{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:06:57Z","timestamp":1792786017072,"version":"4.5.0"},"reference-count":40,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The Assistant Secretary of Defense for Health Affairs","id":[{"id":"https:\/\/ror.org\/02fkh1w66","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000005","name":"Department of Defense","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Peer Reviewed Medical Research Program","award":["W81XWH-22-1-0867"],"award-info":[{"award-number":["W81XWH-22-1-0867"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Sleep restriction can impair shooting performance by 10%-40%, thereby diminishing operational effectiveness. Emerging evidence suggests that exogenous ketones may counteract the physical and cognitive declines associated with sleep loss; however, specific effects on shooting performance during sleep deprivation have not yet been evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>Using a crossover, double-blind, placebo-controlled design, 32 healthy volunteers (16 women) underwent four consecutive nights of 50% sleep restriction in two sequences. Participants received a 25\u00a0g dose of either bis-octanoyl (R)-1,3-butanediol (BO-BD) or an isocaloric flavor-matched placebo before, twice daily during, and once after sleep restriction (9 doses per sequence). Capillary ketones were measured using a point-of-care device. Sleep duration\/architecture were monitored using a wearable infrared skin monitor device. Accuracy, precision, decision-making, and reaction time were evaluated using a reliable virtual reality simulator. The reaction time task, Steel Plates, required participants to engage six targets from left to right as quickly as possible, with Hit Factor [(hits\u2212misses)\/time] serving as the primary metric.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Time in bed decreased from 7 hours 51 minutes at baseline to 4 hours 15 minutes during sleep restriction (\u221246%; P\u2009&amp;lt;\u2009.001). The BO-BD elevated capillary ketones (&amp;gt;1.0 mM) and augmented the time spent in deep sleep 13% relative to the placebo (P\u2009=\u2009.042). Independent of sleep and relative to placebo, BO-BD elicited an 8% greater Hit Factor (P\u2009&amp;lt;\u2009.001), 7% faster completion time (P\u2009&amp;lt;\u2009.001), 1% higher accuracy (P\u2009=\u2009.023), and 7% greater throughput (P\u2009&amp;lt;\u2009.001). Marksmanship and decision-making were overall preserved; however, loss of vertical rifle steadiness was associated with sleep loss (P\u2009=\u2009.052).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A transient state of nutritional ketosis enhanced virtual reality shooting performance both before and after short-term sleep restriction. Acute and twice-daily BO-BD supplementation during sleep restriction may augment shooting speed and efficiency without affecting marksmanship or decision-making under sleep constraints.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial Registration<\/jats:title>\n                    <jats:p>Identifier: NCT05519644.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usag429","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T11:33:43Z","timestamp":1788867223000},"source":"Crossref","is-referenced-by-count":1,"title":["Supplementation With Ketogenic Precursors Enhances Virtual Reality Shooting Performance During Sleep Restriction: A Randomized, Placebo-Controlled, Crossover 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