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DTIC ADA420330: The Efficacy of Modafinil for Sustaining Alertness and Simulator Flight Performance in F-117 Pilots During 37 Hours of Continuous Wakefulness PDF

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Preview DTIC ADA420330: The Efficacy of Modafinil for Sustaining Alertness and Simulator Flight Performance in F-117 Pilots During 37 Hours of Continuous Wakefulness

—_—_———e United States Air Force Research Laboratory aE Ra ee ee THE EFFICACY OF MODAFINIL FOR SUSTAINING ALERTNESS AND SIMULATOR FLIGHT PERFORMANCE IN F-117 PILOTS DURING 37 HOURS OF CONTINUOUS WAKEFULNESS John Caldwell Lynn Caldwell Jennifer Smith Linda Alvarado: Tara Helntz Jeffery Mytar David Brown HUMAN EFFECTIVENESS DIRECTORATE BIOSCIENCES AND PROTECTION DIVISION FATIGUE COUNTERMEASURES BRANCH 2485 GILLINGHAM DRIVE BROOKS GITY-BASE TX 78235-5105 Aanuary 2004 —_____——___ [Aupreved fr public release, distribution unlimited | Avproved fr blierelewse, disuibulion uulimites | 20040226 104. Novices ‘This report is published in the inberast of sclentific and technica! Information ‘exchange and does not constitute approval ar disapproval of Its Ideas or findings. ‘Thi report is published as racaived and has not been edited by the publication staff of the air Farce Research Laboratory, Using Government drawings, specifications, or other data included in this doaiment for any purpose other than Government related procurement does not in ‘any way obligate the US Government. The fact that the Government formulated ar supplied the drawings, specificatians, ar other data, does nat license the holder or Any other person or corporation, or convey any rights oF permission to manufacture, se, or stl any patented invention that may relate to them. ‘The Office of Public affairs has reviewed this paper, and it releasable to the National Technical infonnation Service, where it will be available to te general ‘ublis, nduding foreign nationals. ‘This raport has been reviewed and is approved for publication, ASIGNEDI {JOHN A, CALDWELL, Ph.D. Project Selentiet SIGNED}! THOMAS L, CROPPER Col USAF, BSC chief, Biosciences and Protection Division REPORT DOCUMENTATION PAGE oe Ne brerote® | Saiiar an ae eM ERECTED Te tenes Sue Lise Retire Hen 2 mcr Shear ean ee ont rswmins Ace wl Salata Fgh Fim TREAT ew Duta Hose Grn Was ST HOREER eh0F STH) ‘#5 PROIECT NONBER ‘Caley lok, Colo, Lun, Suit fens, Aber Tania, Meine, Too, iyls, | 377 Jelly. rows, David | PB SCOR TER ot il 1 ERFGRTIN GHANTERTION WARES] AD OORESSTEST EERIE ORSATERTON REPORT Hunn Beretenes Deeb Mwiences and Potstior Diaion argue Cauntermesnies Rrarch AERLAIL-DR-TR 2406-9008, 2788 Giliagnam Drive Brake Giy-Base, TX IASS105 '-SFERSORING MOMTORING AGENCY NRE) RND ADDRESS) - | ia SPORFORMOUTORS ACRONTINS| —| APRLDE UBER) "EL STANTON AVARASTEY €TTETENT Apwoved for publics, seule unlit [a 0RPLEEITARY OTE ‘The poset study detrned heer taf (OD afc 1720, 208.27 hoary whol ep) aeons th effects of fatigue oa figher pl alemnoe and pnfomunee A qhusi-<apecimens ingen, ceacbalaned dos-gn was used in whic 3 pls rum a prvicnsF1) tage study (en hich ne Aigueromody nas exipleye) were eet: wth moda. Thel aa woro combined wi he (sh fo §nevlgennuiod F-117 plete to wer evabsted umfer neal aed ton pecbo. Madatini émprove vgn: apt {cling peters in ivieaenion lik, CNS activation. oelemotr performance ane at2cs of subj mood. FUERt povlonmanon devtenea’s were mitigated on ss eight eaneavere, Beueie mae moxraticeale nie 221 +2 hur wnat beltness, Althnsh odafuu: id not smaio performance pre-depovton lvls, tes eumorous pieces make ita ass not ete oureuty approved fiyus oumtannestre dextonrperamine, Howey, moi seid rat he cote a replacment forth alr sempount. A foloo-o3ifligh andy i recommended. ‘gue, Sastied Operon, Mode, Provgh Avion, Wight Pils, Couterarasues (5 ECORI CLISERICRTON OF ~ [a DRRRTR a NUWRER Toa AME OF RESPORTTELE PEROT Sragereact | OePAGES | Joka Calinedl REPORT EABTRAGT ~~] ETH FREE] unease oo Yan TELEPHORENUOER tara] nels ‘aster Unease a t jas6an Eo aad ‘TABLE OF CONTENTS, BACKGROUND ‘The Casses of Farigne ip Operational Contexts ‘The Ieppact of Fatigue on Military Performance . Fatigue Remedies for Operational Setings ‘Nonpharmavological Strategies ‘Pharmacofogical Strategies ‘Amiphetariines OBLECTIVES. METHODS... Subjects Apparat ‘Compound robe cvaluated (nodal) Mu4-Alribute Test Butery (MATS). “Mubveratical Processing... ‘Oselomotor (FIT Workglace Safety Sereering) Evaluation Physiological data rcording, i. Profil of Mood Stas Vinual Analog Seales Side effets rating scale‘Simulater Si ois Quon (80), light Simulator. WAM (Wrist Activ Menor Pravedce Invprocessing. General approac General schedule for re-reerited pilots General schedle for nen recruited pias, Schedule for both groups of pilots DATA ANALYSIS. RESULTS General Participant Cheactritcs. Sleep Batimales. Muli-Antebute Task Battery Communications Systems monitoring Poel monitoring Unstable wcking -Mathematicel procersing ‘Reaction time for eottect responses. Standard deviation of RI for corre! tempos. ‘Accuracy Through ‘Oculomotor (FIT) data Pupil diameter Pupil consiriction amatitade Pupil constriction latency. Saocadiec velocity Resting EEG data, Delta activity Theta acuity Alpha setivity Profile of Mood States. Tension‘enaiety Depressiam‘lgjection, Angerhostlny Vigoeactivay Fotiguefivertia Confusien-bessldorment. Visual Analog Seale Aleriness Energy Amiely. Iiabilty Jinteriness ‘Sleepiness. Confidence Talkativens§§v To-fight fsinmlator) ERG, ‘Stoulator Flight Performance. Srreighr climb. Straight descent Left 720 tam Loft climbing tum Le 360 tum Right descending tum, Right 360 tum Steaight and lovels, Composite Fight performance + Simulator Sickness Questionnaire Side Effects Questionnaire DISCUSSION, General Fatigue Effects Efficacy of modafinil.. Cognitive effects Physiological status, Subjective raring Simutater flight performance. ‘Modafinil side effects SUMMARY AND CONCLUSIONS we BS ‘ACKNOWLEDGMENTS, vn . RR REFERENCES se . 39 LIST OF FIGURES Pay Figure 1. Schematic of cach ofthe sleep deprivation tet eye... 28 Figure2_ The combined effets of reatueut condition an esting times on TO erors uring the MATB communications task a Figure 3. The effects of sleep deprivation (wih rearment condition cellapeed) on RT (eft) and SDRT (right) during the MATB systems-r.onitaring wk a Figure 4. ‘The effects of sleep deprivation (with treatment condition collapsed) or the Gevintions of fuel ievels in tanks A and B during the MAT fuel-monitoring task... FigurS, Theconbine effets of esimentcaon ad oing ine (Pah the overt effect oftime on MATR tracking (ight). 4s Figwe 6. The combined impact of eatatem condition and testing tine (lc) and the ‘overall offol of testing me (right) cm FIT pupil diameter. a Figure 7, ‘The ovetll etfsc of sleep deprivation (testing timc) en FTT pupil constition neney. ae Figare 8, The combined impect of eatin? condition and testing time em FIT saccadic velocity 49 Figure 9. ‘The imoractive effects of teatmers condition und eye closure on resting FPG. delta activity at Cx and Paz SI Figure 70, The overall condition main effects (modafinil vereus placebu} on esting Eo delta acuivity at Cz, Pz, and Or. Figure 11 Thc overal eflects of sleep deprivation (esting tne) on resting BEG deta activity af Pz and O2... st Figure 12. The infsracive sfftets of condition, testing time, and eye closare on resting ‘BEG theta activity at P 33 Figure "3. The combined fects of testing dine and eyes on resting BEG thote aetivty al Fzand Or. 33 Figure 14. The combinod offcts of weuimen’ condition and testing tie on resting EEG ‘theta activity at Oz. 34 Figure 15. The oveeal eitects of ween! omaition (rmadadail versus placebo) on resting EEG theta scivity al Cz, Pr, and Oz. si igure 16. The effecis af time on resting EEG theta activity at Pz 24 O2 nnn igure 17, The combined cffccta of testing time and eye on resting EEG alpha activity at Cz and Pa. : i" 56 Figure 18. The marginaliy-signéficamt interactive effects of reatmnent com closure ou resting EEG alpha activity 8¢ 02. Figure 19. The interactive effets of woetment condiion and testing time on POMS Uepression-dejetion tings nn 38 Tigare 20, The overal impact of teateneat condition Grodan] versus placebo} on ‘POWS unger-hostity ratings. a" 38 Figure 21. The separate impact of treatment conditinn (modafinil versus placebu) and sleep deprivation (esting timc) 03 POMS vigor-activily ratings oe Figure 22. The impact of sleep deprivation testing time) and condition ae POSES fatigue. neta TaN nn - - st Figure 23. The overall iespact af slesn deprivation (esting time) on POMS confusion. bewilderment ratings. . nl Figure 24, The effocis uf sleep deprivation (isting tite) on VAS alertness, energy, jiteriness, sloepiness, confidence. and tlkativeness ratings, “a Figuro 25. The independent effects of treatment condition and lestiog time on performance of the st2ightclim® sn ; we os Figure 26. Tke independent effecss of treatment condition and testing time 02 performance of the straight 465020 rnsnnnen rene 68 Figure 27. The interactive eifects of both treatment eonsiion and sheep depeivation on performance of We left 720-degree ca. ° Figure 26, The indeperident impact of reafnicat conition (racdafn’l versus places) on performance of the Jet climbing urn. ss ee Figure 28. Tae non-significant pater of condition and tie effets on performance on the left 360-deyree tam . — TD Figure 30, The marginally-significant interactive efesis of weatment condition and deep ‘deprivation (testing time) on the performance ofthe right descending fur, 7 Figure 3). The overall impact af weatmnent condition (medafinil versus placcha) oa tbe pperformaice of the right 360-deyree tam n Figure 32. The overat] impact of treatment condition (modafinil versus placebo) onthe performance ofthe stafght-and-level maneuvers a Figure 33 The overall effects of weat-nont condition on tach maneuver (lef and tre intersetive effects of yeatment condition and sleep deprivation across all raneuveze combined (right) ‘ 74 Figure 34. The general impact of slosp deprivation (testing time) on visuomotor seates ‘eft) ond toral-liscomafor scores (ight) on the SSQ. . oS LIST OF TARLES Base Table 1. Mewsured simolator Hight parameters an a eee) Table 2, Flight maneavers, 7 “Table 3. Peremecters evaluated in each ofthe Aight mancuvers . 34 ‘Table 4. Aye and Slight experience data forthe two groups. 39 Table 5. Actigraph-based estimules of sleep timss. 40 Table 6. Side effects reported under the mpdafinil und placebo eonditions, 76 BACKGROUND US. superiority in eoday’s bare space in pat toms from our aiity to raintain pressure the enemy by making them fight around Ie lock. By forcing our adversaries to mrintin « 2-hour-day operational tempo, enemy eres wil ef fram severe sleepiness leading to procedural ers, sloppy udment por planning, anda general inability to act propery fo repilly changing situations. This provides a tactical aalvanrago for the U.S. snd is part of the reason that the Air Foree Chief of StalT noted that persistent and sustained operations, 24 hour a day, 7 days a week, are essential to extabliching and malntaining superioriy in today’s combat environment (Elliot, 2001). Simply forcing our enemies to perorr continuously without he benef of sufficient daily sloop is very effective weapon in and ofits “The Causes of Fatigue in Operational Conteus ‘Unfortunately, the conduct of eantnuous and sustained opcations cen pose significant harurds 1 our own tops ifs area’ careful 1o property manage fatigne among ourselves, Personnel and resource cutbacks within the U.S, Deparmmencof Defense aver the past several yoars huvs resulted in force reductions of over 40 percent in the Aumny Department of de Army, 1996) and inthe Air Fores (Congressional Rescaret Service, 2002), wile the operations ter bas inereused hy as much es 40 pereent (Comel, 1996). Needless to say. U.S. mlitry capes are increasingly sosined as understaffed arts nrive to axcampiah more work with fewer resources. Some Fe! chat this har rested in dnnished military smal eadiness (Spencer, 2008), in part because of increased cognitive fatigue, ‘There is Tittle doubt that existing manpower consbainis have made it diffe! te continously staf Uhe required work shifs with well-esled personnel around the clock. Thus, prolonged werk bouts bave beeoms comune, sorter than-normal sleep periods. unsvoidrbe, an fatigue Ro: bath ofthese factors tests ta meet operational readiness (Dopantmant ofthe Amy, 1944), Tis well eetablshel hal eustained ‘Wakefitmess andthe resuking cumulative sleep debt inerease the Iheood that personnel will briefly (and uncoainTbly) nod off on thajob, even durig demanding tasks (Angus ang Hslograve, 1985). The longer personnel remit ake, the more likely these sleep attacks” become, I adian, Meepiness aes heavy tol on resction tine, motivation, atention, memory, endatance, and judgment ekrueger, 1991), Even in peacetime, ovedy tired solders and aviators are tout ta he responsible for mumerows Gsfgue-stated incideus an wecilensovery year (personal communication, 14Col oomas Luna, US. Air Forge Safety Center, May, 2003) “The Impact of Fatigue on Miliicy Performance Although proaictions about the exac: eects of fli ae dfticut to ako. mos researchers agree tha fitigns-telated performance and alertness decrements flow a fairly reliable time conse. Canadian resstchers have posted that certain ments abilities decline by about 30 percect after] nighl without sleep ar 6M percent after 2 nights without sleep (Angus, Piyeau, and Haslegtave, 1992), Seleutists at che Walter ood Army Instivate of Research predict xaldios lose abuul 25 percent oftheit ability 10 perform useful mental work for every 24 hours. af eontinuons wake fulness eleuky' et w, 1998). A recent Air Foree Research Laboratory study reveatod thal current, active: duly Cightor pilots suffered Tiyht-performance doctines of 45 pereent below normal afer (Caldvvell ef al, 2003). Fatigue Remodics for Operational Settings 1c isa signifieart prablera in sustained military operations, expecially nthe aviatnm selar whete a bigh level of vogitive perfomance is eesti for safety and effectiveness, However, Frigue can be manaysd with scientifcaly- validated countermescures. Sores ditferent strategies have een proposed for this purpose ‘Nowhscmusolugical Satsrios Fauphesiing oper worktest management is one sate thatthe lary bas rightly focuseé upon for may years. However, when tho nica of combat reaches a cetsn pont, it can be very dificult ta proporly cone sleep paris, ao thi ean lead wo a substential problem with omthoob fatigue (Commun, 1997; Angus, Pigea and Heslegrave, 1992), Even during peacctime, «recent survey of U.S. Army pilots revealed that 26 percent conplsined of poor sep while inthe field or while travoling emay from ‘ur compared to only 5 percent comalaining of poor slasp al heir home post (Caldwell tal, 2008), Slmilse difficulties are no-doubt resect in he US, Air onus, aldioug sublished docunentation on this point is unavailable, Snegie mp can help allovinte slep-deprvaron elated performance decrements in situations where neps ae feasible (Dinges eta, 1988). However, scheduling maps is nota staple mater in that opensional constants can male it very dilcatto ensue ‘proper control over nup timing (placsment of naps at optimal poins in tre sleep deprivation period), nap duration (ensuring sufficient slp time), and nap scheduling,

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