How stressful are 105 days of isolation? Sleep EEG patterns and tonic cortisol in healthy volunteers simulating manned flight to Mars
Introduction
Poor sleep quality has been frequently described as a common response to stress or distress (Van Reeth et al., 2000). The exposure to chronic stress often determines alterations of sleep, affecting both NREM and REM phases. NREM changes consistently observed in human studies are the increase of shallow sleep and the reduction of Slow Wave Sleep (SWS or NREM stage N3). REM changes are the increase of its duration and the shortening of the latency of the first REM period, and a general increase of REM density (Van Reeth et al., 2000). Studies both on animal models of chronic stress (Cheeta et al., 1997, Opp, 1995) and on humans (Opp, 1995) suggest that these alterations are likely mediated via corticotropin-releasing hormone (CRH) release, which in turn stimulates endogenous adreno-cortico-tropic hormone (ACTH) and cortisol secretion (i.e. hypothalamic pituitary adrenal axis – HPA – activation). HPA hyperactivation related to chronic stress is paralleled by a right hemisphere hyperarousal during wake (Hewig et al., 2008).
Astronauts involved in real or simulated long-term missions represent a model for the study of chronic stressful engagement with “real or simulated extreme environment” (Monk et al., 1998). Reduction of SWS and REM sleep, shortening of REM latency and increase of arousals are typically observed in short-term space missions, due to circadian rhythm phase shifts, heightened workload demand, emergencies, and more in general, extraordinary stressful environmental conditions (Dijk et al., 2001, Mallis and DeRoshia, 2005). In this light, a crucial problem for long lasting manned missions in space is represented by sleep alterations. Sleep EEG data from long-term space missions are scarce and ground-based simulation of long lasting missions is at present the experimental condition of choice for the study of such alterations. Recently, a study investigating the relationships between sleep and long lasting spaceflight simulation has been published (Basner et al., 2013). This study, based on actigraphy and neurobehavioral assessment, identified that the simulation of long lasting space mission induces alterations of sleep quality and of sleep-wake periodicity and timing, which are mainly sustained by an inadequate circadian entrainment.
Here we report a study in which the model of stress is represented by the simulation of the human flight to Mars (MARS105, pilot phase of the MARS500 project). Six healthy volunteers were kept for 105 days within an isolation facility mimicking a spacecraft and were studied during the flight simulation as well as right before and after the period of confinement. In this condition, stress was represented by social and environmental confinement, enforced interaction between crewmembers, resources rationing, limited and lagged communications with the outside and environmental acoustic noise.
The working hypothesis of the study addresses the issue of stress vulnerability to spatial confinement and social isolation in a super-selected and well-trained population. This pilot study is the first international attempt aimed at identifying indices of abnormal stress responses in healthy volunteers in order to design and develop ad hoc countermeasures to be administered in the study of 520 days of isolation (MARS 500), which represents the real simulation of human flight to Mars. The aim of the study was to examine how stress, measured by tonic cortisol levels and subjectively perceived stress levels, affects sleep in terms of structure and EEG power/lateralization and whether it produces long lasting effects on cognitive abilities and emotional state that persist beyond the confinement duration.
As in many simulation studies with such complex experimental setups (Basner et al., 2013, Schneider et al., 2010), the choice of an appropriate statistical analysis has been conditioned by two important issues concerning the high number of parameters necessary for sleep characterization and the involvement of a small number of participants and sampling times. In order to override these intrinsic limitations, a hierarchical approach aimed at pruning the numerous variables that characterize sleep patterns was employed in the data analysis. Principal Component Analysis (PCA) and confirmatory ANCOVAs performed on the selected variables allowed the identification of significant associations between specific sleep features and cortisol levels, considered by consensus a reliable indicator of stress.
Section snippets
Subjects selection and experimental setup
Six healthy right-handed male volunteers (mean age 33 ± 6 years) have been selected for a 105-days (from March 31st to July 14th, 2009) mission to Mars simulation organized by the Institute for Biomedical Problems (IBMP, Moscow, Russia) and the European Space Agency (ESA). Crewmembers selection procedures, based on a thorough psychophysical evaluation of the candidates, were the same of those used for real astronauts (for further details on the selection procedure see Supplementary material). The
Cognitive and emotional neuro-psychological evaluation
The comparison of psychometric scores did not reveal significant differences between BDC and RDC phases either for cognitive abilities or for emotional state (see Table 1).
Stress and sleep time-domain parameters
Table 2 summarizes descriptive statistics of stress and sleep time-domain parameters related to each subject. Note that crewmembers showed on average: (i) perceived stress scale (PSS) scores lower than normative levels (Cohen and Williamson, 1988); (ii) cortisol levels within the normality range (Görges et al., 1999), and
Discussion
We investigated the relationships between stress, sleep, cognitive abilities and emotional state in six male volunteers enrolled in the MARS500 pilot phase and sealed within an isolation facility module for 105 days.
The principal result of this study is the identification of relationships between stress markers and specific sleep macrostructure features as well as EEG rhythms.
Crewmembers showed perceived stress scale (PSS) scores lower than normative levels (Cohen and Williamson, 1988) and
Acknowledgments
This work is dedicated to the memory of Prof. Mario Guazzelli.
This research was supported by Italian Space Agency (ASI) through grant ASI no. I/006/09/0
We thank the Institute of Biomedical Problems (IBMP, Moscow, Russia) and the European Space Agency (ESA) for the organization of the 105 day simulation.
We thank Luca Bastiani and Marco Scalese of Social Epidemiological Section of the Institute of Clinical Physiology of the National Research Council for revising the statistical procedures.
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