Nutrition Intervention to Promote Immune Recovery From Sleep Restriction
Condition: Sleep Restriction
Study type: Interventional

Summary: 
      Physical and psychological stress on Warfighters during training and operational missions can
      suppress immune responsiveness. Skin wound models can be used to detect changes in immune
      function. Investigators have recently demonstrated that relatively modest sleep disruption
      degrades immune response at the site of the disrupted skin barrier and delays the initial
      restoration of the skin barrier. Provision of additional protein and a multi-nutrient
      beverage during and after sleep restriction seems to mitigate decrements in local immune
      function, without producing detectable effects on initial restoration of the skin barrier.
      However, the prior work used a parallel-group study design and inter-subject variability may
      have made it more difficult to detect significant differences in skin barrier restoration
      between participants receiving the nutrition intervention versus those receiving the placebo.
      Therefore, the purpose of the proposed cross-over study is to test the efficacy of a
      multi-nutrient beverage and additional protein (1.5 g protein per kg body weight versus 0.9 g
      protein per kg body weight) on immune function and the initial restoration of the skin
      barrier consequent to an operational stressor (i.e., 72-h sleep restriction). The effect of
      sleep restriction on a friend-foe marksmanship task, flow state, and measures of cognitive
      and neuromotor performance, will be investigated as a sub-study (Appendix A). Additionally,
      the effects of sleep restriction on appetite physiology, eating behaviors and intestinal
      permeability will be tested. Research will be conducted in a laboratory environment using
      male and female Soldiers from the human research participant detachment (NSRDEC), or Soldiers
      or civilians at NSRDEC and/or USARIEM. Participants in the study described herein (n = 20)
      will be exposed, in a single-blind, cross-over design to a ~72 hour normal sleep control
      phase, and to 2 periods of ~72 hours of sleep restriction (monitored in laboratory with ~2-h
      sleep per night) during which time eight blisters will be induced via suction on
      participant's forearm and the top layer of blisters will be removed to reveal the dermal
      layer of skin. In the normal sleep trial, participants will consume ~0.9 g protein per kg
      body weight per day and a placebo beverage during (3 days). In the first sleep restriction
      trial, participants will consume ~0.9 g protein per kg body weight per day and a placebo
      beverage during (3 days) and after (5 days) sleep restriction; and, in the second sleep
      restriction trial (after at least two weeks wash-out) participants will instead consume ~1.5
      g protein per kg body weight and a multi-nutrient beverage (arginine: 20 g·d-1, glutamine: 30
      g·d-1, zinc sulfate: 24 mg·d-1, vitamin C: 400 mg·d-1, vitamin D3: 800 IU·d-1 and omega-3
      fatty acids: 1 g·d-1). Outcome measures include immune function (e.g., circulating markers of
      inflammation, cytokines at the blister site, and secretory immunoglobin A), skin barrier
      restoration time (by transepidermal water loss), subjective appetite ratings,
      appetite-mediating hormone concentrations, food preferences and cravings, gut microbiota
      composition, and intestinal permeability. Findings from this study will determine if a
      nutritional intervention attenuates the loss of immune responsiveness to a military relevant
      stressor (i.e., sleep restriction), and will determine the effects of acute sleep restriction
      on appetite, gut microbiota composition, and intestinal permeability.
    


Intervention name(s): Additional protein and multi-nutrient beverage; Placebo beverage
Intervention type(s): Other; Other
Intervention description(s): During SR+, participants will consume a multi-nutrient beverage and additional protein (~1.5 grams·kg-1 body weight·day-1 versus the lower end of MDRI of ~0.9 grams·kg-1 body weight·day-1) during and after the period of sleep restriction. The multi-nutrient beverage contains arginine, glutamine, vits C & D, zinc and omega-3 fatty acids (DHA and EPA).; The placebo beverage (NS and SR) will be composed of a commercially-available artificially sweetened (e.g., containing aspartame, splenda or another artificial sweetener) beverage powder base and grapefruit extract (i.e., naringen) and/or quinine (i.e., a common ingredient found in tonic water).
Allocation: Non-Randomized
Intervention model: Crossover Assignment
Intervention model description: Participants will undergo the study during normal sleep, sleep restriction without the multi-nutrient beverage and sleep restriction with the multi-nutrient beverage
Masking: Single (Participant)
Primary purpose: Basic Science