Napping and heart rate variability in elite athletes.

Sleep and autonomic nervous system (ANS) influence each other in a bidirectional fashion. Importantly, it has been proposed that sleep has a beneficial regulatory influence over cardiovascular activity, which is mostly controlled by autonomic regulation through the activity of sympathetic and parasympathetic pathways of the ANS. A well-established method to non-invasively assess cardiac autonomic activity is heart rate variability (HRV) analysis. We aimed to investigate the effect of a 40-min nap opportunity on HRV. Twelve professional basketball players randomly accomplished two conditions: 40-min nap (NAP) and control (CON). Nocturnal sleep and naps were monitored by actigraphic recording and sleep diaries. Total sleep time (TST), time in bed (TIB), sleep efficiency (SE), sleep onset latency (SOL), and wake after sleep onset (WASO) were analyzed. HRV was analyzed in 5-min segments during quiet wake before and after each condition with controlled breathing. Were analysed high (HF) and low frequency (LF) bands, the standard deviation of NN interval (SDNN), HRV index and stress index (SI). Wellness Hooper index and Epworth Sleepiness Scale (ESS) were assessed before and after both conditions. There was no significant difference in TIB, TST, SE, WASO, and VAS between NAP and CON. A significant increase in SDNN, HRV index, and LF and a significant decrease in HF, SI, ESS, and Hooper's stress and fatigue scores were observed from pre- to post-nap. In conclusion, napping reduces sleepiness, stress and fatigue, and might provide an advantage by preparing the body for a much-required sympathetic comeback following peaceful rest.

Nap improved game-related technical performance and physiological response during small-sided basketball game in professional players.

The effect of 40-min nap (NAP) opportunity on psycho-physiological outcomes and technical performance during small-sided basketball game (SSG) was examined in ten professional basketball players. Nocturnal sleep and naps were monitored by actigraphic recording and sleep diaries. Nocturnal total sleep time (TST), time in bed (TIB), sleep efficiency (SE), sleep onset latency (SOL) and wake after sleep onset (WASO) were analyzed. Subjective sleep quality was assessed with visual analogue scale (VAS). Profile of mood state (POMS) and simple reaction time (SRT) were measured before and after Nap and no-nap (CON) conditions. During both test sessions, participants played 10-min SSG. Technical and tactical performances were assessed using Team Sport Assessment Procedure. Volume of play (VP), attack with ball (AB), efficiency index (EI) and performance score (PS) were determined. Heart rate (HR) was measured during SSG, and rating of perceive excretion (RPE) after. Lower HR (p ≤ 0.03, d ≥ 0.78) and RPE (p = 0.007, d = 1.11) were obtained in NAP compared to CON. There was no significant difference in TIB, TST, SE, WASO and VAS between CON and NAP conditions. AB, EI and PS were higher in NAP compared to CON (0.0002 ≤ p ≤ 0.001, 1.3 ≤ d ≤ 1.8). A significant reduction was observed in POMS' fatigue (p = 0.005, d = -1.16, Δ = -53.6%), anxiety (p = 0.02, d = -0.9, Δ = -32.1%), anger (p = 0.01, d = -0.94, Δ = -30.3%), and an improvement in vigor (p = 0.01, d = 0.99, Δ = + 23.8%); which may reflect better readiness after nap and more concentration to start a game-situation. In summary, NAP reduced fatigue, anger, anxiety and enhanced vigor, allowing better technical and tactical performances during basketball SSG.

40-min nap opportunity attenuates heart rate and perceived exertion and improves physical specific abilities in elite basketball players.

The effect of a 40-min nap opportunity on physiological responses and specific abilities was investigated. Twelve high-level professional basketball players (26.33±5.2 years; 193.17±7.1 m; 87.48±11.2 kg) undertook randomly 40-min nap opportunity (NAP) and control condition (CON). Wellness (Hooper Index) and Epworth Sleepiness Scale (ESS) were measured before and after both conditions. Defensive (DA) and offensive (OA) agility and upper body power (UBP) were assessed after both conditions. Shooting skill (SST) performance was evaluated prior and after a fatiguing task (FT). Heart rate (HR) and rating of perceived exertion (RPE) were recorded during SST-test, FT and SST-retest. ESS, Hooper's stress and fatigue score were significantly lower after nap compared to those before nap (0.009 ≤ p ≤ 0.03). Better performance was obtained in NAP compared to CON condition for DA, OA and UBP (0.0005 ≤ p ≤ 0.02). SST performance was significantly higher in NAP compared to CON in the retest session (p = 0.003, Δ = 20.2%).         The improved performance was associated with significant lower HRpeak (p = 0.01, Δ = 5.25%) and RPE (p = 0.003, Δ = 15.12%). In conclusion, NAP reduced sleepiness and stress and fatigue and enhances physical outcomes of specific skills in elite basketball players.

Benefits and risks of napping in older adults: A systematic review.

A growing body of evidence indicates that napping is common among older adults. However, a systematic review on the effect of napping on the elderly is lacking. The aim of this systematic review was to (i) determine how studies evaluated napping behavior in older adults (frequency, duration and timing); (ii) explore how napping impacts perceptual measures, cognitive and psychomotor performance, night-time sleep and physiological parameters in the elderly (PROSPERO CRD42022299805). A total of 738 records were screened by two researchers using the PICOS criteria. Fifteen studies met our inclusion criteria with a mean age ranging from 60.8 to 78.3 years and a cumulative sample size of n = 326. Daytime napping had an overall positive impact on subjective measures (i.e., sleepiness and fatigue), psychomotor performances (i.e., speed and accuracy) and learning abilities (i.e., declarative and motor learning). Additionally, studies showed (i) consistency between nap and control conditions regarding sleep duration, efficiency and latency, and proportion of sleep stages, and (ii) increase of 24 h sleep duration with nap compared to control condition. Based on the findings of the present review, there is minimal evidence to indicate that napping is detrimental for older adults' nighttime sleep. Future studies should consider involving repeated naps during a micro-cycle in order to investigate the chronic effect of napping on older adults. Systematic review registration: identifier: CRD42022299805.

In vitro thrombogenicity testing of pulsatile mechanical circulatory support systems: Design and proof-of-concept.

Thrombogenic complications are a main issue in mechanical circulatory support (MCS). There is no validated in vitro method available to quantitatively assess the thrombogenic performance of pulsatile MCS devices under realistic hemodynamic conditions. The aim of this study is to propose a method to evaluate the thrombogenic potential of new designs without the use of complex in-vivo trials. This study presents a novel in vitro method for reproducible thrombogenicity testing of pulsatile MCS systems using low molecular weight heparinized porcine blood. Blood parameters are continuously measured with full blood thromboelastometry (ROTEM; EXTEM, FIBTEM and a custom-made analysis HEPNATEM). Thrombus formation is optically observed after four hours of testing. The results of three experiments are presented each with two parallel loops. The area of thrombus formation inside the MCS device was reproducible. The implantation of a filter inside the loop catches embolizing thrombi without a measurable increase of platelet activation, allowing conclusions of the place of origin of thrombi inside the device. EXTEM and FIBTEM parameters such as clotting velocity (α) and maximum clot firmness (MCF) show a total decrease by around 6% with a characteristic kink after 180 minutes. HEPNATEM α and MCF rise within the first 180 minutes indicate a continuously increasing activation level of coagulation. After 180 minutes, the consumption of clotting factors prevails, resulting in a decrease of α and MCF. With the designed mock loop and the presented protocol we are able to identify thrombogenic hot spots inside a pulsatile pump and characterize their thrombogenic potential.

The incidence and fate of endoleaks vary between ruptured and elective endovascular abdominal aortic aneurysm repair.

BACKGROUND: The number of ruptured abdominal aortic aneurysm (r-AAA) patients who are treated by endovascular means is increasing as ruptured endovascular aneurysm repair (r-EVAR) enters the mainstream. However, even today, data on the incidence and behavior of endoleaks after r-EVAR are scarce. This study analyzed whether endoleaks behave differently after EVAR for rupture vs elective AAA repair. METHODS: From 2002 to 2013, there were 2052 patients who underwent EVAR for treatment of rupture (n = 166 [8.1%]) and elective repair (n = 1886 [91.9%]) of infrarenal AAA. Follow-up included computed tomography angiography at 1 month, at 6 months, and yearly thereafter. All type I and type III endoleaks were treated at the time of or shortly after the diagnosis. Persistent type II endoleaks at >6 months after EVAR without a decrease in AAA sac underwent translumbar or transfemoral embolization procedures. Data were prospectively collected in a vascular database. RESULTS: During a mean follow-up of 30 months, patients had a significantly lower incidence of type II endoleaks after r-EVAR compared with elective endovascular aneurysm repair (e-EVAR; n = 15 [9.0%] vs n = 380 [20.2%]; P < .01). Although the incidence of type I endoleaks is similar after r-EVAR (n = 9 [5.4%] and e-EVAR (n = 83 [4.4%]; P = .68), the r-EVAR patients required stent graft explantation more frequently (n = 9 [5.4%] vs n = 20 [1.1%]; P < .01). Whereas the need for secondary intervention was comparable in both r-EVAR (n = 33 [19.9%]) and e-EVAR (n = 439 [23.3%]; P = .37) groups, patients undergoing percutaneous embolization procedures trended toward significance between the two groups (n = 11 [6.6%] vs n = 216 [11.5%]; P = .06) with endoleaks. CONCLUSIONS: Compared with e-EVAR, patients who undergo r-EVAR experience a similar incidence of type I endoleaks and a significantly lower incidence of type II endoleaks. The endoleaks in both e-EVAR and r-EVAR patients can frequently be managed by endovascular means. However, r-EVAR patients with type I and type II endoleaks are at a significantly higher risk for stent graft explantation.

Randomised, double blind, placebo controlled trial of interferon, ribavirin, and amantadine versus interferon, ribavirin, and placebo in treatment naïve patients with chronic hepatitis C.

BACKGROUND AND AIM: In this study, we compared the efficacy of triple therapy (interferon alfa, ribavirin, and amantadine) with standard therapy (interferon alfa and ribavirin) in treatment naïve patients with chronic hepatitis C virus (HCV). METHODS: In this prospective, randomised, double blind, placebo controlled, multicentre study, 85 patients (amantadine group) received a three drug regimen of interferon alfa-2b 3 million units three times per week, ribavirin 1000-1200 mg daily in divided doses, and amantadine 100 mg twice daily, and 86 patients (placebo group) received interferon alfa-2b, ribavirin, and identical placebo. Treatment was discontinued at 24 weeks if patients had detectable HCV RNA by polymerase chain reaction (PCR). All patients were followed for 24 weeks after completion of treatment. The primary end point was undetectable HCV-RNA by PCR at 24 weeks (sustained viral clearance) after completion of treatment. RESULTS: At the end of treatment, HCV RNA clearance was seen in 32.9% of the amantadine group and 38.4% of the placebo group (p=0.3). Sustained virological response was seen in 24.7% of the amantadine group and in 27.9% of the placebo group by intention to treat analysis; response rate was 30.4% and 34.8%, respectively, in those who completed 24 weeks of treatment. Poor response was seen in both groups among cirrhotics, African-Americans, genotype 1, and those with a higher viral load. By multivariate analysis, genotype 1, high viral load, and low serum albumin were the only predictors of poor response. Addition of amantadine to the standard regimen did not result in any unexpected side effects. CONCLUSION: Response to triple therapy of interferon alfa, ribavirin, and amantadine was similar to standard therapy of interferon alfa and ribavirin. Our results suggest that amantadine has no role in the management of HCV.

Levels of some trace metals and related enzymes in workers at storage-battery factories in Iraq.

Levels of some trace metals (copper, iron, lead and zinc), aminolevulinate dehydratase (ALAD), caeruloplasmin and haemoglobin were measured in the blood of 37 male workers from private-sector storage-battery factories. The men were divided into three groups depending on their jobs: 11 chargers (group I), 8 repair workers (group II) and 18 casting workers (group III); 60 men were selected as controls. Mean levels were 14.63, 36.35, 58.00 and 71.70 micrograms/100 mL for lead, 192.54, 133.90, 96.75 and 45.37 U/mL for ALAD, and 14.02, 12.72, 12.20 and 11.40 g/100 mL for haemoglobin for control and groups I, II and III respectively. Significant negative correlations were found between lead and both ALAD and haemoglobin. The only significant positive correlation was between lead levels and duration of exposure.

Levels of some trace metals and related enzymes in workers at storage-battery factories in Iraq

Levels of some trace metals [copper, iron, lead and zinc], aminolevulinate dehydratase [ALAD], caeruloplasmin and haemoglobin were measured in the blood of 37 male workers from private-sector storage-battery factories. The men were divided into three groups depending on their jobs: 11 chargers [group I], 8 repair workers [group II] and 18 casting workers [group III]; 60 men were selected as controls. Mean levels were 14.63, 36.35, 58.00 and 71.70 mg/100 mL for lead, 192.54, 133.90, 96.75 and 45.37 U/mL for ALAD, and 14.02, 12.72, 12.20 and 11.40 g/100 mL for haemoglobin for control and groups I, II and III respectively. Significant negative correlations were found between lead and both ALAD and haemoglobin. The only significant positive correlation was between lead levels and duration of exposure