{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:07:29Z","timestamp":1787029649646,"version":"build-2736575974"},"reference-count":71,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2024,12,3]],"date-time":"2024-12-03T00:00:00Z","timestamp":1733184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Naval Sea Systems Command (NAVSEA)","award":["N0463A-12-C-0001 P00001"],"award-info":[{"award-number":["N0463A-12-C-0001 P00001"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>We examined data from Naval Sea Systems Command grant project N0463A-12-C-001, \u201cHypercapnia: cognitive effects and monitoring\u201d, with the objective of validating or repudiating heart rate variability (HRV) as a warning sign of cognitive impairment from diving gas narcosis or oxygen toxicity. We compared HRV feature scores to their temporally corresponding cognitive outcomes under normal and narcotizing conditions to identify specific HRV features associated with cognitive changes. N0463A-12-C-001 was conducted between 17 September 2013 and 29 January 2016 and employed NASA\u2019s multi-attribute task battery (MATB-II) flight simulator to examine the independent effects of CO2, N2, and O2 partial pressure on diver performance at simulated depths up to 61 msw (200 fsw). We assessed the association of 23 distinct HRV features scores from 432 of the study\u2019s analyzable exposure stages in relation to MATB-II\u2019s four performance subclasses (motor, memory, attention, strategy) while controlling for exercise and CO2, N2, and O2 gas partial pressure. Performance decrements were associated with normalized high-frequency HRVfeatures (HFnu, p = 0.0016) and the number of pairs of successive R-R intervals that differed by more than 50 ms (NN50count1, p = 0.04). Secondary analysis with stratification restricted to non-exercise stages showed that several HRV parameters, including root mean square of the successive difference (RMSSD, p = 0.0015), width of Poincar\u00e9 plot (p = 0.0017), NN50count1 (p = 0.0019), and standard deviation of normal-to-normal R peaks (p = 0.0082), were associated with performance impairment. The RMSSD association retained statistical significance after Bonferroni correction for multiple tests. HRV features collected from divers tested under narcotizing conditions of breathing gas partial pressure and exercise were associated with performance impairment.<\/jats:p>","DOI":"10.3390\/s24237726","type":"journal-article","created":{"date-parts":[[2024,12,4]],"date-time":"2024-12-04T06:38:25Z","timestamp":1733294305000},"page":"7726","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Does Heart Rate Variability Predict Impairment of Operational Performance in Divers?"],"prefix":"10.3390","volume":"24","author":[{"given":"John","family":"Freiberger","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Duke University, Durham, NC 27708, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6395-2338","authenticated-orcid":false,"given":"Bruce","family":"Derrick","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Duke University, Durham, NC 27708, USA"},{"name":"Department of Emergency Medicine, Duke University, Durham, NC 27708, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4422-4837","authenticated-orcid":false,"given":"Ki H.","family":"Chon","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2344-8321","authenticated-orcid":false,"given":"Md Billal","family":"Hossain","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4514-4772","authenticated-orcid":false,"given":"Hugo F.","family":"Posada-Quintero","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Cooter","sequence":"additional","affiliation":[{"name":"School of Medicine, Duke University, Durham, NC 27710, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Moon","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Duke University, Durham, NC 27708, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,3]]},"reference":[{"key":"ref_1","first-page":"107","article-title":"Latency Changes in the Human Somatosensory Evoked Potential at Extreme Depths","volume":"10","author":"Simpson","year":"1983","journal-title":"Undersea Biomed. 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