Dr. David F. Dinges and colleagues developed a best practices summary for the use of nine sleep-promoting and three wake-promoting medications during spaceflight. The evidence-based summary was developed to help reduce fatigue-related risks to performance. Information was compiled from medical/scientific literature, government regulatory agency databases and Department of Defense sources. The best practices summary database will help flight surgeons, astronauts, and NASA researchers and management remain aware of the risk mitigation needed in the pharmacological management of sleep-wake cycles in space. The research will also help with the management of sleep-wake cycles on Earth.
Overview
Sleep-Wake Medications in Spaceflight: Review of Best Practices
Principal Investigator:
David F. Dinges, Ph.D.
Organization:
University of Pennsylvania School of Medicine
Technical Summary
This project developed an evidence-based summary for best practices regarding the use of pharmacological sleep-promoting agents and wake-promoting agents in spaceflight, to mitigate fatigue-related risks to performance. Evidence was integrated from the medical and scientific literature (via PubMed and Web of Science), from regulatory databases (Food and Drug Administration and Drug Enforcement Agency), and from available Department of Defense sources, regarding the most effective and safe use of nine sleep-promoting agents, a benzodiazepine receptor antagonist, and three wake-promoting agents, to form a summary of best practices relevant to the physiological and operational conditions that occur in space. Best practices entails integration of the following factors in the evidence database to be developed: pharmacokinetics and pharmacodynamics, safety evidence, indication and efficacy evidence, abuse potential, evidence of interactions with other medications (especially those used in space), carry-over effects, reversibility of drug effects and carryover effects in the event of an emergency.
Project Goals
- Make scientifically-based recommendations on which of the currently available sleep-promoting medications and wake-promoting agents are most appropriate for use in spaceflight.
- Identify unwanted consequences and ways to mitigate them for these pharmacological agents (e.g., carry-over sedation by sleep-promoting medications and sleep-disruption by wake-promoting medications).
- Ongoing surveillance of ground-based evidence on adverse events and undesirable consequences of sleep-promoting and wake-promoting medications being used in space.
The best practices summary database is linked electronically to scientific publications through the federal PubMed database. It was made available electronically to key NASA personnel in the Human Research Program of the Space and Life Sciences Directorate at NASA Johnson Space Center. The importance of reducing fatigue-related performance errors in space by the optimal use of sleep-wake medications is very high, and the resulting best practices summary database will help flight surgeons, astronauts, NASA Behavioral Health Program personnel and NASA Management remain aware of the opportunities and risk mitigation needed in the pharmacological management of sleep-wake dynamics in space.
Earth Applications
This electronic database is linked to the scientific literature on the most commonly used sleep-promoting and wake-promoting medications. It has significant benefits on Earth beyond its utility for spaceflight. Physicians in the military and civilian sectors responsible for the safe and effective use of sleep-wake medications can use the database to optimize their decision making regarding these medications.
This project's funding ended in 2007