CASPER
Sleep In Extreme Environments
UTMB Aerospace
Medicine Grand Rounds
24th June 2008
Dr Marc Ó Gríofa MB BCh BAO1,2,5
Dr Derek T O’Keeffe PhD1, Dr Robert Thomas MD3, Dr Tim Monk MD4, Dr Ken Cohen PhD5, Dr Luis Moreno MD5
1
University Of Limerick, 2University College Dublin, 3Beth Israel (Harvard), 4University Of Pittsburgh, 5NASA KSC Biomedical Lab
Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
CASPER
• C.A.S.P.E.R. (Cardiac Adapted
Electrocardiogram Recorder)
Sleep
Parameters
• A simple, portable and efficient method of monitoring
sleep stability and disturbance
• Using both physiological and subjective data, system
provides an autonomous method of monitoring sleep
stability patterns and disruption on a long term, noninvasive, practical basis, which is especially adapted for
the spaceflight and microgravity environment
• 3 primary components (objective & subjective data)
– ECG parameters via LifeShirt [1]
– Adapted Pittsburgh sleep diary [2]
– Diagnostic sleep stability software [3]
24th June 2008
UTMB
Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
CASPER: Sleep in Extreme Environments
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CASPER Project
Sleep disturbance and chronobiology
History of sleep disruption in space
Subjective sleep monitoring
Objective sleep monitoring using cardiac
autonomic activity and cardiopulmonary
coupling
• FMARS Martian analogue mission
• NEEMO mission proposal
24th June 2008
UTMB
Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Astrolab Mission
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ESA Astrolab LDM
First ESA long duration ISS
mission
ESA astronaut flying as a Russian
Cosmonaut
STS-121 July 2006
– Kennedy Space Centre
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Progress 23 October 2006
– Baikonur Cosmodrome
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24th June 2008
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STS-116 December 2006
Non-disclosure
Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
24th June 2008
UTMB
Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Background
• Eliminates limits of previous orbital sleep studies by
removing the need for the presence of full PSG
equipment
• Relies upon an assessment of cardiac autonomic activity
from a single-lead electrocardiogram (ECG) as a surrogate
marker
• Increasingly clear that cardiac autonomic activity varies
with sleep stage
• The adoption of a single-lead ECG has also been verified
as a useful diagnostic tool in the detection of sleep
pathology [4-6]
• Significant steps towards addressing one of the primary
needs identified by agencies for the advancement of long
term human spaceflight in bioastronautics roadmaps
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
John Glenn STS-95
•Limitations of
current PSG
techniques
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Application
• Dynamic measurement of sleep stability and
disruption
• Indication of the “quality” of sleep, not just staging
• Tracking changes and/or deterioration in crew’s sleep
pattern or stability
• Both in individual blocks and over duration of mission
(short & long missions)
• Allows assessment of environmental noise and other
environmental factors on quality and stability of sleep
in a mission or extreme environment
• Assessment of countermeasures
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
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Chronobiology
Circadian pacemaker – “Bodyclock”
Hypothalamus and pineal gland
– Melatonin
– Cortisol
Homeostatic synchronisation
– Body temperature, GH
production and urine production
– Activity of heart intrinsically
linked to circadian rhythm
Free running : 23.8 - 24.2 hrs
– Substantial individual variation
Environmental synchronisation
Strongest cue (Zeitgeber) is sunlight
– Terran light pattern
Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Background and Relevance
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Sleep disruption is a common and important problem among astronauts on
a routine basis [7]
50% crew take hypnotic medication on some shuttle flights
– Analysis of sleep on shuttle missions [8]
25% experience dramatic impairment in quality/quantity
Orbital dawn & circadian rhythm disentrainment
Average 6 hrs sleep per night
– Sleep and circadian rhythms in four orbiting astronauts [9]
Implications of restricted
sleep schedule
– Progress 234 on Mir
Extended missions and
long-term acclimation [10]
- Manned mission to Mars
- Human spaceflight ground support
(Martian Sol 24.65 hrs)
Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Progress 234 On Mir
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
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Sleep
In
Space
NASA-Mir Increment missions
1. Circadian rhythms and sleep patterns in micro gravity
2. Determine effects of prolonged space flight on ECP
• Astronaut Jerry M. Linenger, Michael Foale
– 5 months on Mir (1997)
• Endogenous circadian pacemaker (ECP) : Disentrained
after ~ 100 days of spaceflight
– May be failure to drive rhythm after 3 months
– Diminished influence of ECP [7]
– Suffer effects of sleep deprivation
• Actigraphy in Space [11]
– Movement monitoring using accelerometer
– Wrist actigraphy, modified sleep diary & PSG
– Ongoing experimentation (Actiwatch)
24th June 2008
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Vivometrics LifeShirt
• Innovative, ambulatory, multi-sensor, continuous monitoring
system for collecting, analyzing and reporting health data [1]
• FDA/CE approved
• More than 30 parameters cardiopulmonary function
• Inductive respiratory plethysmography
• Gold standard for bedside respiratory monitoring in ICU
for 20 years
• Clinical trials
• Stanford university [12]
• US Army & Air Force
• NYFD first responders
• Everest expeditions
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
LifeShirt & Flight Configuration
PDA, data cable and lycra
shirt before assembly
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
LifeShirt & How It Works
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Pittsburgh Sleep Diary
• Subjective sleep monitoring [2]
• Important feedback on perceived stresses and individual
quality of sleep
• Previously used in spaceflight [9]
• Instrument in itself with separate waketime and bedtime
components (pre- and post-sleep diaries)
• Shown to demonstrate the usefulness, validity and
reliability of various measures from instruments
• Validity in agreeing with estimates of sleep timing and
quality
• Sensitivity in detecting differences of individual
parameters & across different physiological &
behavioral states
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Pre-Sleep Diary
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10 Questions
How tired were you at the start of this shift? (1 – 10
How tired are you now at the end of this shift? (1 – 10)
How hectic / busy was this shift? (1 – 10)
A)Which affected you personally?
Equipment problems / Timeline problems / Environment
problems (Yes/No)
B) Have you had any in the last 5 hours?
Caffeine/Other stimulant (Yes/No)
24th June 2008
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Post-Sleep Diary
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10 Questions
After asleep awoke this many times by:
(Fill in appropriate number [1-6])
a) Mission circumstances / b) To use bathroom / c) Wearing
of equipment / d) General discomfort / e) Just woke
Which disrupted your sleep last “night”?
Ambient temperature / Air flow / Noise / Vibration (Yes/No)
Awakened this “morning” by:
Something / Someone / Just woke
Sleep quality? (1 – 10)
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
PDA & Sleep Diary
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
CASPER Equipment
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
CASPER Li-Ion Battery Charger
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Cardiac Autonomic Activity During Sleep
• Standard PSG expensive and encumbering
• Conventional sleep stages are scored as:
-Wake
- Rapid eye movement (REM) sleep
- Stages 1-4 of non-REM sleep (approximate continuum
of depth)
[comprises ~80% average night]
• Stages 3 & 4 decrease across lifespan and majority of
adult NREM is stage 2
- Thus reduces value of conventional system as a
precise measure of sleep quality and stability
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Cardiac Autonomic Activity During Sleep
• Autonomic nervous system dynamics (HRV,
respiration & related variables) have characteristic
behaviors that vary according to sleep depth and type
• Sleep disordered breathing (SDB) and sleep instability
associated with predictable characteristics
• Previous methods to detect SDB from surface ECG
were limited
• Based on detection of cardiac interbeat intervals (R-R)
- Limited use in subjects with reduced HRV
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Cardiac Autonomic Activity During Sleep
• Complementary signal, independent of R-R
variability, is a surrogate signal referred to as
ECG-derived respiration
• EDR (ECG derived respiration) based on
observation that positions of ECG electrodes on
chest surface move relative to heart
- Transthoracic impedance varies as lungs fill
and empty
• Designed to assess breathing dynamics more
directly from QRS shifts
- However, by itself is relatively noisy
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Cardiac Autonomic Activity During Sleep
• EDR signal is difficult to quantify in long, typically
noisy, clinical records
• Overcome limitations of both methods by
simultaneously incorporating both R-R and EDR
data
• Signals are readily extractable from a continuous
single-lead ECG and can be used to generate a
visual spectrographic measure of cardiopulmonary
coupling
- ie. Sleep Spectrogram
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Sleep Parameters
• Standard staging
• Wake, Stages 1-4 (non-REM), REM sleep
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Low vs. High frequency coupling
CAP (cyclic alternating pattern)
Cardiopulmonary Coupling (CPC)
– CPC detection algorithm
• Combining EDR & R-R
– Sleep spectrograms
Normal sleep
• Sleep state switching
• Sleep apnea detection
• Unstable sleep detection
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Non-CAP/Stable
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
CAP/Unstable
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Cyclic Alternating Pattern
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Cyclic alternating pattern (CAP)
Measure sleep instability
Unstable sleep characterized by
1) recurrent phasic EEG complexes (CAP)
2) Low threshold for arousal
3) Predominance of periodic behaviors (eg. SDB)
Stable sleep characterized by
1) Absence of recurrent phasic EEG complexes (nonCAP)
– 2) Elevated arousal thresholds
– 3) Minimal periodic behaviors
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Heart Rate Flutuates During Unstable Sleep
• These low frequency oscillations contrast with higher
frequency fluctuations called physiologic respiratory sinus
arrhythmia (RSA)
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
ECG-Derived Respiration (EDR)
• Respiration also modulates ECG amplitudes
ECG
Respiration
signal
~ 10 seconds of data
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[13]
Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Sleep Spectrogram
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Map of sleep stability using sleep-modulated
autonomic and respiratory drive interactions
Fast Fourier Transforming techniques
1024-sample points (8.5 minutes) within a
single window
3 overlapping 512-sample sub-windows within
the 1024-sample coherence window
1024-sample coherence window is then
advanced by 256 samples (2.1 minutes)
Calculation repeated until the entire N-N
interval/EDR series is analyzed
Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Sleep Spectrogram
8.5
2.1
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512
Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Sleep Spectrogram In A Healthy 22-yr Old
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Sleep Spectrogram In A Healthy 56-yr Old
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Sleep State Switching In A Healthy Subject
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
CPC Reveals 2 Cardiopulmonary
Coupling Regimes
• High frequency coupling (0.1 - 0.4 Hz. band)
corresponds to respiratory sinus arrhythmia
• Low frequency coupling (0.01 - 0.1 Hz. band)
associated with SDB
• Coupling states do not correspond with standard sleep
staging but do follow scoring using the EEG-based
“Cyclic Alternating Pattern” (CAP) paradigm
– CAP: unstable, light sleep; low frequency coupling
– Non-CAP: stable, deep sleep; high frequency
coupling
24th June 2008
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
CPC Detection Of CAP/Non-CAP Sleep States
• Using appropriate thresholds for high and low frequency
coupling magnitudes and their ratios it is possible to detect
CAP/Non-CAP sleep states
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HFC - high frequency coupling (0.1 - 0.4 Hz)
- Stable sleep
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LFC - low frequency coupling (0.01 - 0.1 Hz)
- Unstable sleep
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e-LFC [elevated-LFC] (Lo/Hi ratio > 30)
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Narrow band coupling [e-LFC]: Central apnea
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Broad band coupling [e-LFC]: Obstructive apnea
VLFC - very low frequency coupling (0 - 0.01 Hz)
- REM or wake
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Sleep Spectrogram : Apnea Detection
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Sleep Spectrogram : Severe Apnea Detection
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Sleep Spectrogram In A 56-yr old Male with SDB
•Application of
CPAP
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Narrow-Band and Broad-Band Low Frequency
Coupling In Sleep Apnea Syndromes
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
CASPER : High Altitude
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Scientific expedition
~ 14 days at altitude
Large group: 20 –30 people
Scientists
Living at ~ 11,000 ft
Working between 10,000 – 13,000 ft
Proposal to monitor 6 subject’s sleep
patterns before, during & after expedition
combining subjective and objective data
Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
2 weeks At 13,000 Feet
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
FMARS
24th June 2008
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
FMARS
• Flashline Mars Arctic Research Station
• Located on Devon Island, Arctic Circle
• 4 month long duration space analogue
mission
• 7 person crew (male & female)
• 3rd month : 37 days living a “Martian Sol”
• 24 hour sunlight mission environment
• Operational space analogue simulated in
conjunction with using “Mars Time”
24th June 2008
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Project CASPER:FMARS
• 4 crew-members monitored physiologically
• Data from early, middle, late mission
• Continuous subjective monitoring during pre-Mars,
post-Mars & Mars Time for every crew-member
• Pre- & Post-sleep adapted Pittsburgh sleep diaries
• During Mars Time every crew-member completed
pre- & post-sleep diary
• Also completed pre- & post-sleep computer based
reaction time and decision speed tests every
morning and night during Martian Sol protocol
24th June 2008
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Circadian Rhythm Disruption
• Resilience and adaptive nature of the human
circadian system when stressed by extreme
environments and conditions
• Number of factors during this mission that were
designed to stress the circadian rhythm of the crewmembers:
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Mars analogue mission environment
Long duration 100 day mission
24 hour sunlight
Implementation of the long duration (37 days)
operational Martian Sol (24.65 hrs) protocol
Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
24th June 2008
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Subjective Sleep Diary
• Subjective sleep monitoring [2]
• Pre- & Post-sleep questionaires
• Aim to visually identify trends and patterns
across the spectrum of the mission and in
particular Mars time for the crew as a whole
• Each data point on graphs represents a “subject
group score” for the entire crew during a single
night (7 data points)
• Individual sleep diaries can also be correlated
against crewmembers that suffer unstable nights
sleep as recorded through ECG
24th June 2008
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Pre-Sleep Diary
• How tired were you at the start of this shift? (1 – 10)
10.0
9.0
8.0
7.0
6.0
5.0
4.0
3.0
2.0
1.0
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Score (1-10)
Subject Group Score (Q1 Pre-Sleep)
Pre Mars Time
(night of)
Mars Time (sol, night of)
Timeline
Subject Group Score (Q1 Pre-Sleep)
24th June 2008
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Post Mars Time
(night of)
Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Pre-Sleep Diary
• How tired are you now at the end of this shift? (1 – 10)
10.0
9.0
8.0
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6.0
5.0
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2.0
1.0
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Score (1-10)
Subject Group Score (Q2. Pre-Sleep)
Pre Mars Time
(night of)
Mars Time (sol, night of)
Timeline
Subject Group Score (Q2. Pre-Sleep)
24th June 2008
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Post Mars Time
(night of)
Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Pre-Sleep Diary
• How hectic / busy was this shift? (1 – 10)
10.0
9.0
8.0
7.0
6.0
5.0
4.0
3.0
2.0
1.0
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Score (1-10)
Subject Group Score (Q3 Pre-Sleep)
Pre Mars Time
(night of)
Mars Time (sol, night of)
Timeline
Subject Group Score (Q3 Pre-Sleep)
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Post Mars Time
(night of)
Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Pre-Sleep Diary
• How physically strenuous was your work today? (1 – 10)
10.0
9.0
8.0
7.0
6.0
5.0
4.0
3.0
2.0
1.0
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Score (1-10)
Subject Group Score (Q4 Pre-Sleep)
Pre Mars Time
(night of)
Mars Time (sol, night of)
Timeline
Subject Group Score (Q4 Pre-Sleep)
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Post Mars Time
(night of)
Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Pre-Sleep Diary
• How mentally taxing was your work today? (1 – 10)
10.0
9.0
8.0
7.0
6.0
5.0
4.0
3.0
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1.0
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Score (1-10)
Subject Group Score (Q5 Pre-Sleep)
Pre Mars Time
(night of)
Mars Time (sol, night of)
Timeline
Subject Group Score (Q5 Pre-Sleep)
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Post Mars Time
(night of)
Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Post-Sleep Diary
• Difficulty to fall asleep last “night”? (1 – 10)
10.0
9.0
8.0
7.0
6.0
5.0
4.0
3.0
2.0
1.0
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08091011121314151617181920-
Score (1-10)
Subject Group Score (Q2 Post-Sleep)
Pre Mars Time
(morning of)
Mars Time (sol, morning of)
Timeline
Subject Group Score (Q2 Post-Sleep)
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Post Mars Time
(morning of)
Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Post-Sleep Diary
• Sleep quality? (1 – 10)
10.0
9.0
8.0
7.0
6.0
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Score (1-10)
Subject Group Score (Q6 Post-Sleep)
Pre Mars Time
(morning of)
Mars Time (sol, morning of)
Timeline
Subject Group Score (Q6 Post-Sleep)
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Post Mars Time
(morning of)
Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Post-Sleep Diary
• Alertness (how well rested) on final wakeup? (1 – 10)
10.0
9.0
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Score (1-10)
Subject Group Score (Q8 Post-Sleep)
Pre Mars Time
(morning of)
Mars Time (sol, morning of)
Timeline
Subject Group Score (Q8 Post-Sleep)
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Post Mars Time
(morning of)
Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
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Non-Mars
Mars
Pre-Sleep
Q10. Affected you last night (Y/N):
- Equipment problems
- Timeline problems
- Environment problems
6.5%
11.7%
8.4%
9.3%
13.6%
11.7%
Post-Sleep
Q3. After being asleep, awoke this
many times (0-4):
- Mission circumstances
- Bathroom
- General discomfort
- Just woke
11.4%
22.1%
75.8%
70.5%
26.2%
30.9%
55.5%
60.9%
Q4. Disrupted sleep last night (Y/N):
- Ambient temperature
- Airflow
- Noise
- Vibration
25.2%
4.6%
14.6%
4.0%
18.3%
4.3%
16.3%
1.6%
Q5. Awakened this morning by:
- Something
- Someone
- Just woke
60.9%
14.6%
72.5%
58.0%
12.1%
30.0%
Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Martian Time Decision Speed Test
100
95
Score Vs % Correct
90
85
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65
60
55
21-Jun
22-Jun
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30-Jun
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19-Aug
50
Pre Mars Time
Subject Group Score (Pre-Sleep)
24th June 2008
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Martian Sol Time
Timeline
Subject Group % Correct (Pre-Sleep)
Subject Group Score (Post-Sleep)
Post Mars Time
Subject Group % Correct (Post-Sleep)
Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Martian Time Reaction Time Test
Reaction Time (sec)
0.35
0.3
0.25
0.2
0.15
0.1
0.05
21-Jun
22-Jun
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24-Jun
25-Jun
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30-Jun
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Pre Mars Time
Martian Sol Time
Timeline
Subject Group (Pre-Sleep)
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Subject Group (Post-Sleep)
Post Mars Time
Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
CPC & CAP During Sleep
• Standard staging
• Wake, Stages 1-4 (non-REM), REM sleep
•
Low & high frequency states
•
Cyclic alternating pattern (CAP)
– Measure sleep instability
• Unstable sleep characterised by
– Low threshold for arousal & Predominance of periodic
behaviors
• Stable sleep characterised by
– Elevated arousal thresholds & Minimal periodic behaviors
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
FMARS CASPER CPC
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
FMARS CASPER CPC
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
CASPER FMARS Sleep Spectrogram
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
CASPER FMARS Sleep Spectrogram
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
CASPER FMARS Sleep Spectrogram
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
CASPER NEEMO
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
CASPER NEEMO Proposal
• Monitor sleep stability of crewmembers aboard
Aquarius during NASA NEEMO mission
• Subjective and objective measurements
• Subjective sleep diary
• Pre- & Post-Sleep
• Objective measurements
• Cardiac autonomic activity & CPC
- Sleep spectrograms
• Core body temperature
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
CASPER NEEMO Proposal
• 4 crewmembers monitored for duration of
mission
• 4 measurement blocks
• 3 nights (2-3 months) pre-mission
- (preferably during non-intensive preparation
period)
• 3 nights immediately pre-mission
• Mission duration
• 3 nights post-mission
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Internal Core Body Temperature Measurement
• Mini-Mitter temperature pill
• One pill swallowed each morning
• Each pill identifiable and recorded
by small wearable data recorder
• Provides internal body temperature
for duration of recording period
• Internal body temperature previously
used in spaceflight missions for
indicator circadian rhythm disruption
[9]
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
Acknowledgements
•
•
•
•
•
•
University of Limerick, University College Dublin
Enterprise Ireland, ESA Prodex
Dr Derek O’Keeffe
ESA
FMARS Crew
Dr Robert Thomas, Dr Ary Goldberger, Joe Mietus Beth
Israel Medical Facility (Harvard)
• Dr Tim Monk & University of Philadelphia
• KSC Biomedical Lab and Medical Operations, Dr Ken
Cohen & Dr Luis Moreno
• FÁS Science Challenge Programme
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Cardiac Adapted Sleep Parameters Electrocardiogram Recorder
References
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[1]Viviometrics Lifeshirt
http://www.vivometrics.com/site/system_howitworks.html
[2] Monk TH, Reynolds CF 3D, Kupfer DJ, Buysse DJ, Coble PA, Hayes AJ, Machen MA, Petrie SR,
Ritenour AM. The Pittsburgh Sleep Diary. J Sleep Res. 1994;3:111-20.
[3] Thomas RJ, Mietus JE, Chung-Kang P, Goldberger AL. An electrocardiogram based technique to assess
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mog@projectcasper.com