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Kevin B Gregory

Publications and source records attributed to Kevin B Gregory.

Sex Differences in Perceptions of Sleep Inertia Following Nighttime Awakenings

Study Objectives: The influence of biological sex on sleep inertia symptoms is currently unknown. We investigated the role of sex differences in the subjective experience and objective cognitive manifestation of sleep inertia following nighttime awakenings. Methods: Thirty-two healthy adults (16 female, 25.91 ± 5.63 years) completed a one-week at-home study with one experimental night during which sleep was measured by polysomnography and participants were awakened during their habitual sleep time. Participants completed a psychomotor vigilance task (PVT), Karolinska Sleepiness Scale (KSS), visual analog mood scales, and a descending subtraction task (DST) prior to sleep (baseline) and at 2, 12, 22, and 32 minutes after awakening. A series of mixed-effects models with Bonferroni-corrected post-hoc tests were used to examine the main effects of test bout and sex, and their interaction, with a random effect of participant, and order of wake-up and sleep history as covariates. Results: All outcomes except for percent correct on the DST showed a significant main effect of test bout, with worse performance after waking compared to baseline (all p s < .003). Significant effects of sex ( p = .002) and sex × test bout ( p = .01; R 2 M = .49, R 2 C = .69) were observed for KSS, with females reporting a greater increase in sleepiness from baseline to after waking compared to males. Conclusions : These results suggest that while females reported feeling sleepier than males following nighttime awakenings, their cognitive performance was comparable. Future research is needed to determine whether perceptions of sleepiness influence decision-making during the transition from sleep to wakefulness.

Sleep inertia↗

Mitigating fatigue on the flight deck: how is controlled rest used in practice?

Controlled Rest (CR) refers to a short, voluntary nap opportunity taken by pilots on the flight deck as a countermeasure to unanticipated sleepiness in flight. This study explores the profile of CR use in a long-haul commercial airline. Forty-four pilots wore actiwatches and filled in an application-based sleep/work diary for approximately 2 weeks resulting in complete records from 239 flights. Timing of sleep periods and flight schedules were analyzed relative to home-base time. Pearson correlations were used to assess the influence of pilot demographics on CR use. A mixed-effects logistic regression was used to analyze the impact of schedule factors on CR. CR was taken on 46% (n=110) of flights, with 80% (n=106/133) of all CR attempts estimated by actigraphy to have successfully achieved sleep. Average sleep duration during successful rest periods was estimated as 31.7 ± 12.2 minutes. CR was more frequent on return (60%, n=71) vs. outbound flights (33%, n=39); 2-pilot (69%, n=83) vs. >2-pilot flights (23%, n=27); <10h (63%, n=80) vs. >10h duration flights (27%, n=30); and night (55%, n=76) vs. day flights (34%, n=34) (all p≤0.001). There was no significant difference for direction of travel (eastbound: 51%, n= 57; westbound: 40%, n= 44; p=0.059). Of note, 22% (n=26) of augmented flights contained both CR and bunk rest. Data from this airline show that CR is most commonly used as a countermeasure to sleepiness on flights <10h duration (2-pilot crews) and home-base nighttime flights. Future studies are required to determine the generalizability of these results to other airlines.

sleepiness↗

Sleep, Sleepiness, and Performance Across Three In-Flight Bunk Rest Opportunities

Introduction: Airline pilots are required to take a rest break in a bunk during long-haul flights in an effort to reduce sleepiness during critical phases of flight. It is unclear, however, whether each rest break affords equal opportunity for sleep. We aimed to characterize sleep, sleepiness, and performance outcomes across three in-flight rest breaks during long-haul flights. Methods: Thirty-seven pilots wore actiwatches and completed sleep diaries for approximately two weeks while flying a variety of long-haul routes (n=126 flights). Self-reported in-flight bunk rest (BR) periods were used to set rest intervals and sleep was estimated within these intervals using actigraphy software (wake threshold set to medium). Pilots provided Karolinska Sleepiness Scale ratings (KSS) and performed a 5-minute psychomotor vigilance task (PVT) before landing. A linear mixed-effects model with participant included as a random effect and allowed to vary by intercept was used to assess differences between BR opportunities. Results : The majority (97%, n=122) of bunk rest periods contained sleep (as estimated by actigraphy). The mean (+/- standard deviation) sleep duration for the first, middle, and third BR opportunity was 152.8 (69.7), 149.2 (44.1), 125.2 (44.9) minutes, respectively. There was a significant effect of BR opportunity for sleep duration (F2,54 = 3.747, p=.03) and KSS (F2,44 = 7.869, p=.001). Bonferroni adjusted planned pairwise contrasts revealed that pilots using the third BR obtained significantly less sleep than in the first BR (p=.029). KSS ratings prior to landing were higher for the third BR compared to both the first (p=.001) and middle BR (p=.017). There were no significant differences for PVT speed or lapses (all p>05). Conclusion: These results suggest that the last rest break is associated with shorter sleep, lower alertness, and no differences in performance relative to the other rest breaks. Further analysis is required to determine whether the higher KSS ratings following the third rest break are associated with sleep inertia, or whether other factors may be involved.

sleepiness↗

The Influence of Self-Reported Distractions on the Psychomotor Vigilance Task (PVT) in Laboratory and Field Environments

Introduction: The Psychomotor Vigilance Task (PVT) is a measure of vigilant attention that is commonly used in laboratory environments to assess the neurobehavioral impact of sleep loss and circadian misalignment. The PVT has been increasing in popularity for use in field environments; however, the potential for distraction is higher in the field compared to the lab. It is unclear how distractions experienced by individuals taking the PVT in the real world may influence reaction time metrics. We investigated the influence of self-reported distraction on PVT outcomes across laboratory and field environments. Methods: We examined PVT data from five studies including short (n=36 participants, 3799 PVTs) and long-haul (n=75 participants, 3283 PVTs) airline personnel, control center personnel (n=5 participants, 96 PVTs), and healthy individuals who participated in a study involving at-home and laboratory assessments (n=12 participants, 486 and 310 PVTs). Individuals in all of the studies were asked to complete the five-minute NASA PVT at least three times daily. Participants were asked to indicate the number of distractions they experienced immediately after each PVT. Mean PVT reaction time (RT) and number of distractions were computed for each study and overall. Results: Participants reported more distractions in field environments compared to the lab (short-haul=1.29 +/- 1.48, long-haul=0.66 +/- 1.07, control-center=1.20 +/- 1.37, at-home=0.86 +/- 1.36, laboratory=0.46 +/- 1.07) Across all studies, we found that PVT RT slowed as self-reported distractions increased (all studies combined: 0 distractions=PVT RT 274.4ms; 1=284.6ms; 2=302.9ms; 3=321.2ms; >4=409.3ms). These findings were similar for healthy participants completing PVTs at home (0 distractions=287.1ms; 1=309.9ms; 2=328.3ms; 3=369.8ms; >4=385.1ms) but were less consistent during in-lab assessments (0 distractions=278.7ms; 1=316.2ms; 2=396.2ms; 3=370.4ms; >4=354.4ms). These findings were similar for other PVT outcomes. Conclusion: Participants reported more distractions in field environments compared to the laboratory. Our findings suggest that the number of distractions that individuals report experiencing while taking a PVT increases the reaction time registered by the device. Researchers should collect information about distractions during the PVT and should be aware that distractions may influence the recorded PVT reaction time.

behavior↗

Controlled Rest: Investigating the Use of an In-Flight Sleepiness Countermeasure

INTRODUCTION: Sleepiness is commonly reported amongst commercial airline pilots and is recognized as a safety risk due to its impact on performance. Controlled Rest (CR) refers to a short, voluntary nap opportunity taken by pilots on the flight deck as a countermeasure to unanticipated sleepiness in flight. This study explores the profile of CR use in a long-haul commercial airline. METHODS: Forty-four pilots filled in an application-based sleep/work diary and wore actiwatches for approximately 2 weeks. Complete data sets from 239 flights including sleep diaries, actigraphy, and schedules were merged and analyzed. Sleep diary entries were used to set CR intervals in the actigraphy software, which was then used to predict sleep within these intervals. All time-stamps of sleep periods and flight schedules were adjusted for home-base time of the pilots. Pearson Correlations were used to assess the influence of pilot demographics on CR use. A mixed-effects logistic regression was used to analyze the impact of schedule factors on CR. RESULTS: Pilots reported taking CR on 46% (n=110) of observed flights. Average CR attempt duration was 43.1 ± 11.0 minutes. Eighty-percent (n=106/133) of all CR attempts were estimated by actigraphy to have successfully achieved sleep with an average sleep duration during successful rest periods of 31.7 ± 12.2 minutes. Captains reported taking CR on 38% of flights (n=39/102), compared to First Officers reporting 52% (n=71/137) of flights with CR (p=0.131). Age, experience, BMI, and sleep need were not associated with the percentage of flights with CR (all p>0.244). The following schedule factors were associated with a higher frequency of CR: night (55%, n=76) vs. day flights (34%, n=34); <10h (63%, n=80) vs. >10h duration flights (27%, n=30); return (60%, n=71) vs. outbound flights (33%, n=39); and 2-pilot (69%, n=83) vs. >2-pilot flights (23%, n=27) (all p≤0.001). There was a trend for more CR on eastbound flights, but this was not significant (eastbound: 51%, n= 57; westbound: 40%, n= 44; p=0.059). Of note, 22% (n=26) of augmented flights (>2-pilots) contained both CR and Bunk Rest (in a designated rest facility). DISCUSSION: Data from this airline show that pilots commonly use CR to mitigate sleepiness in-flight, especially on flights <10h duration and during home-base nighttime flights. Future studies are required to determine generalizability of these results to other airlines.

sleepiness↗

Investigating the Causes and Consequences of Controlled Rest on the Flight Deck

INTRODUCTION: Long and irregular working hours can lead to fatigue in aviation operations. In some regions, a short nap taken on the flight deck (known as controlled rest) can be used as a countermeasure to unexpected in-flight sleepiness. We aimed to investigate the impact of taking controlled rest on self-reported sleepiness at top-of-descent. METHODS: Data from 120 long-haul (> 6 h flight duration), unaugmented flights were analyzed (n = 31 pilots). Pilots wore actigraphs and completed sleep logs before and during trips. At pre-flight and top-of-descent, pilots completed a Karolinska Sleepiness Scale (KSS). A mixed-effects model was used to assess the impact of controlled rest on KSS at top-of-descent. Sleep duration in the 48 hours prior to departure, timing of the flight (day vs. night), and pre-flight KSS scores were included as covariates. RESULTS: Due to missing data, complete data from 83 flights (n = 29 participants) were available in the analyses of the KSS. There were no differences by controlled rest status for KSS scores at top-of-descent (estimated marginal means ± SEM with controlled rest: 5.10 ± 0.22, without controlled rest: 5.37 ± 0.29; p = .45, η2p = 0.01). DISCUSSION: Our results suggest that there is no difference in self-reported sleepiness at top-of-descent on flights in which controlled rest was taken compared to flights without controlled rest. Further research is necessary to determine the impact of controlled rest on objective measures of performance at top-of-descent.

aviation↗

Cabin Crew Alertness and Performance During Long-Haul Flights

INTRODUCTION: -Sleep loss and circadian disruption pose a significant risk in aviation. -Previous literature has shown that inflight rest facilities influence alertness and performance among pilots, but few studies have evaluated cabin crew. -The aim of this research was to assess alertness and performance among cabin crew members sleeping in different rest locations during a long-haul out-and-back trip. METHODS: -Twenty-nine cabin crewmembers flew the same long-haul route (outbound and inbound). -Participants were randomly assigned to fly on an aircraft with a bunk in both directions or to fly an aircraft with a bunk in one direction and with a high comfort jump seat (HCJS) in the other direction. -Throughout the study they completed a Karolinska Sleepiness Scale (KSS) and a 5-minute Psychomotor Vigilance Task (PVT) at the beginning and at the end of each flight. RESULTS: -A series of mixed-effects models were performed to assess the changes in KSS and PVT when crewmembers slept in the bunk during both directions of flight (bunk-only) compared to when sleep was obtained in the HCJS during one direction and bunk in the other (bunk + HCJS). -There was no significant difference in KSS alertness between the two conditions. - There were no significant differences in PVT response speed or lapses between the two conditions. CONCLUSIONS: -Limitations: small number of participants. Our study stopped abruptly because of the COVID-19 pandemic which limited our sample size. -Further research is needed to understand how other factors such as duty start time and workload might influence the sleep of cabin crewmembers during long-haul flights.

long-haul↗