Dose-response relationship between sleep duration and human psychomotor vigilance and subjective alertness

Although it has been well documented that sleep is required for human performance and alertness to recover from low levels after prolonged periods of wakefulness, it remains unclear whether they increase in a linear or asymptotic manner during sleep. It has been postulated that there is a relation between the rate of improvement in neurobehavioral functioning and rate of decline of slow-wave sleep and/or slow-wave activity (SWS/SWA) during sleep, but this has not been verified. Thus, a cross-study comparison was conducted in which dose-response curves (DRCs) were constructed for Stanford Sleepiness Scale (SSS) and Psychomotor Vigilance Task (PVT) tests taken at 1000 hours by subjects who had been allowed to sleep 0 hours, 2 hours, 5 hours or 8 hours the previous night. We found that the DRCs to each PVT metric improved in a saturating exponential manner, with recovery rates that were similar [time constant (T) approximately 2.14 hours] for all the metrics. This recovery rate was slightly faster than, though not statistically significantly different from, the reported rate of SWS/SWA decline (T approximately 2.7 hours). The DRC to the SSS improved much more slowly than psychomotor vigilance, so that it could be fit equally well by a linear function (slope = -0.26) or a saturating exponential function (T = 9.09 hours). We conclude that although SWS/SWA, subjective alertness, and a wide variety of psychomotor vigilance metrics may all change asymptotically during sleep, it remains to be determined whether the underlying physiologic processes governing their expression are different.     

The sensitivity of a PDA-based psychomotor vigilance task to sleep restriction in 10-year-old girls

The impact of sleep restriction on sustained attention in children has not been well quantified. To address this shortcoming, this study tested the sensitivity of a 5-min personal digital assistant-psychomotor vigilance task (PDA-PVT) to sleep restriction in 14 female children [mean (SD) age = 10.6 ± 0.3 years]. The children underwent PDA-PVT trials at regular intervals both before and after a sleep restriction (5 h time-in-bed) and a control (10 h time-in-bed) condition. Sleep restriction was associated with longer mean response times and increased number of lapses. These results are consistent with findings in the adult literature suggesting an association between inadequate sleep and impaired functioning. In conclusion, the 5-min PDA-PVT is sensitive to sleep restriction in pre-adolescent female children supporting the utility of the PDA-PVT for examining the impact of sleep deprivation on daytime functioning in children.     

A new likelihood ratio metric for the psychomotor vigilance test and its sensitivity to sleep loss

The Psychomotor Vigilance Test (PVT) is a widely used assay of behavioural alertness sensitive to the effects of sleep loss and circadian misalignment. However, there is currently no accepted PVT composite outcome metric that captures response slowing, attentional lapses and compensatory premature reactions observed typically in sleep‐deprived subjects. We developed a novel likelihood ratio metric (LRM) based on relative frequency distributions in 50 categories of reaction times (RT) and false starts in alert and sleep‐deprived subjects (acute total sleep deprivation: n = 31 subjects). The LRM had the largest effect size both in a 33‐h total sleep deprivation protocol [1.96; 95% confidence interval (CI): 1.61–2.44; followed by response speed 1/RT, effect size 1.93, 95% CI: 1.55–2.65] and in a chronic partial sleep restriction protocol (1.22; 95% CI: 0.96–1.59; followed by response speed 1/RT, effect size 1.21, 95% CI: 0.94–1.59; 5 nights at 4 h sleep per night; n = 43 subjects). LRM scores correlated highly with response speed (R² = 0.986), and less well with five other common PVT outcome metrics (R² = 0.111–0.886). In conclusion, the new LRM is a sensitive PVT outcome metric with high statistical power that takes subtle sleep loss‐related changes in the distribution of reaction times (including false starts) into account, is not prone to outliers, does not require baseline data and can be calculated and interpreted easily. Congruence between LRM and PVT response speed and their similar effect size rankings support the use of response speed as the primary, most sensitive and most parsimonious standard PVT outcome metric for determining neurobehavioural deficits from sleep loss.     

The effect of self-awakening from nocturnal sleep on sleep inertia

The present study examined the effects of self-awakening on sleep inertia after nocturnal sleep. Ten undergraduate and graduate students participated in the study. Their polysomnograms were recorded for five consecutive nights; the first, second, and third to fifth nights were adaptation, forced-awakening, and self-awakening nights, respectively. Participants rated sleepiness, fatigue, comfort, and work motivation, and these ratings were followed by switching (7 min) and auditory reaction time tasks (6 min), both before bedtime (15 min) and immediately after awakening (4 min × 15 min). Although reaction times on the auditory were task prolonged, and participants complained of feeling uncomfortable immediately after forced-awakening, reaction times were shortened after self-awakening, and the participants did not complain of feeling uncomfortable on these nights. The results of this study suggest that sleep inertia occurs after forced-awakening and that it can be prevented by self-awakening.     

The neural basis of the psychomotor vigilance task

STUDY OBJECTIVE: To identify brain regions underlying the fastest and slowest reaction times on the Psychomotor Vigilance task (PVT) under well-rested conditions, as well as brain regions related to particularly poor performance after sleep deprivation. DESIGN: Subjects took the PVT twice while undergoing functional magnetic resonance imaging: once 12 hours after waking from a normal night of sleep and once after 36 hours of total sleep deprivation (TSD). Session order was counterbalanced. SETTING: UCSD J. Christian Gillin Laboratory for Sleep and Chronobiology (the sleep core of the General Clinical Research Center) and UCSD Magnetic Resonance Institute. PATIENTS OR PARTICIPANTS: Twenty right-handed healthy adults (8 women; age = 27.4 +/- 6.7 years; education = 15.6 +/- 1.5 years). MEASUREMENTS AND RESULTS: After a normal night of sleep, optimal performance was related to greater cerebral responses within a cortical sustained attention network and the cortical and subcortical motor systems. Slow reaction times, particularly after TSD, were associated with greater activity in the "default mode network" consisting of frontal and posterior midline regions. CONCLUSIONS: Optimal performance on the PVT appears to rely on activation both within the sustained attention system and within the motor system. Poor performance following TSD may result from a disengagement from the task and related inattention, and brain regions responsible for this localize within midline structures shown to be involved in the brain's "default mode." Finally, particularly poor performance after TSD may elicit a subsequent attentional recovery that manifests as greater activation within the same regions normally responsible for fast reaction times.     

Comparison of sustained attention assessed by auditory and visual psychomotor vigilance tasks prior to and during sleep deprivation

To date, no detailed examination of the pattern of change in reaction time performance for different sensory modalities has been conducted across the circadian cycle during sleep deprivation. Therefore, we compared sustained auditory and visual attention performance during 40 h of sleep deprivation assessing multiple metrics of auditory and visual psychomotor vigilance tasks (PVT). Forty healthy participants (14 women) aged 30.8 ± 8.6 years were studied. Subjects were scheduled for an ∼8 h sleep schedule at home prior to three–six laboratory baseline days with an 8 h sleep schedule followed by 40 h sleep deprivation. Visual and auditory PVTs were 10 min in duration, and were administered every 2 h during sleep deprivation. Data were analysed with mixed‐model anova . Sleep deprivation and circadian phase increased response time, lapses, anticipations, standard deviation of response times and time on task decrements for visual and auditory PVTs. In general, auditory vigilance was faster and less variable than visual vigilance, with larger differences between auditory and visual PVT during sleep deprivation versus baseline. Failures to respond to stimuli within 10 s were four times more likely to occur to visual versus auditory stimuli. Our findings highlight that lapses during sleep deprivation are more than just long responses due to eye closure or visual distraction. Furthermore, our findings imply that the general pattern of change in attention during sleep deprivation (e.g. circadian variation, response slowing, lapsing and anticipations, time on task decrements and state instability) is similar among sensory–motor behavioral response modalities.     

24 hours of sleep deprivation in the rat increases sleepiness and decreases vigilance: introduction of the rat‐psychomotor vigilance task

A novel animal‐analog of the human psychomotor vigilance task (PVT) was validated by subjecting rats to 24 h of sleep deprivation (SD) and examining the effect on performance in the rat‐PVT (rPVT), and a rat multiple sleep latency test (rMSLT). During a three‐phase (separate cohorts) crossover design, vigilance performance in the rPVT was compared with 24 h SD‐induced changes in sleepiness assessed by polysomnographic evaluation and the rMSLT. Twenty‐four hours of SD was produced by brief rotation of activity wheels at regular intervals in which the animals resided throughout the experiment. In the rPVT experiment, exercise controls (EC) experienced the same overall amount of locomotor activity as during SD, but allowed long periods of undisturbed sleep. After 24 h SD response latencies slowed, and lapses increased significantly during rPVT performance when compared with baseline and EC conditions. During the first 3 h of the recovery period following 24 h SD, polysomnographic measures indicated sleepiness. Latency to fall asleep after 24 h SD was assessed six times during the first 3 h after SD. Rats fell asleep significantly faster immediately after SD, than after non‐SD baseline sessions. In conclusion, 24 h of SD in rats increased sleepiness, as indicated by polysomnography and the rMSLT, and impaired vigilance as measured by the rPVT. The rPVT closely resembles the human PVT test widely used in human sleep research and will assist investigation of the neurobiologic mechanisms that produce vigilance impairments after sleep disruption.     

Microdialysis elevation of adenosine in the basal forebrain produces vigilance impairments in the rat psychomotor vigilance task

STUDY OBJECTIVE: The inhibitory neuromodulator adenosine has been proposed as a homeostatic sleep factor that acts potently in the basal forebrain (BF) to increase sleepiness. Here 300 microM of adenosine was dialyzed in the BF of rats, and the effect on vigilance was determined in the rat Psychomotor Vigilance Task (rPVT). DESIGN: Rats experienced all experimental conditions in a repeated-measures, cross-over design. PATIENTS OR PARTICIPANTS: Twelve young adult male Fischer-Norway rats. INTERVENTIONS: Sustained attention performance in the rPVT was evaluated following 2 hours of bilateral microdialysis perfusion of vehicle, adenosine (300 microM), or codialysis of 300 microM of adenosine with the A1 receptor antagonist 8-cyclopentyltheophylline. MEASUREMENTS AND RESULTS: During rPVT performance, response latencies and performance lapses increased significantly after adenosine dialysis when compared with baseline (no dialysis) or vehicle dialysis sessions. The codialysis of 8-cyclopentyltheophylline with adenosine completely blocked the effects produced by adenosine alone, resulting in performance equivalent to that of the vehicle sessions. CONCLUSIONS: Pharmacologic elevation of BF adenosine in rats produced vigilance impairments resembling the effect of sleep deprivation on vigilance performance in both man and rats. This effect of exogenous adenosine was completely blocked by codialysis with an adenosine A1 receptor antagonist. The results are consistent with the hypothesis that sleep loss induces elevations of BF adenosine that, acting via A1 receptors, lead to increased sleepiness and impaired vigilance.     

Colic, sleep inertia, melatonin and circannual rhythms.

Colic is periodic behavior occurring at the end of the day during the first 3 months of life characterized by crying. It is hypothesized that the crying at the end of the day is due to sleep inertia or a state dissociation during which the infant is simultaneously partially awake and partially asleep because of the absence of a melatonin diurnal rhythm. The melatonin timing mechanisms, which codes for day length, is initiated prenatally by the maternal pineal gland, and after 3 months postnatally, the melatonin nocturnal secretion rhythm is maintained by the infant's pineal gland. To record the seasonal variation in day length away from the equator, 12 months are required to complete the melatonin chemical calendar. This circannual process is only 9 months completed at the time of birth, and 3 additional months are needed during which the infant may have difficulty reconciling cues for the timing of evening sleep due to discrepancies between the expected photoperiod derived from the prenatal maternal pineal melatonin circadian rhythm and the postnatally experienced photoperiod. Data is presented showing that the incidence of colic increases with increasing latitude in support of the hypothesis that infant crying at the end of the day during the first 3 months represents the last quarter of a circannual photoperiodic development process.     

A new metric for quantifying performance impairment on the psychomotor vigilance test

We have developed a new psychomotor vigilance test (PVT) metric for quantifying the effects of sleep loss on performance impairment. The new metric quantifies performance impairment by estimating the probability density of response times (RTs) in a PVT session, and then considering deviations of the density relative to that of a baseline‐session density. Results from a controlled laboratory study involving 12 healthy adults subjected to 85 h of extended wakefulness, followed by 12 h of recovery sleep, revealed that the group performance variability based on the new metric remained relatively uniform throughout wakefulness. In contrast, the variability of PVT lapses, mean RT, median RT and (to a lesser extent) mean speed showed strong time‐of‐day effects, with the PVT lapse variability changing with time of day depending on the selected threshold. Our analysis suggests that the new metric captures more effectively the homeostatic and circadian process underlying sleep regulation than the other metrics, both directly in terms of larger effect sizes (4–61% larger) and indirectly through improved fits to the two‐process model (9–67% larger coefficient of determination). Although the trend of the mean speed results followed those of the new metric, we found that mean speed yields significantly smaller (～50%) intersubject performance variance than the other metrics. Based on these findings, and that the new metric considers performance changes based on the entire set of responses relative to a baseline, we conclude that it provides a number of potential advantages over the traditional PVT metrics.     

The effects of sleep inertia on decision-making performance

Sleep inertia, the performance impairment that occurs immediately after awakening, has not been studied previously in relation to decision-making performance. Twelve subjects were monitored in the sleep laboratory for one night and twice awoken by a fire alarm (slow wave sleep, SWS and REM sleep). Decision making was measured over 10 3-min trials using the ‘Fire Chief’ computer task under conditions of baseline, SWS and REM arousal. The most important finding was that sleep inertia reduces decision-making performance for at least 30 min with the greatest impairments (in terms of both performance and subjective ratings) being found within 3 min after abrupt nocturnal awakening. Decision-making performance was as little as 51% of optimum (i.e. baseline) during these first few minutes. However, after 30 min, performance may still be as much as 20% below optimum. The initial effects of sleep inertia during the first 9 min are significantly greater after SWS arousal than after REM arousal, but this difference is not sustained. Decision-making performance after REM arousal showed more variability than after SWS arousal. Subjects reported being significantly sleepier and less clear-headed following both SWS and REM awakenings compared with baseline and this was sustained across the full 30 min. In order to generalize this finding to real-life situations, further research is required on the effects of continuous noise, emotional arousal and physical activity on the severity and duration of sleep inertia.     

Circadian and wake-dependent modulation of fastest and slowest reaction times during the psychomotor vigilance task

Performance on the psychomotor vigilance task (PVT) sensitively reflects a circadian modulation of neurobehavioral functions, as well as the effect of sleep pressure developing with duration of time awake, without being confounded by a learning curve. Sixteen healthy volunteers underwent two 40-h constant posture protocols in a balanced crossover design. During these protocols, either low sleep pressure conditions were attained by an alternating cycle of 150 min of wakefulness and 75 min of sleep (NAP) protocol, or high sleep pressure conditions were achieved by total sleep deprivation (SD) protocol. During scheduled wakefulness in both protocols, the PVT was carried out every 225 min. Quantitative analysis of the lapses, slowest (90th percentile) and fastest (10th percentile) reaction times (RTs) during the protocols, indicated that the lapses and slowest RTs were sensitive to changes in homeostatic sleep pressure. Our data indicate that the difference between the fastest and slowest RTs (interpercentile range 10th–90th percentile) was particular sensitive to detect very early effects of growing sleep pressure. On the other hand, decrements in PVT performance which were related to circadian phase did not depend significantly on any categorization (such as percentiles of the RTs).     

Effects of sleep deprivation on signal detection measures of vigilance: implications for sleep function

In an attempt to tease out the extent to which the performance decline during sleep deprivation might be due to a fall in the inherent capacity (d') of a subject, the parameters of the theory of signal detection were applied to auditory vigilance data obtained five times per 24 h during 60 h of continuous wakefulness. Eight subjects were exposed to both control and deprivation conditions in a balanced design. Oral temperature and self-assessed alert-drowsy reports were taken at three hourly intervals. The value of d' exhibited a significant stepwise decline during deprivation, falling sharply within the usual sleep period and levelling out during the daytime. Both temperature and self-assessment data exhibited clear circadian rhythms overlying the declines due to deprivation. The changes in d' were seen to be consistent with a brain "restitutive" role for sleep function.     

Relationships between affect, vigilance, and sleepiness following sleep deprivation

This pilot study examined the relationships between the effects of sleep deprivation on subjective and objective measures of sleepiness and affect, and psychomotor vigilance performance. Following an adaptation night in the laboratory, healthy young adults were randomly assigned to either a night of total sleep deprivation (SD group; n = 15) or to a night of normal sleep (non-SD group; n = 14) under controlled laboratory conditions. The following day, subjective reports of mood and sleepiness, objective sleepiness (Multiple Sleep Latency Test and spontaneous oscillations in pupil diameter, PUI), affective reactivity/regulation (pupil dilation responses to emotional pictures), and psychomotor vigilance performance (PVT) were measured. Sleep deprivation had a significant impact on all three domains (affect, sleepiness, and vigilance), with significant group differences for eight of the nine outcome measures. Exploratory factor analyses performed across the entire sample and within the SD group alone revealed that the outcomes clustered on three orthogonal dimensions reflecting the method of measurement: physiological measures of sleepiness and affective reactivity/regulation, subjective measures of sleepiness and mood, and vigilance performance. Sleepiness and affective responses to sleep deprivation were associated (although separately for objective and subjective measures). PVT performance was also independent of the sleepiness and affect outcomes. These findings suggest that objective and subjective measures represent distinct entities that should not be assumed to be equivalent. By including affective outcomes in experimental sleep deprivation research, the impact of sleep loss on affective function and their relationship to other neurobehavioral domains can be assessed.     

Caffeine protects against increased risk-taking propensity during severe sleep deprivation

Previous research suggests that sleep deprivation is associated with declines in metabolic activity within brain regions important for judgement and impulse control, yet previous studies have reported inconsistent findings regarding the effects of sleep loss and caffeine on risk-taking. In this study, 25 healthy adults (21 men, four women) completed the Balloon Analog Risk Task (BART) and Evaluation of Risks (EVAR) scale at regular intervals to examine behavioral and self-reported risk-taking propensity during 75 h of continuous sleep deprivation. Participants received either four double-blind administrations of 200 mg caffeine (n=12) or indistinguishable placebo (n=13) gum bi-hourly during each of the 3 nights of sleep deprivation. No significant effects of drug group or sleep deprivation were evident on the BART or EVAR when measured at 51 h of wakefulness. However, by 75 h, the placebo group showed a significant increase in risk-taking behavior on the cost-benefit ratio and total number of exploded balloons on the BART, whereas the caffeine group remained at baseline levels. On the EVAR, several factors of self-reported risk-taking propensity, including total risk, impulsivity and risk/thrill seeking, were reduced among subjects receiving caffeine across the 3 days of sleep deprivation, but remained at baseline levels for the placebo group. These results suggest that 3 nights of total sleep deprivation led to a significant increase in behavioral risk-taking but not self-reported perception of risk-propensity. Overnight caffeine prevented this increase in risky behavior.     

Time-on-task impairment of psychomotor vigilance is affected by mild skin warming and changes with aging and insomnia

STUDY OBJECTIVES: To investigate the effect of mild manipulations of core and skin temperature on psychomotor vigilance (PVT) in young adults, elderly, and elderly insomniacs. DESIGN: 432 PVTs were obtained during a 2-day semi-constant routine protocol, while differentially manipulating core and skin temperatures within a comfortable thermoneutral range. SETTING: Sleep laboratory of the Netherlands Institute for Neuroscience. PATIENTS OR PARTICIPANTS: Groups of 8 sex-matched young adults (27.0 +/- 2.4 years, mean +/- s.e.m.), elderly (65.8 +/- 2.8 years), and insomniacs (59.1 +/-1.9 years). MEASUREMENTS AND RESULTS: During the 7-minute PVTs, response speed typically declined with increasing time-on-task. Proximal skin warming by only +/- 0.6 degrees C accelerated this decline by 67% (P = 0.05) in young adults and by 50% (P < 0.05) in elderly subjects. In elderly insomniacs, proximal warming slowed down the mean response speed already from the onset of the task (3% level drop, P < 0.001). Response speed tended to decrease with age (P < 0.10), reaching significance only in elderly insomniacs (P < 0.05). Speed decrements occurred mostly towards the end of the time-on-task in young adults; earlier and more gradually in elderly without sleep complaints; and very early and in a pronounced fashion in insomniacs. Interestingly, the worsening by warming followed the time pattern already present within each group. CONCLUSIONS: The results are compatible with the hypothesis that the endogenous circadian variation of skin temperature could modulate vigilance regulating brain areas and thus contribute to the circadian rhythm in vigilance. Minute-by-minute PVT analyses revealed effects of age and insomnia not previously disclosed in studies applying time-point aggregation. Our data indicate that "age-related cognitive slowing" may result, in part, from age-related sleep problems.