Task Progress:
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The data outlined in this report were collected at the Institute for Aerospace Medicine at the German Aerospace Center (DLR) :envihab facility at an altitude of ~50 meters as part of the “VIIP and Psychological :envihab Research (VaPER)” bedrest campaign. Data collection occurred from October 2 through December 4, 2017. Twelve subjects (six female) consented to participate in this study, but one female subject dropped out after the start of data collection. Data from the remaining 11 subjects are presented here.
The novel approach to this study compared to previous head-down tilt bed rest (HDTBR) studies was to more closely match the International Space Station (ISS) environment. To do this, two modifications were implemented that differed from previous HDTBR studies.
First, this study included a 3.8 mmHg (0.5%) CO2 environment (3.8 mmHg) in the ambient air during the 30 days of HDTBR. During the pre- and post-HDTBR period subjects were exposed to normal indoor CO2 levels. The mild elevation in ambient CO2 levels was made possible because of the unique climate control capabilities of the DLR :envihab facility that allows for elevated CO2 levels to be maintained throughout the entire module the subjects lived in, including the 12 individual bedrooms used by subjects.
Second, previous head-down tilt bed rest (HDTBR) studies have allowed subjects to use a pillow during the day and at night which lifts the head out of the HDTBR position relative to the rest of their body. Additionally, subjects were previously allowed to raise their head and upper body onto an elbow to eat during meals. In the current study subjects were not allowed use of a traditional pillow during HDTBR, nor were they allowed to lift their head and upper body during meals. A custom head-support was developed for use during side-sleeping, which some subjects chose to use. As a result, these subjects maintained a strict head-down tilt posture throughout the duration of the study, more accurately mimicking the chronic nature of the headward fluid shift that occurs on ISS.
Currently, an astronaut is diagnosed with SANS if they develop optic disc edema based on fundoscopic images revealing a Frisèn Scale grade 1 or higher. However, additional ocular structural changes including choroidal and/or retinal folds, cotton wool spots, hyperopic shifts, and globe flattening have also been documented in astronauts and are being tracked as metrics related to SANS by Flight Medicine. In this study, we documented for the first time the development of optic disc edema in 5 of 11 subjects, but did not identify any choroidal or retinal folds or cotton wool spots. We did not conduct MRI imaging to determine if globe flattening developed. Cycloplegic refraction was not conducted so we do not have an objective assessment of refractive error change, but there were no changes in corrected visual acuity.
Data collection and analysis are complete. Three manuscripts have been published in peer reviewed journals, with additional manuscripts currently being drafted for submission.
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Abstracts for Journals and Proceedings
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Laurie SS, Macias BR, Lee SMC, Stenger MB. "VaPER: Linking PCO2 to physiology." Presented at the NASA Human Research Program Investigators' Workshop, Galveston, TX, January 22-25, 2019. Abstracts. NASA Human Research Program Investigators' Workshop, Galveston, TX, January 22-25, 2019. , Jan-2019
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Abstracts for Journals and Proceedings
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Christian K, Petitti C, Ortega-Schwartz K, Penrose S, Schallerer A, Lovering A, Laurie S. "Assessment of Sleep and Circadian Rhythm During Hypercapnic 6-degree Head-Down Tilt Bed Rest." Presented at American College of Sports Medicine Northwest Chapter, Annual Meeting, Bend, OR, February 2018. American College of Sports Medicine Northwest Chapter, Annual Meeting, Bend, OR, February 2018. , Feb-2018
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Abstracts for Journals and Proceedings
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Kysar J, Christian K, Olson T, Laurie SS, Lovering AT. "Breath-by-Breath: Effect of mild hypercapnic bedrest on ventilatory chemosensitivity to carbon dioxide." Presented at American College of Sports Medicine Northwest Chapter, Annual Meeting, Bend, OR, February 2018. American College of Sports Medicine Northwest Chapter, Annual Meeting, Bend, OR, February 2018. , Feb-2018
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Articles in Peer-reviewed Journals
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Laurie SS, Macias BR, Dunn JT, Young M, Stern C, Lee SMC, Stenger MB. "Optic disc edema after 30 days of strict head-down tilt bed rest." Ophthalmology. 2019 Mar;126(3):467-8. Epub 2018 Oct 9. https://doi.org/10.1016/j.ophtha.2018.09.042 ; PubMed PMID: 30308219 , Mar-2019
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Articles in Peer-reviewed Journals
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Zwart SR, Laurie SS, Chen JJ, Macias BR, Lee SMC, Stenger MB, Grantham B, Carey K, Young M, Smith SM. "Association of genetics and B vitamin status with the magnitude of optic disc edema during 30-day strict head-down tilt bed rest." JAMA Ophthalmol. 2019;137(10):1195-200. Epub 2019 Aug 15. https://doi.org/10.1001/jamaophthalmol.2019.3124 ; PubMed PMID: 31415055; PubMed Central PMCID: PMC6696878 , Oct-2019
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Articles in Peer-reviewed Journals
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Laurie SS, Christian K, Kysar J, Lee SMC, Lovering AT, Macias BR, Moestl S, Sies W, Mulder E, Young M, Stenger MB. "Unchanged cerebrovascular CO2 reactivity and hypercapnic ventilatory response during strict head-down tilt bed rest in a mild hypercapnic environment." J Physiol. 2020 Jun;598(12):2491-505. https://doi.org/10.1113/JP279383 ; PMID: 32196672
, Jun-2020
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Dissertations and Theses
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Christian KH. "VaPER: The Development of Spaceflight Associated Neuro-ocular Syndrome (SANS): sans sufficient sleep?" Master's Thesis, University of Oregon, Eugene, OR, August 2018. , Aug-2018
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