Effects of training burnout and sleep quality on heat regulation response and severe heatstroke in people performed 5-km armed cross-country training / 中华危重病急救医学

ABSTRACT

Objective To explore the relationship between training burnout, sleep quality and heat regulation response, severe heatstroke in people performed 5-km armed cross-country training. Methods 600 male officers and soldiers who participated in 5-km armed cross-country training in summer from 2017 to 2018 were enrolled. All trainees participated in 5-km armed cross-country training in environment with ambient temperature > 32 ℃ and (or) humidity > 65%. They were divided into two groups according to whether severe heatstroke occurred during 5-km armed cross-country training. The age, military age, body mass index (BMI), physical fitness score, external environment (such as ambient temperature, relative humidity, wind speed, heat index), training burnout score and Pittsburgh sleep quality index scale (PSQI) score, heart rate (HR), core temperature (Tc), sweating volume and serum Na+, K+, Cl- levels were compared between the groups. The risk factors of severe heatstroke during 5-km armed cross-country training were screened by binary multivariate Logistic regression analysis. Results There were 26 cases of severe heatstroke in 600 trainees who participated in 5-km armed cross-country training, with an incidence of 4.33%. There was no significant difference in age, military age, BMI, physical fitness score and external environment of 5-km armed cross-country training between people with or without severe heatstroke. Compared with those without severe heatstroke, the dimensions of training burnout and the total average scores of training burnout of severe heatstroke personnel before 5-km armed cross-country training were increased significantly (physical and mental exhaustion score 12.4±2.5 vs. 9.4±3.5, training alienation score 8.8±2.8 vs. 5.8±2.3, low sense of achievement score 8.2±2.7 vs. 5.6±2.3, total score of training burnout 9.8±3.2 vs. 6.9±3.2, all P < 0.01), all factors except daytime dysfunction (DD) of PSQI and total PSQI score were also increased significantly [sleep quality (SQ) score 1.0 (1.0, 2.0) vs. 1.0 (1.0, 1.0), fall asleep time (SL) score 2.0 (1.0, 3.0) vs. 1.0 (1.0, 1.0), sleep time (SH) score 1.0 (0.8, 2.0) vs. 1.0 (0, 1.0), sleep efficiency (SE) score 1.0 (0, 1.0) vs. 0 (0, 0.8), sleep disorder (SD) score 2.0 (1.0, 3.0) vs. 1.0 (0, 2.0), total PSQI score 1.0 (1.0, 2.0) vs. 1.0 (0, 1.0), all P < 0.01], HR was increased significantly at onset (bpm 120.00±10.57 vs. 86.49±14.91, P < 0.01), Tc was increased significantly (℃ 41.46±0.57 vs. 37.97±0.83, P < 0.01), serum electrolyte contents were decreased significantly [Na+ (mmol/L) 130.54±5.97 vs. 143.15±10.56, K+ (mmol/L) 3.72±0.44 vs. 4.37±0.50, Cl- (mmol/L)97.58±4.80 vs. 102.10±2.39, all P < 0.01], and the amount of sweat during training was increased significantly (g 395.81±16.16 vs. 371.88±40.76, P < 0.01). Binary multivariate Logistic regression analysis showed that total score of training burnout [odd ratio (OR) = 0.653, 95% confidence interval (95%CI) = 0.563-0.757], total PSQI score (OR =0.693, 95%CI = 0.525-0.916), HR (OR = 0.871, 95%CI = 0.838-0.908), Tc (OR = 0.088, 95%CI = 0.043-0.179), sweating volume (OR = 0.988, 95%CI = 0.979-0.997), Na+ (OR = 1.112, 95%CI = 1.069-1.158), K+ (OR = 13.900, 95%CI = 5.343-36.166), Cl- (OR = 1.393, 95%CI = 1.252-1.550) were independent risk factors for severe heatstroke during 5-km armed cross-country training (all P < 0.01). Conclusion Increase in training burnout, total PSQI score, excessive changes of body heat regulation response and excessive loss of Na+, K+, Cl- in serum are independent risk factors for severe heatstroke during 5-km armed cross-country training under the same conditions with high temperature and humidity environment.