Supplementation With Ketogenic Precursors Enhances Virtual Reality Shooting Performance During Sleep Restriction: A Randomized, Placebo-Controlled, Crossover Trial

INTRODUCTION: 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. MATERIALS AND METHODS: 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 g 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-misses)/time] serving as the primary metric. RESULTS: Time in bed decreased from 7 hours 51 minutes at baseline to 4 hours 15 minutes during sleep restriction (-46%; P < .001). The BO-BD elevated capillary ketones (>1.0 mM) and augmented the time spent in deep sleep 13% relative to the placebo (P = .042). Independent of sleep and relative to placebo, BO-BD elicited an 8% greater Hit Factor (P < .001), 7% faster completion time (P < .001), 1% higher accuracy (P = .023), and 7% greater throughput (P < .001). Marksmanship and decision-making were overall preserved; however, loss of vertical rifle steadiness was associated with sleep loss (P = .052). CONCLUSION: 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. CLINICAL TRIAL REGISTRATION: Identifier: NCT05519644.