base Lewis-McChord, WA 98431 USA
| | - Lars Hungerford
- Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 USA
- Defense and Veterans Brain Injury Center, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134 USA
| | - Traci Sitzer
- Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 USA
| | - Vincent Mysliwiec
- Division of Behavioral Medicine, Department of Psychiatry, UT Health San Antonio, 7703 Floyd Curl Drive, MC 7747, San Antonio, TX 78229-3900 USA
| | - Joseph J. Hout
- Knowesis, Inc., 816 Camaron St. Suite 231, San Antonio, TX 78212 USA
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25
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Devine JK, Chinoy ED, Markwald RR, Schwartz LP, Hursh SR. Validation of Zulu Watch against Polysomnography and Actigraphy for On-Wrist Sleep-Wake Determination and Sleep-Depth Estimation. Sensors (Basel) 2020; 21:E76. [PMID: 33375557 PMCID: PMC7796293 DOI: 10.3390/s21010076] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/17/2020] [Accepted: 12/22/2020] [Indexed: 11/24/2022]
Abstract
Traditional measures of sleep or commercial wearables may not be ideal for use in operational environments. The Zulu watch is a commercial sleep-tracking device designed to collect longitudinal sleep data in real-world environments. Laboratory testing is the initial step towards validating a device for real-world sleep evaluation; therefore, the Zulu watch was tested against the gold-standard polysomnography (PSG) and actigraphy. Eight healthy, young adult participants wore a Zulu watch and Actiwatch simultaneously over a 3-day laboratory PSG sleep study. The accuracy, sensitivity, and specificity of epoch-by-epoch data were tested against PSG and actigraphy. Sleep summary statistics were compared using paired samples t-tests, intraclass correlation coefficients, and Bland-Altman plots. Compared with either PSG or actigraphy, both the accuracy and sensitivity for Zulu watch sleep-wake determination were >90%, while the specificity was low (~26% vs. PSG, ~33% vs. actigraphy). The accuracy for sleep scoring vs. PSG was ~87% for interrupted sleep, ~52% for light sleep, and ~49% for deep sleep. The Zulu watch showed mixed results but performed well in determining total sleep time, sleep efficiency, sleep onset, and final awakening in healthy adults compared with PSG or actigraphy. The next step will be to test the Zulu watch's ability to evaluate sleep in industrial operations.
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Affiliation(s)
- Jaime K. Devine
- Institutes for Behavior Resources, Inc., Baltimore, MD 21218, USA; (L.P.S.); (S.R.H.)
| | - Evan D. Chinoy
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA 92106, USA; (E.D.C.); (R.R.M.)
- Leidos, Inc., San Diego, CA 92106, USA
| | - Rachel R. Markwald
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA 92106, USA; (E.D.C.); (R.R.M.)
| | - Lindsay P. Schwartz
- Institutes for Behavior Resources, Inc., Baltimore, MD 21218, USA; (L.P.S.); (S.R.H.)
| | - Steven R. Hursh
- Institutes for Behavior Resources, Inc., Baltimore, MD 21218, USA; (L.P.S.); (S.R.H.)
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26
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Stone JD, Rentz LE, Forsey J, Ramadan J, Markwald RR, Finomore VS, Galster SM, Rezai A, Hagen JA. Evaluations of Commercial Sleep Technologies for Objective Monitoring During Routine Sleeping Conditions. Nat Sci Sleep 2020; 12:821-842. [PMID: 33149712 PMCID: PMC7603649 DOI: 10.2147/nss.s270705] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/17/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The commercial market is saturated with technologies that claim to collect proficient, free-living sleep measurements despite a severe lack of independent third-party evaluations. Therefore, the present study evaluated the accuracy of various commercial sleep technologies during in-home sleeping conditions. MATERIALS AND METHODS Data collection spanned 98 separate nights of ad libitum sleep from five healthy adults. Prior to bedtime, participants utilized nine popular sleep devices while concurrently wearing a previously validated electroencephalography (EEG)-based device. Data collected from the commercial devices were extracted for later comparison against EEG to determine degrees of accuracy. Sleep and wake summary outcomes as well as sleep staging metrics were evaluated, where available, for each device. RESULTS Total sleep time (TST), total wake time (TWT), and sleep efficiency (SE) were measured with greater accuracy (lower percent errors) and limited bias by Fitbit Ionic [mean absolute percent error, bias (95% confidence interval); TST: 9.90%, 0.25 (-0.11, 0.61); TWT: 25.64%, -0.17 (-0.28, -0.06); SE: 3.49%, 0.65 (-0.82, 2.12)] and Oura smart ring [TST: 7.39%, 0.19 (0.04, 0.35); TWT: 36.29%, -0.18 (-0.31, -0.04); SE: 5.42%, 1.66 (0.17, 3.15)], whereas all other devices demonstrated a propensity to over or underestimate at least one if not all of the aforementioned sleep metrics. No commercial sleep technology appeared to accurately quantify sleep stages. CONCLUSION Generally speaking, commercial sleep technologies displayed lower error and bias values when quantifying sleep/wake states as compared to sleep staging durations. Still, these findings revealed that there is a remarkably high degree of variability in the accuracy of commercial sleep technologies, which further emphasizes that continuous evaluations of newly developed sleep technologies are vital. End-users may then be able to determine more accurately which sleep device is most suited for their desired application(s).
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Affiliation(s)
- Jason D Stone
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Lauren E Rentz
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Jillian Forsey
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Jad Ramadan
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Rachel R Markwald
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
| | - Victor S Finomore
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Scott M Galster
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Ali Rezai
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Joshua A Hagen
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
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27
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Depner CM, Cogswell DT, Bisesi PJ, Markwald RR, Cruickshank-Quinn C, Quinn K, Melanson EL, Reisdorph N, Wright KP. Developing preliminary blood metabolomics-based biomarkers of insufficient sleep in humans. Sleep 2020; 43:zsz321. [PMID: 31894238 PMCID: PMC7355401 DOI: 10.1093/sleep/zsz321] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/27/2019] [Indexed: 01/20/2023] Open
Abstract
STUDY OBJECTIVE Identify small molecule biomarkers of insufficient sleep using untargeted plasma metabolomics in humans undergoing experimental insufficient sleep. METHODS We conducted a crossover laboratory study where 16 normal-weight participants (eight men; age 22 ± 5 years; body mass index < 25 kg/m2) completed three baseline days (9 hours sleep opportunity per night) followed by 5-day insufficient (5 hours sleep opportunity per night) and adequate (9 hours sleep opportunity per night) sleep conditions. Energy balanced diets were provided during baseline, with ad libitum energy intake provided during the insufficient and adequate sleep conditions. Untargeted plasma metabolomics analyses were performed using blood samples collected every 4 hours across the final 24 hours of each condition. Biomarker models were developed using logistic regression and linear support vector machine (SVM) algorithms. RESULTS The top-performing biomarker model was developed by linear SVM modeling, consisted of 65 compounds, and discriminated insufficient versus adequate sleep with 74% overall accuracy and a Matthew's Correlation Coefficient of 0.39. The compounds in the top-performing biomarker model were associated with ATP Binding Cassette Transporters in Lipid Homeostasis, Phospholipid Metabolic Process, Plasma Lipoprotein Remodeling, and sphingolipid metabolism. CONCLUSION We identified potential metabolomics-based biomarkers of insufficient sleep in humans. Although our current biomarkers require further development and validation using independent cohorts, they have potential to advance our understanding of the negative consequences of insufficient sleep, improve diagnosis of poor sleep health, and could eventually help identify targets for countermeasures designed to mitigate the negative health consequences of insufficient sleep.
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Affiliation(s)
- Christopher M Depner
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO
| | - Dasha T Cogswell
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO
| | - Paul J Bisesi
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO
| | - Rachel R Markwald
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO
| | | | - Kevin Quinn
- Skaggs School of Pharmacology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Edward L Melanson
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Eastern Colorado Veterans Affairs Geriatric Research, Education, and Clinical Center, Denver, CO
| | - Nichole Reisdorph
- Skaggs School of Pharmacology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kenneth P Wright
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
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28
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Chinoy ED, Hirsch DA, Cuellar JA, Snider MN, Dunn TL, Brookfield JS, Markwald RR. 0097 Effects of Experimental Sleep Disruption on Morning Cognitive Performance and Alertness. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
While sleep duration is known to affect next-day cognitive performance and alertness, largely in a dose-response manner, the effects of disrupted sleep (where one is awoken multiple times overnight, common in military settings) are much less understood. Therefore, we examined the effects of experimentally disrupted sleep on morning cognitive performance and alertness.
Methods
We tested 34 healthy participants (12 men, 22 women, 28.1±3.9 years; mean±SD) who slept for 8-hours time-in-bed on three consecutive nights with polysomnography in a controlled sleep lab. The final two nights were randomized and counterbalanced between an undisrupted and a disrupted sleep condition. On the disrupted sleep night, participants were awoken by auditory tones for a 5–10 min period every hour. The following morning, participants completed a cognitive test battery that included Karolinska Sleepiness Scale (KSS), 10-min psychomotor vigilance task (PVT), addition calculations (ADD), go/no-go (GNG), task switching (TS), and working memory (WM). Mixed effects models were used to test factors: condition (undisrupted vs. disrupted), condition-order, and their interaction.
Results
Significant (p<0.05) effects of condition (i.e., disrupted sleep caused worse performance) were found for PVT reaction time (RT), GNG RT, TS RT, WM percent correct, and KSS alertness ratings. Condition was not significant for number or percent correct on ADD, GNG, and TS. Condition-order was significant for TS percent correct, and significant interactions were found for ADD number correct and TS RT.
Conclusion
One night of sleep disruption caused significant negative effects on morning subjective alertness and on several, but not all, cognitive performance domains tested, including RT and WM. Condition-order and interaction effects were also found, indicating that some performance outcomes were impacted by possible learning effects over the study. Sleep disruption factors should be taken into account, especially in operational settings like the military where environmental factors (e.g., noise) disrupt sleeping conditions.
Support
Office of Naval Research, Code 34
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Affiliation(s)
- E D Chinoy
- Naval Health Research Center, San Diego, CA
- Leidos Inc., San Diego, CA
| | - D A Hirsch
- Naval Health Research Center, San Diego, CA
| | - J A Cuellar
- Naval Health Research Center, San Diego, CA
- Leidos Inc., San Diego, CA
| | - M N Snider
- Naval Health Research Center, San Diego, CA
- Innovative Employee Solutions, San Diego, CA
| | - T L Dunn
- Naval Health Research Center, San Diego, CA
- Leidos Inc., San Diego, CA
| | - J S Brookfield
- Naval Health Research Center, San Diego, CA
- Leidos Inc., San Diego, CA
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29
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Cogswell DT, Bisesi PJ, Markwald RR, Cruickshank-Quinn C, Quinn K, McHill AW, Melanson EL, Reisdorph N, Wright KP, Depner CM. 0050 Identification of a Plasma Metabolome-Based Biomarker for Dim-Light Melatonin Offset and Onset in Humans. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Easily measuring individual circadian timing is increasingly important to inform personalized chronotherapy, screen for circadian disorders and circadian misalignment, and advance circadian research. Findings from multiple studies show that transcriptomics is a viable method to estimate dim-light melatonin onset (DLMO), but no published omics-based findings have predicted dim-light melatonin offset (DLMOff), and only one known study has used metabolomics to predict DLMO. Here, we developed and tested a plasma metabolomics-based biomarker of circadian phase using DLMO and DLMOff as phase markers.
Methods
Sixteen (8M/8F) healthy participants aged 22.4 ± 4.8y (mean ± SD) completed an in-laboratory study with 3 baseline days (9h sleep opportunity/night), followed by a randomized cross-over protocol with 9h sleep and 5h sleep conditions, each lasting 5 days. Blood was collected every 4h on the final 24h of each condition for untargeted metabolomics analyses. DLMO and DLMOff were determined during the final 24h of each condition. Samples from all conditions were randomly split into training (68%) and test (32%) datasets. DLMO and DLMOff models were developed using partial least squares regression in the training dataset and validated in the test dataset.
Results
When validating with the test dataset, R2 for the DLMO model was 0.60, median absolute error (MdAE) was 2.2 ± 2.8h (± interquartile range), and 44% of samples had MdAE under 2h. R2 for the DLMOff model was 0.62, MdAE was 1.8 ± 2.6, and 51% of samples had MdAE under 2h. The DLMOff model predicted baseline samples, under conditions of 9h sleep and controlled food intake, with an R2 of 0.91 and MdAE 1.1 ± 1.1h.
Conclusion
These findings show promise for metabolomics-based biomarkers of circadian phase and highlight the need for biomarker efforts to predict multiple circadian phase markers. Additional analyses with an independent validation dataset will help advance these initial findings.
Support
NIH-R01HL085705, NIH-R01HL109706, NIH-R01HL132150, NIH-K01HL145099, NIH-F32DK111161, and NIH-UL1TR000154; and Sleep Research Society Foundation 011-JP-16;
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Affiliation(s)
| | - P J Bisesi
- University of Colorado at Boulder, Boulder, CO
| | | | | | - K Quinn
- University of Colorado Anschutz Medical Campus, Aurora, CO
| | - A W McHill
- University of Colorado at Boulder, Boulder, CO
| | - E L Melanson
- University of Colorado Anschutz Medical Campus, Aurora, CO
| | - N Reisdorph
- University of Colorado Anschutz Medical Campus, Aurora, CO
| | - K P Wright
- University of Colorado at Boulder, Boulder, CO
| | - C M Depner
- University of Colorado at Boulder, Boulder, CO
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30
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Dahlquist DT, Chinoy ED, Markwald RR, Chabal SA. 0284 The Effects of a Circadian-Aligned Watchbill Shift Work Schedule on Sleep Quality and Quantity in U.S. Navy Submarine Personnel. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Prior to 2014, the U.S. Navy Submarine Force operated on a non-circadian-aligned watchbill shift work schedule (18-hour day-length) that resulted in insufficient sleep. For instance, prior research reported that submariners received insufficient sleep on this schedule, and modest sleep restrictions can adversely affect performance, alertness, and, ultimately, negatively impact mission outcomes. Thus, the present study characterized sleep patterns of submariners operating on a newer, circadian-aligned 24-hour day-length watchbill.
Methods
Submariners (n=58; 27.8±5.9 years) of various ranks volunteered from a U.S. Navy submarine. Submariners wore a research-grade actigraphy watch over a 30-day underway mission, for objective sleep measurement of time in bed (TIB), total sleep time (TST), and sleep efficiency (SE). Subjective sleep was measured from questionnaires (Pittsburgh Sleep Quality Index [PSQI], Insomnia Severity Index [ISI], Profile of Mood States [POMS-fatigue subscale]) that were taken pre- and post-underway.
Results
Compared with pre-underway, at post-underway submariners reported significantly higher scores on the ISI, PSQI global sleep quality, and POMS-fatigue (all p<0.05, indicating worse sleep and fatigue ratings). According to actigraphy, submariners acquired on average 6.7±1.0 hours TST, 7.5±1.1 hours TIB, and 88.9±3.9 % SE per day throughout the underway mission. Actigraphy-determined TIB and TST were variable compared with PSQI self-reported TIB and TST.
Conclusion
Study results indicate that submariners experience modest sleep restriction on a newly implemented 24-hour watchbill, which is an improvement in sleep relative to prior assessments of the former standard 18-hour watchbill. However, submariners endorsed lower sleep quality and higher fatigue levels from a month-long underway mission. This study is one of the first examinations of sleep under the 24-hour watchbill mandate that was instated in 2014. Future studies should further evaluate sleep and test fatigue mitigation strategies in different shift configurations of the 24-hour watchbill.
Support
Joint Program Committee-5 Fatigue Mechanisms and Countermeasures Working Group
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Affiliation(s)
- D T Dahlquist
- Naval Health Research Center, San Diego, CA
- Leidos Inc., San Diego, CA
| | - E D Chinoy
- Naval Health Research Center, San Diego, CA
- Leidos Inc., San Diego, CA
| | | | - S A Chabal
- Naval Submarine Medical Research Laboratory, Groton, CT
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Markwald RR, Germain A. Waking Up to the Impacts of Sleep Health on Human Performance. Sleep Med Clin 2020; 15:xi. [PMID: 32005354 DOI: 10.1016/j.jsmc.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Rachel R Markwald
- Sleep and Fatigue Research Laboratory, Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92101, USA.
| | - Anne Germain
- University of Pittsburgh School of Medicine, NOCTEM, 218 Oakland Avenue, Pittsburgh, PA 15213, USA.
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Chinoy ED, Huwa KE, Snider MN, Bessman SC, Cuellar JA, Cooper AD, Hirsch DA, Nardulli PJ, Jameson JT, Drummond SPA, Markwald RR. 1002 Examination of Wearable and Non-Wearable Consumer Sleep-Tracking Devices Versus Polysomnography. Sleep 2019. [DOI: 10.1093/sleep/zsz067.999] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Evan D Chinoy
- Naval Health Research Center, San Diego, CA, USA
- Leidos, Inc., San Diego, CA, USA
| | - Kirbie E Huwa
- Naval Health Research Center, San Diego, CA, USA
- Leidos, Inc., San Diego, CA, USA
| | - Michelle N Snider
- Naval Health Research Center, San Diego, CA, USA
- Innovative Employee Solutions, San Diego, CA, USA
| | - Sara C Bessman
- Naval Health Research Center, San Diego, CA, USA
- Eagle Applied Sciences, San Diego, CA, USA
| | - Joseph A Cuellar
- Naval Health Research Center, San Diego, CA, USA
- Innovative Employee Solutions, San Diego, CA, USA
| | | | | | - Patrick J Nardulli
- Naval Health Research Center, San Diego, CA, USA
- Leidos, Inc., San Diego, CA, USA
| | - Jason T Jameson
- Naval Health Research Center, San Diego, CA, USA
- Leidos, Inc., San Diego, CA, USA
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33
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Cogswell D, Markwald RR, Cruickshank-Quinn C, Quinn K, Melanson EL, Reisdorph N, Wright KP, Depner CM. 0041 Preliminary Identification and Validation of a Plasma Metabolome-Based Biomarker for Circadian Phase in Humans. Sleep 2019. [DOI: 10.1093/sleep/zsz067.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dasha Cogswell
- Integrative Physiology, Sleep and Chronobiology Laboratory, University of Colorado, Boulder, CO, USA
| | - Rachel R Markwald
- Sleep and Chronobiology Laboratory, University of Colorado, Boulder, CO, USA
| | | | - Kevin Quinn
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Edward L Melanson
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nichole Reisdorph
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kenneth P Wright
- Sleep and Chronobiology Laboratory, University of Colorado, Boulder, CO, USA
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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34
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Cooper AD, Markwald RR, Kolaja CA, Jacobson IG, Chinoy ED. 0342 Longitudinal Examination of Military-Specific Factors Affecting Sleep Quantity and Quality among U.S. Service Members. Sleep 2019. [DOI: 10.1093/sleep/zsz067.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Claire A Kolaja
- Naval Health Research Center, San Diego, CA, USA
- Leidos, Inc., San Diego, CA, USA
| | - Isabel G Jacobson
- Naval Health Research Center, San Diego, CA, USA
- Leidos, Inc., San Diego, CA, USA
| | - Evan D Chinoy
- Naval Health Research Center, San Diego, CA, USA
- Leidos, Inc., San Diego, CA, USA
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35
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Withrow D, Depner CM, Markwald RR, Melanson EL, Perreault L, Eckel RH, Higgins J, Wright KP. 0108 Insufficient Sleep Alters After-Dinner Consumption of High-Carbohydrate Snacks. Sleep 2019. [DOI: 10.1093/sleep/zsz067.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Dana Withrow
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, CO, USA
| | - Christopher M Depner
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, CO, USA
| | - Rachel R Markwald
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, CO, USA
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Edward L Melanson
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Leigh Perreault
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Robert H Eckel
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Janine Higgins
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kenneth P Wright
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, CO, USA
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Mitzkewich MP, Seda G, Jameson J, Markwald RR. Effects of Insomnia and Depression on CPAP Adherence in a Military Population. Fed Pract 2019; 36:134-139. [PMID: 30983854 PMCID: PMC6453608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Initial self-reported depression and insomnia prior to the diagnosis and treatment of obstructive sleep apnea with continuous positive airway pressure therapy did not reliably predict short- and long-term adherence in a sample of active-duty military and veteran patients.
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Affiliation(s)
- Maggy P Mitzkewich
- is a Clinical Nurse Specialist and is Chair of Pulmonary and Sleep Medicine, both in the Department of Pulmonary, Critical Care, and Sleep Medicine at the Naval Medical Center San Diego in California. is a Senior Scientist, Leidos and is a Sleep Research Physiologist, both in the Warfighter Performance Department of the Naval Health Research Center in San Diego
| | - Gilbert Seda
- is a Clinical Nurse Specialist and is Chair of Pulmonary and Sleep Medicine, both in the Department of Pulmonary, Critical Care, and Sleep Medicine at the Naval Medical Center San Diego in California. is a Senior Scientist, Leidos and is a Sleep Research Physiologist, both in the Warfighter Performance Department of the Naval Health Research Center in San Diego
| | - Jason Jameson
- is a Clinical Nurse Specialist and is Chair of Pulmonary and Sleep Medicine, both in the Department of Pulmonary, Critical Care, and Sleep Medicine at the Naval Medical Center San Diego in California. is a Senior Scientist, Leidos and is a Sleep Research Physiologist, both in the Warfighter Performance Department of the Naval Health Research Center in San Diego
| | - Rachel R Markwald
- is a Clinical Nurse Specialist and is Chair of Pulmonary and Sleep Medicine, both in the Department of Pulmonary, Critical Care, and Sleep Medicine at the Naval Medical Center San Diego in California. is a Senior Scientist, Leidos and is a Sleep Research Physiologist, both in the Warfighter Performance Department of the Naval Health Research Center in San Diego
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Hernández LM, Markwald RR, Kviatkovsky SA, Perry LN, Taylor MK. Morning Cortisol Is Associated With Stress and Sleep in Elite Military Men: A Brief Report. Mil Med 2018; 183:e255-e259. [PMID: 29660025 DOI: 10.1093/milmed/usy047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/13/2017] [Accepted: 03/06/2018] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Accumulating evidence suggests that trends in salivary cortisol after awakening may be reliable biological predictors of morbidity and mortality. In a sample of elite military men, our lab recently established summary parameters of morning cortisol as well as their stability across 2 d of repeated sampling. MATERIALS AND METHODS In this follow-on study, we evaluated summary parameters and their relationships to theoretically relevant demographic (i.e., age, body mass index) and biobehavioral correlates (i.e., blood pressure [BP], sleep parameters, fatigue, and perceived stress). Fifty-eight male active duty U.S. Navy SEALs self-collected salivary samples on 2 consecutive, midweek workdays upon waking (WAKE), WAKE+30 min, WAKE+60 min, 4 p.m., and 9 p.m. in a nondeployed, free-living setting. Resting BP was measured manually, and sleep-wake periods were objectively derived using actigraphy. Daily fatigue and perceived stress were measured by self-report. Summary parameters of morning cortisol magnitude (i.e., peak value [Peak], area under the curve in terms of ground [AUCG], and average of morning samples [AVE]) were assessed with respect to each demographic and biobehavioral item via correlational analyses. A subgroup of 29 participants was selected for compliance with salivary sampling in the morning across 2 d. RESULTS Perceived stress was positively associated with Peak (r[27] = 0.437, p < 0.05), AUCG (r[25] = 0.500, p < 0.01), and AVE (r[25] = 0.506, p < 0.01). Total sleep time was also positively associated with Peak (r[26] = 0.378, p < 0.05). There were borderline associations between some summary parameters and diastolic BP, percent sleep, and wake after sleep onset. Age, systolic BP, body mass index, time in bed, sleep efficiency, and fatigue did not associate with morning cortisol. CONCLUSIONS Preliminary evidence of morning cortisol summary parameters as biobehavioral indicators was established, and these parameters appeared to associate with stress and sleep in elite military men.
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Affiliation(s)
- Lisa M Hernández
- Department of Warfighter Performance, Naval Health Research Center, 140 Sylvester Road, San Diego, CA
| | - Rachel R Markwald
- Department of Warfighter Performance, Naval Health Research Center, 140 Sylvester Road, San Diego, CA
| | - Shiloah A Kviatkovsky
- Department of Warfighter Performance, Naval Health Research Center, 140 Sylvester Road, San Diego, CA
| | - Lori N Perry
- Department of Warfighter Performance, Naval Health Research Center, 140 Sylvester Road, San Diego, CA
| | - Marcus K Taylor
- Department of Warfighter Performance, Naval Health Research Center, 140 Sylvester Road, San Diego, CA
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38
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Abstract
UNLABELLED Cognitive-behavioral therapy for insomnia is superior to sleeping pills for treating insomnia, and its accessibility is rapidly improving. Exercise can also promote sleep in insomnia. A list of recommendations on good sleep practices can be applied prior to consulting with a clinician and can often resolve insomnia symptoms. SUMMARY STATEMENT Insomnia is associated with negative psychological and physiological health outcomes. Established behavioral strategies for addressing insomnia such as adoption of good sleep habits and engagement in Cognitive Behavioral Therapy for Insomnia have documented efficacy. Exercise is also efficacious with unique health benefits.
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Affiliation(s)
| | | | - Shawn D Youngstedt
- College of Health Solutions, Arizona State University
- College of Nursing and Health Innovation, Arizona State University
- Phoenix VA Health Care System
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39
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Markwald RR, Bessman SC, Reini SA, Drummond SPA. Performance of a Portable Sleep Monitoring Device in Individuals with High Versus Low Sleep Efficiency. J Clin Sleep Med 2017; 12:95-103. [PMID: 26285110 DOI: 10.5664/jcsm.5404] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 07/27/2015] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Portable and automated sleep monitoring technology is becoming widely available to consumers, and one wireless system (WS) has recently surfaced as a research tool for sleep and sleep staging assessment outside the hospital/laboratory; however, previous research findings indicate low sensitivity for wakefulness detection. Because difficulty discriminating between wake and sleep is likely to affect staging performance, we sought to further evaluate the WS by comparing it to the gold-standard polysomnography (PSG) and actigraphy (ACT) for overall sleep/wakefulness detection and sleep staging, within high and low sleep efficiency sleepers. METHODS Twenty-nine healthy adults (eight females) underwent concurrent WS, PSG, and ACT assessment in an overnight laboratory study. Epoch-by-epoch agreement was determined by comparing sleep/wakefulness decisions between the WS to both PSG and ACT, and for detection of light, deep, and rapid eye movement (REM) sleep stages between the WS and PSG. RESULTS Sensitivity for wakefulness was low (40%), and an overestimation of total sleep time and underestimation of wake after sleep onset was observed. Prevalence and bias adjusted kappa statistic indicated moderate-to-high agreement between the WS and PSG for sleep staging. However, upon further inspection, WS performance varied by sleep efficiency, with the best performance during high sleep efficiency. CONCLUSIONS The benefit of the WS as a sleep monitoring device over ACT is the ability to assess sleep stages, and our findings suggest this benefit is only realized within high sleep efficiency. Care should be taken to collect data under conditions where this is expected.
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Affiliation(s)
- Rachel R Markwald
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA
| | - Sara C Bessman
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA
| | - Seth A Reini
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA
| | - Sean P A Drummond
- Psychiatry Department, University of California, San Diego, CA.,Psychology Service, VA San Diego Healthcare System, San Diego, CA
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40
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Burke TM, Markwald RR, McHill AW, Chinoy ED, Snider JA, Bessman SC, Jung CM, O'Neill JS, Wright KP. Effects of caffeine on the human circadian clock in vivo and in vitro. Sci Transl Med 2016; 7:305ra146. [PMID: 26378246 DOI: 10.1126/scitranslmed.aac5125] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Caffeine's wakefulness-promoting and sleep-disrupting effects are well established, yet whether caffeine affects human circadian timing is unknown. We show that evening caffeine consumption delays the human circadian melatonin rhythm in vivo and that chronic application of caffeine lengthens the circadian period of molecular oscillations in vitro, primarily with an adenosine receptor/cyclic adenosine monophosphate (AMP)-dependent mechanism. In a double-blind, placebo-controlled, ~49-day long, within-subject study, we found that consumption of a caffeine dose equivalent to that in a double espresso 3 hours before habitual bedtime induced a ~40-min phase delay of the circadian melatonin rhythm in humans. This magnitude of delay was nearly half of the magnitude of the phase-delaying response induced by exposure to 3 hours of evening bright light (~3000 lux, ~7 W/m(2)) that began at habitual bedtime. Furthermore, using human osteosarcoma U2OS cells expressing clock gene luciferase reporters, we found a dose-dependent lengthening of the circadian period by caffeine. By pharmacological dissection and small interfering RNA knockdown, we established that perturbation of adenosine receptor signaling, but not ryanodine receptor or phosphodiesterase activity, was sufficient to account for caffeine's effects on cellular timekeeping. We also used a cyclic AMP biosensor to show that caffeine increased cyclic AMP levels, indicating that caffeine influenced a core component of the cellular circadian clock. Together, our findings demonstrate that caffeine influences human circadian timing, showing one way that the world's most widely consumed psychoactive drug affects human physiology.
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Affiliation(s)
- Tina M Burke
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, Center for Neuroscience, University of Colorado Boulder, Boulder, CO 80309-0354, USA
| | - Rachel R Markwald
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, Center for Neuroscience, University of Colorado Boulder, Boulder, CO 80309-0354, USA
| | - Andrew W McHill
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, Center for Neuroscience, University of Colorado Boulder, Boulder, CO 80309-0354, USA
| | - Evan D Chinoy
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, Center for Neuroscience, University of Colorado Boulder, Boulder, CO 80309-0354, USA
| | - Jesse A Snider
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, Center for Neuroscience, University of Colorado Boulder, Boulder, CO 80309-0354, USA
| | - Sara C Bessman
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, Center for Neuroscience, University of Colorado Boulder, Boulder, CO 80309-0354, USA
| | - Christopher M Jung
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, Center for Neuroscience, University of Colorado Boulder, Boulder, CO 80309-0354, USA
| | - John S O'Neill
- MRC Laboratory of Molecular Biology, Francis Crick Avenue, Cambridge CB2 0QH, UK.
| | - Kenneth P Wright
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, Center for Neuroscience, University of Colorado Boulder, Boulder, CO 80309-0354, USA.
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41
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Eckel RH, Depner CM, Perreault L, Markwald RR, Smith MR, McHill AW, Higgins J, Melanson EL, Wright KP. Morning Circadian Misalignment during Short Sleep Duration Impacts Insulin Sensitivity. Curr Biol 2015; 25:3004-10. [PMID: 26549253 DOI: 10.1016/j.cub.2015.10.011] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/30/2015] [Accepted: 10/05/2015] [Indexed: 12/19/2022]
Abstract
Short sleep duration and circadian misalignment are hypothesized to causally contribute to health problems including obesity, diabetes, metabolic syndrome, heart disease, mood disorders, cognitive impairment, and accidents. Here, we investigated the influence of morning circadian misalignment induced by an imposed short nighttime sleep schedule on impaired insulin sensitivity, a precursor to diabetes. Imposed short sleep duration resulted in morning wakefulness occurring during the biological night (i.e., circadian misalignment)-a time when endogenous melatonin levels were still high indicating the internal circadian clock was still promoting sleep and related functions. We show the longer melatonin levels remained high after wake time, insulin sensitivity worsened. Overall, we find a simulated 5-day work week of 5-hr-per-night sleep opportunities and ad libitum food intake resulted in ∼20% reduced oral and intravenous insulin sensitivity in otherwise healthy men and women. Reduced insulin sensitivity was compensated by an increased insulin response to glucose, which may reflect an initial physiological adaptation to maintain normal blood sugar levels during sleep loss. Furthermore, we find that transitioning from the imposed short sleep schedule to 9-hr sleep opportunities for 3 days restored oral insulin sensitivity to baseline, but 5 days with 9-hr sleep opportunities was insufficient to restore intravenous insulin sensitivity to baseline. These findings indicate morning wakefulness and eating during the biological night is a novel mechanism by which short sleep duration contributes to metabolic dysregulation and suggests food intake during the biological night may contribute to other health problems associated with short sleep duration.
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Affiliation(s)
- Robert H Eckel
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Christopher M Depner
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder CO, 80309, USA
| | - Leigh Perreault
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Rachel R Markwald
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder CO, 80309, USA
| | - Mark R Smith
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder CO, 80309, USA
| | - Andrew W McHill
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder CO, 80309, USA
| | - Janine Higgins
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Edward L Melanson
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Kenneth P Wright
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder CO, 80309, USA.
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42
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Burke TM, Markwald RR, Chinoy ED, Snider JA, Bessman SC, Jung CM, Wright KP. Combination of light and melatonin time cues for phase advancing the human circadian clock. Sleep 2013; 36:1617-24. [PMID: 24179293 DOI: 10.5665/sleep.3110] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Photic and non-photic stimuli have been shown to shift the phase of the human circadian clock. We examined how photic and non-photic time cues may be combined by the human circadian system by assessing the phase advancing effects of one evening dose of exogenous melatonin, alone and in combination with one session of morning bright light exposure. DESIGN Randomized placebo-controlled double-blind circadian protocol. The effects of four conditions, dim light (∼1.9 lux, ∼0.6 Watts/m(2))-placebo, dim light-melatonin (5 mg), bright light (∼3000 lux, ∼7 Watts/m(2))-placebo, and bright light-melatonin on circadian phase was assessed by the change in the salivary dim light melatonin onset (DLMO) prior to and following treatment under constant routine conditions. Melatonin or placebo was administered 5.75 h prior to habitual bedtime and 3 h of bright light exposure started 1 h prior to habitual wake time. SETTING Sleep and chronobiology laboratory environment free of time cues. PARTICIPANTS Thirty-six healthy participants (18 females) aged 22 ± 4 y (mean ± SD). RESULTS Morning bright light combined with early evening exogenous melatonin induced a greater phase advance of the DLMO than either treatment alone. Bright light alone and melatonin alone induced similar phase advances. CONCLUSION Information from light and melatonin appear to be combined by the human circadian clock. The ability to combine circadian time cues has important implications for understanding fundamental physiological principles of the human circadian timing system. Knowledge of such principles is important for designing effective countermeasures for phase-shifting the human circadian clock to adapt to jet lag, shift work, and for designing effective treatments for circadian sleep-wakefulness disorders.
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Affiliation(s)
- Tina M Burke
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, Center for Neuroscience, University of Colorado, Boulder, CO
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43
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Mehesz AN, Brown J, Hajdu Z, Beaver W, da Silva JVL, Visconti RP, Markwald RR, Mironov V. Scalable robotic biofabrication of tissue spheroids. Biofabrication 2011; 3:025002. [PMID: 21562365 DOI: 10.1088/1758-5082/3/2/025002] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Development of methods for scalable biofabrication of uniformly sized tissue spheroids is essential for tissue spheroid-based bioprinting of large size tissue and organ constructs. The most recent scalable technique for tissue spheroid fabrication employs a micromolded recessed template prepared in a non-adhesive hydrogel, wherein the cells loaded into the template self-assemble into tissue spheroids due to gravitational force. In this study, we present an improved version of this technique. A new mold was designed to enable generation of 61 microrecessions in each well of a 96-well plate. The microrecessions were seeded with cells using an EpMotion 5070 automated pipetting machine. After 48 h of incubation, tissue spheroids formed at the bottom of each microrecession. To assess the quality of constructs generated using this technology, 600 tissue spheroids made by this method were compared with 600 spheroids generated by the conventional hanging drop method. These analyses showed that tissue spheroids fabricated by the micromolded method are more uniform in diameter. Thus, use of micromolded recessions in a non-adhesive hydrogel, combined with automated cell seeding, is a reliable method for scalable robotic fabrication of uniform-sized tissue spheroids.
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Affiliation(s)
- A Nagy Mehesz
- Advanced Tissue Biofabrication Center, Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, USA
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44
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Markwald RR, Kirby BS, Crecelius AR, Carlson RE, Voyles WF, Dinenno FA. Combined inhibition of nitric oxide and vasodilating prostaglandins abolishes forearm vasodilatation to systemic hypoxia in healthy humans. J Physiol 2011; 589:1979-90. [PMID: 21486803 DOI: 10.1113/jphysiol.2011.205013] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
We tested the hypothesis that nitric oxide (NO) and vasodilating prostaglandins (PGs) contribute independently to hypoxic vasodilatation, and that combined inhibition would reveal a synergistic role for these two pathways in the regulation of peripheral vascular tone. In 20 healthy adults, we measured forearm blood flow (Doppler ultrasound) and calculated forearm vascular conductance (FVC) responses to steady-state (SS) isocapnic hypoxia (O₂ saturation ~85%). All trials were performed during local α- and β-adrenoceptor blockade (via a brachial artery catheter) to eliminate sympathoadrenal influences on vascular tone and thus isolate local vasodilatory mechanisms. The individual and combined effects of NO synthase (NOS) and cyclooxygenase (COX) inhibition were determined by quantifying the vasodilatation from rest to SS hypoxia, as well as by quantifying how each inhibitor reduced vascular tone during hypoxia. Three hypoxia trials were performed in each subject. In group 1 (n = 10), trial 1, 5 min of SS hypoxia increased FVC from baseline (21 ± 3%; P < 0.05). Infusion of N(G)-nitro-L-arginine methyl ester (L-NAME) for 5 min to inhibit NOS during continuous SS hypoxia reduced FVC by -33 ± 3% (P < 0.05). In Trial 2 with continuous NOS inhibition, the increase in FVC from baseline to SS hypoxia was similar to control conditions (20 ± 3%), and infusion of ketorolac for 5 min to inhibit COX during continuous SS hypoxia reduced FVC by -15 ± 3% (P < 0.05). In Trial 3 with combined NOS and COX inhibition, the increase in FVC from baseline to SS hypoxia was abolished (~3%; NS vs. zero). In group 2 (n = 10), the order of NOS and COX inhibition was reversed. In trial 1, five minutes of SS hypoxia increased FVC from baseline (by 24 ± 5%; P < 0.05), and infusion of ketorolac during SS hypoxia had minimal impact on FVC (-4 ± 3%; NS). In Trial 2 with continuous COX inhibition, the increase in FVC from baseline to SS hypoxia was similar to control conditions (27 ± 4%), and infusion of L-NAME during continuous SS hypoxia reduced FVC by -36 ± 7% (P < 0.05). In Trial 3 with combined NOS and COX inhibition, the increase in FVC from baseline to SS hypoxia was abolished (~3%; NS vs. zero). Our collective findings indicate that (1) neither NO nor PGs are obligatory to observe the normal local vasodilatory response from rest to SS hypoxia; (2) NO regulates vascular tone during hypoxia independent of the COX pathway, whereas PGs only regulate vascular tone during hypoxia when NOS is inhibited; and (3) combined inhibition of NO and PGs abolishes local hypoxic vasodilatation (from rest to SS hypoxia) in the forearm circulation of healthy humans during systemic hypoxia.
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Affiliation(s)
- Rachel R Markwald
- Human Cardiovascular Physiology Laboratory, Department of Health and Exercise Science, Vascular Physiology Research Group, Colorado State University, Fort Collins, CO 80523-1582, USA
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Norris RA, Moreno-Rodriguez R, Wessels A, Merot J, Bruneval P, Chester AH, Yacoub MH, Hagège A, Slaugenhaupt SA, Aikawa E, Schott JJ, Lardeux A, Harris BS, Williams LK, Richards A, Levine RA, Markwald RR. Expression of the familial cardiac valvular dystrophy gene, filamin-A, during heart morphogenesis. Dev Dyn 2010; 239:2118-27. [PMID: 20549728 DOI: 10.1002/dvdy.22346] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Myxoid degeneration of the cardiac valves is a common feature in a heterogeneous group of disorders that includes Marfan syndrome and isolated valvular diseases. Mitral valve prolapse is the most common outcome of these and remains one of the most common indications for valvular surgery. While the etiology of the disease is unknown, recent genetic studies have demonstrated that an X-linked form of familial cardiac valvular dystrophy can be attributed to mutations in the Filamin-A gene. Since these inheritable mutations are present from conception, we hypothesize that filamin-A mutations present at the time of valve morphogenesis lead to dysfunction that progresses postnatally to clinically relevant disease. Therefore, by carefully evaluating genetic factors (such as filamin-A) that play a substantial role in MVP, we can elucidate relevant developmental pathways that contribute to its pathogenesis. In order to understand how developmental expression of a mutant protein can lead to valve disease, the spatio-temporal distribution of filamin-A during cardiac morphogenesis must first be characterized. Although previously thought of as a ubiquitously expressed gene, we demonstrate that filamin-A is robustly expressed in non-myocyte cells throughout cardiac morphogenesis including epicardial and endocardial cells, and mesenchymal cells derived by EMT from these two epithelia, as well as mesenchyme of neural crest origin. In postnatal hearts, expression of filamin-A is significantly decreased in the atrioventricular and outflow tract valve leaflets and their suspensory apparatus. Characterization of the temporal and spatial expression pattern of filamin-A during cardiac morphogenesis is a crucial first step in our understanding of how mutations in filamin-A result in clinically relevant valve disease.
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Affiliation(s)
- R A Norris
- Cardiovascular Developmental Biology Center, Department of Regenerative Medicine and Cell Biology, Children's Research Institute, Medical University of South Carolina, 173 Ashley Avenue, Charleston, SC 29425, USA.
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Markwald RR, Lee-Chiong TL, Burke TM, Snider JA, Wright KP. Effects of the melatonin MT-1/MT-2 agonist ramelteon on daytime body temperature and sleep. Sleep 2010; 33:825-31. [PMID: 20550024 DOI: 10.1093/sleep/33.6.825] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES A reduction in core temperature and an increase in the distal-proximal skin gradient (DPG) are reported to be associated with shorter sleep onset latencies (SOL) and better sleep quality. Ramelteon is a melatonin MT-1/MT-2 agonist approved for the treatment of insomnia. At night, ramelteon has been reported to shorten SOL. In the present study we tested the hypothesis that ramelteon would reduce core temperature, increase the DPG, as well as shorten SOL, reduce wakefulness after sleep onset (WASO), and increase total sleep time (TST) during a daytime sleep opportunity. DESIGN Randomized, double-blind, placebo-controlled, cross-over design. Eight mg ramelteon or placebo was administered 2 h prior to a 4-h daytime sleep opportunity. SETTING Sleep and chronobiology laboratory. PARTICIPANTS Fourteen healthy adults (5 females), aged (23.2 +/- 4.2 y). MEASUREMENTS AND RESULTS Primary outcome measures included core body temperature, the DPG and sleep physiology (minutes of total sleep time [TST], wake after sleep onset [WASO], and SOL). We also assessed as secondary outcomes, proximal and distal skin temperatures, sleep staging and subjective TST. Repeated measures ANOVA revealed ramelteon significantly reduced core temperature and increased the DPG (both P < 0.05). Furthermore, ramelteon reduced WASO and increased TST, and stages 1 and 2 sleep (all P < 0.05). The change in the DPG was negatively correlated with SOL in the ramelteon condition. CONCLUSIONS Ramelteon improved daytime sleep, perhaps mechanistically in part by reducing core temperature and modulating skin temperature. These findings suggest that ramelteon may have promise for the treatment of insomnia associated with circadian misalignment due to circadian sleep disorders.
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Affiliation(s)
- Rachel R Markwald
- Department of Integrative Physiology, Sleep and Chronobiology Laboratory, Center for Neuroscience, University of Colorado, Boulder, CO 80309-0354, USA
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Markwald RR, Kirby BS, Carlson RE, Voyles WF, Dinenno FA. Hypoxic Vasodilation in Human Skeletal Muscle: contributions of nitric oxide and vasodilating prostaglandins. FASEB J 2008. [DOI: 10.1096/fasebj.22.1_supplement.967.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Brett S Kirby
- Health and Exercise ScienceColorado State UniversityFort CollinsCO
| | - Rick E Carlson
- Health and Exercise ScienceColorado State UniversityFort CollinsCO
| | - Wyatt F Voyles
- Heart Center of the RockiesPoudre Valley Health System, Fort CollinsCO
| | - Frank A Dinenno
- Health and Exercise ScienceColorado State UniversityFort CollinsCO
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Carlson RE, Pudwill L, Kirby BS, Markwald RR, Voyles WF, Dinenno FA. Influence of sympathetic vasoconstriction on contraction‐ and mechanically‐induced rapid vasodilation in humans. FASEB J 2008. [DOI: 10.1096/fasebj.22.1_supplement.745.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rick E Carlson
- Health and Exercise ScienceColorado State UniversityFort CollinsCO
| | - Linnea Pudwill
- Health and Exercise ScienceColorado State UniversityFort CollinsCO
| | - Brett S Kirby
- Health and Exercise ScienceColorado State UniversityFort CollinsCO
| | | | - Wyatt F Voyles
- Heart Center of the RockiesPoudre Valley Health System, Fort CollinsCO
| | - Frank A Dinenno
- Health and Exercise ScienceColorado State UniversityFort CollinsCO
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Kirby BS, Carlson RE, Markwald RR, Voyles WF, Dinenno FA. Mechanical influences on skeletal muscle vascular tone in humans: insight into contraction-induced rapid vasodilatation. J Physiol 2007; 583:861-74. [PMID: 17495044 PMCID: PMC2277182 DOI: 10.1113/jphysiol.2007.131250] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We tested the hypothesis that mechanical deformation of forearm blood vessels via acute increases in extravascular pressure elicits rapid vasodilatation in humans. In healthy adults, we measured forearm blood flow (Doppler ultrasound) and calculated forearm vascular conductance (FVC) responses to whole forearm compressions and isometric muscle contractions with the arm above heart level. We used several experimental protocols to gain insight into how mechanical factors contribute to contraction-induced rapid vasodilatation. The findings from the present study clearly indicate that acute increases in extravascular pressure (200 mmHg for 2 s) elicit a significant rapid vasodilatation in the human forearm (peak DeltaFVC approximately 155%). Brief, 6 s sustained compressions evoked the greatest vasodilatation (DeltaFVC approximately 260%), whereas the responses to single (2 s) and repeated compressions (five repeated 2 s compressions) were not significantly different (DeltaFVC approximately 155% versus approximately 115%, respectively). This mechanically induced vasodilatation peaks within 1-2 cardiac cycles, and thus is dissociated from the temporal pattern normally observed in response to brief muscle contractions ( approximately 4-7 cardiac cycles). A non-linear relation was found between graded increases in extravascular pressure and both the immediate and peak rapid vasodilatory response, such that the responses increased sharply from 25 to 100 mmHg, with no significant further dilatation until 300 mmHg (maximal DeltaFVC approximately 185%). This was in contrast to the linear intensity-dependent relation observed with muscle contractions. Our collective findings indicate that mechanical influences contribute largely to the immediate vasodilatation (first cardiac cycle) observed in response to a brief, single contraction. However, it is clear that there are additional mechanisms related to muscle activation that continue to cause and sustain vasodilatation for several more cardiac cycles after contraction. Additionally, the potential contribution of mechanical influences to the total contraction-induced hyperaemia appears greatest for low to moderate intensity single muscle contractions, and this contribution becomes less significant for sustained and repeated contractions. Nevertheless, this mechanically induced vasodilatation could serve as a feedforward mechanism to increase muscle blood flow at the onset of exercise, as well as in response to changes in contraction intensity, prior to alterations in local vasodilating substances that influence vascular tone.
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Affiliation(s)
- Brett S Kirby
- Department of Health and Exercise Science, Colorado State University, 220 Moby-B Complex, Fort Collins, CO 80523-1582, USA
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Abstract
Muscle sympathetic vasoconstrictor nerve activity increases with advancing age, but does not result in elevated forearm vasoconstrictor tone because of a selective reduction in alpha1-adrenoceptor responsiveness. In contrast, the leg circulation of older adults is under greater tonic sympathetic vasoconstriction, but it is unclear whether alpha-adrenoceptor responsiveness is altered with age. In the present study, we tested the hypothesis that postjunctional alpha-adrenergic vasoconstrictor responsiveness is reduced in the leg circulation with age. We measured femoral blood flow (Doppler ultrasound) and calculated the femoral vascular conductance (FVC) responses to alpha-adrenoceptor stimulation during local blockade of beta-adrenoceptors in 12 young (24 +/- 1 year) and seven healthy older men (62 +/- 2 year). Whole-leg vasoconstrictor responses to local intrafemoral artery infusions of tyramine (evokes noradrenaline (NA) release), phenylephrine (alpha1-agonist) and dexmedetomidine (alpha2-agonist) were assessed. Consistent with previous data, resting femoral blood flow and FVC were approximately 30% lower in older compared with young men (P < 0.05). Maximal vasoconstrictor responses to tyramine (-30 +/- 3 versus -41 +/- 3%), phenylephrine (-25 +/- 4 versus -45 +/- 5%), and dexmedetomidine (-22 +/- 4 versus -44 +/- 3%) were all significantly lower in older compared with young men (all P < 0.05). Our results indicate that human ageing is associated with a reduction in leg postjunctional alpha-adrenoceptor responsiveness to endogenous NA release, and this reduction is evident for both alpha1- and alpha2-adrenoceptors. However, given that basal leg vascular conductance is reduced with age and is primarily mediated by sympathetic vasoconstriction, impaired alpha-adrenoceptor responsiveness does not negate the ability of the sympathetic nervous system to evoke greater tonic vasoconstriction in the leg vasculature of older men.
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Affiliation(s)
- Erica G Smith
- Department of Health and Exercise Science, Colorado State University, 220 Moby-B Complex, Fort Collins, CO 80523-1582, USA
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