INTERINDIVIDUAL DIFFERENCES IN NEUROBEHAVIORAL PERFORMANCE IN RESPONSE TO INCREASING HOMEOSTATIC SLEEP PRESSURE

Neurobehavioral function deteriorates with increasing homeostatic sleep pressure during wakefulness. It has been claimed that some individuals exhibit a quicker rate of such deterioration than others, thus being more vulnerable than others to the detrimental impact of increasing homeostatic sleep pressure. Evidence supporting the claim, however, has been limited by methodological issues. To overcome these limitations, the current study used a 12-calendar-day, 28-h forced desynchrony (FD) protocol (sleep:wake period?=?1:2) to study individual differences in the rate of change in neurobehavioral performance with increasing homeostatic sleep pressure. Neurobehavioral performance was assessed with a psychomotor vigilance task and a serial addition subtraction task. A significant performance decline on both tasks was revealed within as short as 17?h of wakefulness. The rates of decline of individual performance trajectories were, however, not different from the group average rate. This suggests that individuals are not differentially vulnerable to the detrimental impact of increasing homeostatic sleep pressure. (Author correspondence: xuan.zhou@unisa.edu.au)     

Sustained attention performance during sleep deprivation: evidence of state instability

Nathaniel Kleitman was the first to observe that sleep deprivation in humans did not eliminate the ability to perform neurobehavioral functions, but it did make it difficult to maintain stable performance for more than a few minutes. To investigate variability in performance as a function of sleep deprivation, n = 13 subjects were tested every 2 hours on a 10-minute, sustained-attention, psychomotor vigilance task (PVT) throughout 88 hours of total sleep deprivation (TSD condition), and compared to a control group of n = 15 subjects who were permitted a 2-hour nap every 12 hours (NAP condition) throughout the 88-hour period. PVT reaction time means and standard deviations increased markedly among subjects and within each individual subject in the TSD condition relative to the NAP condition. TSD subjects also had increasingly greater performance variability as a function of time on task after 18 hours of wakefulness. During sleep deprivation, variability in PVT performance reflected a combination of normal timely responses, errors of omission (i.e., lapses), and errors of commission (i.e., responding when no stimulus was present). Errors of omission and errors of commission were highly intercorrelated across deprivation in the TSD condition (r = 0.85, p = 0.0001), suggesting that performance instability is more likely to include compensatory effort than a lack of motivation. The marked increases in PVT performance variability as sleep loss continued supports the "state instability" hypothesis, which posits that performance during sleep deprivation is increasingly variable due to the influence of sleep initiating mechanisms on the endogenous capacity to maintain attention and alertness, thereby creating an unstable state that fluctuates within seconds and that cannot be characterized as either fully awake or asleep.     

Dynamical properties of the two-process model for sleep-wake cycles in infantile autism

The two-process model is a scheme for the timing of sleep that consists of homeostatic (Process S) and circadian (Process C) variables. The two-process model exhibits abnormal sleep patterns such as internal desynchronization or sleep fragmentation. Early infants with autism often experience sleep difficulties. Large day-by-day changes are found in the sleep onset and waking times in autistic children. Frequent night waking is a prominent property of their sleep. Further, the sleep duration of autistic children is often fragmented. These sleep patterns in infants with autism are not fully understood yet. In the present study, the sleep patterns in autistic children were reproduced by a modified two-process model using nonlinear analysis. A nap term was introduced into the original two-process model to reproduce the sleep patterns in early infants. The nap term and the time course of Process S are mentioned in the present study. Those parameters led to bifurcation of the sleep-wake cycle in the modified two-process model. In a certain range of these parameter sets, a small external noise was amplified, and an irregular sleep-wake cycle appeared. The short duration of sleep led to another irregular sleep onset or waking. Consequently, an irregular sleep-wake cycle appeared in early infantile autism.     

SUBJECTIVE PERCEPTIONS OF THE EFFECTS OF SUSTAINED PERFORMANCE UNDER SLEEP-DEPRIVATION CONDITIONS

In today's society, numerous situations arise in which sleep deprivation is a common occurrence. Subjective perceptions are a vital component to understanding the effects of sustained performance during sleep deprivation, as they may be the first indication of the effects of sustained performance or sleep deprivation on the individual. Using the theoretical framework of the Controlled Attention Model, this study examined the effects of 16?h of sustained performance under 28?h of acute sleep deprivation on perceived effort, motivation, and stress of 24 participants while completing a complex cognitive and a simple vigilance task. Perceived effort increased for both tasks, with higher effort reported on the cognitive than the vigilance task at the beginning of the experimental period, but with higher effort reported on the vigilance than the cognitive task at the end. Subjective motivation decreased for both tasks, with significantly higher levels of motivation on the cognitive than the vigilance task. Perceived stress did not change for either task. Results suggest that functioning under sustained performance and sleep-deprivation conditions affects subjective perceptions differently for cognitive versus vigilance tasks. The controlled attention model offers one means of understanding how different tasks could affect a person's subjective perceptions and ability to perform, in that different levels of controlled attention are required for the two tasks. (Author correspondence: hodle@gettysburg.edu)     

Sleep initiation and initial sleep intensity: interactions of homeostatic and circadian mechanisms

Sleep initiation and sleep intensity in humans show a dissimilar time course. The propensity of sleep initiation (PSI), as measured by the multiple sleep latency test, remains at a relatively constant level throughout the habitual period of waking or exhibits a midafternoon peak. When waking is extended into the sleep period, PSI rises rapidly within a few hours. In contrast, sleep intensity, as measured by electroencephalographic slow-wave activity during naps, shows a gradual increase during the period of habitual waking. In the two-process model of sleep regulation, it corresponds to the rising limb of the homeostatic Process S. We propose that PSI is determined by the difference between Process S and the threshold H defining sleep onset, which is modulated by the circadian process C. In contrast to a previous version of the model, the parameters of H (amplitude, phase, skewness) differ from those of threshold L, which defines sleep termination. The present model is able to simulate the time course of PSI under baseline conditions as well as following recovery sleep after extended sleep deprivation. The simulations suggest that during the regular period of waking, a circadian process counteracts the increasing sleep propensity induced by a homeostatic process. Data obtained in the rat indicate that during the circadian period of predominant waking, a circadian process prevents a major intrusion of sleep.     

PRIOR NIGHT SLEEP DURATION IS ASSOCIATED WITH PSYCHOMOTOR VIGILANCE IN A HEALTHY SAMPLE OF POLICE ACADEMY RECRUITS

Aviation, military, police, and health care personnel have been particularly interested in the operational impact of sleep restriction and work schedules given the potential severe consequences of making fatigue-related errors. Most studies examining the impact of sleep loss or circadian manipulations have been conducted in controlled laboratory settings using small sample sizes. This study examined whether the relationship between prior night sleep duration and performance on the psychomotor vigilance task could be reliably detected in a field study of healthy police academy recruits. Subjects (N?=?189) were medically and psychiatrically healthy. Sleep-wake activity was assessed with wrist actigraphy for 7 days. Subjects performed the psychomotor vigilance task (PVT) for 5?min on a personal digital assistant (PDA) device before and after their police academy workday and on comparable times during their days off. Mixed-effects logistic regression was used to estimate the probability of having ≥1 lapse on the PVT as a function of the previous night sleep duration during the 7 days of field testing. Valid estimates of sleep duration were obtained for 1082 nights of sleep. The probability of a lapse decreased by 3.5%/h sleep the night prior to testing. The overall probability of having a lapse decreased by 0.9%/h since awakening, holding hours of sleep constant. Perceived stress was not associated with sleep duration or probability of performance lapse. These findings demonstrate the feasibility of detecting sleep and circadian effects on cognitive performance in large field studies. These findings have implications regarding the daytime functioning of police officers. (Author correspondence: Thomas.Neylan@ucsf.edu)     

Effects of One Night of Partial Sleep Deprivation upon Diurnal Rhythms of Accuracy and Consistency in Throwing Darts

Sixty subjects were tested five times per waking day on two occasions for accuracy and reliability in throwing 20 darts at a target. Two experimental conditions were investigated: following a normal nocturnal sleep (7–8 h sleep, normal) and after having retired to bed 4 h later than normal the previous night but rising at the normal time (3–4 h sleep, sleep deprivation). Sublingual (core) temperature and subjective estimates of alertness and fatigue were measured in all sessions. Performance at throwing darts was assessed by three methods: mean distance of the dart from the bulls-eye; number of times the target was missed; and variability of the scores from the darts thrown. There was no evidence that performance was affected by physical fatigue arising during the course of throwing the 20 darts. All variables showed significant diurnal rhythms, those of alertness and performance being phased over 1 h earlier than core temperature, and that of fatigue over 1 h earlier than the inverse of temperature. Core temperature was not affected by sleep deprivation, but all other variables showed significant changes, indicative of mood and performance decrement. Increasing time awake was associated with decreased alertness and increased fatigue, as well as slight negative effects upon performance. We conclude that the simple task of throwing darts at a target provides information about chronobiological changes in circumstances where time awake and sleep loss might affect psychomotor performance. (Author correspondence: b.j.edwards@ljmu.ac.uk)     

Mood, alertness, and performance in response to sleep deprivation and recovery sleep in experienced shiftworkers versus non-shiftworkers

Previous studies have shown increased sleepiness and mood changes in shiftworkers, which may be due to sleep deprivation or circadian disruption. Few studies, however, have compared responses of experienced shiftworkers and non-shiftworkers to sleep deprivation in an identical laboratory setting. The aim of this laboratory study, therefore, was to compare long-term shiftworkers and non-shiftworkers and to investigate the effects of one night of total sleep deprivation (30.5 h of continuous wakefulness) and recovery sleep on psychomotor vigilance, self-rated alertness, and mood. Eleven experienced male shiftworkers (shiftwork ≥5 yrs) were matched with 14 non-shiftworkers for age (mean ± SD: 35.7 ± 7.2 and 32.5 ± 6.2 yrs, respectively) and body mass index (BMI) (28.7 ± 3.8 and 26.6 ± 3.4 kg/m(2), respectively). After keeping a 7-d self-selected sleep/wake cycle (7.5/8 h nocturnal sleep), both groups entered a laboratory session consisting of a night of adaptation sleep and a baseline sleep (each 7.5/8 h), a sleep deprivation night, and recovery sleep (4-h nap plus 7.5/8 h nighttime sleep). Subjective alertness and mood were assessed with the Karolinska Sleepiness Scale (KSS) and 9-digit rating scales, and vigilance was measured by the visual psychomotor vigilance test (PVT). A mixed-model regression analysis was carried out on data collected every hour during the sleep deprivation night and on all days (except for the adaptation day), at .25, 4.25, 5.25, 11.5, 12.5, and 13.5 h after habitual wake-up time. Despite similar circadian phase (melatonin onset), demographics, food intake, body posture, and environmental light, shiftworkers felt significantly more alert, more cheerful, more elated, and calmer than non-shiftworkers throughout the laboratory study. In addition, shiftworkers showed a faster median reaction time (RT) compared to non-shiftworkers, although four other PVT parameters did not differ between the groups. As expected, both groups showed a decrease in subjective alertness and PVT performance during and following the sleep deprivation night. Subjective sleepiness and most aspects of PVT performance returned to baseline levels after a nap and recovery sleep. The mechanisms underlying the observed differences between shiftworkers and non-shiftworkers require further study, but may be related to the absence of shiftwork the week prior to and during the laboratory study as well as selection into and out of shiftwork.     

Sleep and cortical temperature in the Djungarian hamster under baseline conditions and after sleep deprivation

The Djungarian hamster (Phodopus sungorus) is a markedly photoperiodic rodent which exhibits daily torpor under short photoperiod. Normative data were obtained on vigilance states, electroencephalogram (EEG) power spectra (0.25–25.0 Hz), and cortical temperature (T_CRT) under a 168 h light-dark schedule, in 7 Djungarian hamsters for 2 baseline days, 4 h sleep deprivation (SD) and 20 h recovery.During the baseline days total sleep time amounted to 59% of recording time, 67% in the light period and 43% in the dark period. The 4 h SD induced a small increase in the amount of non-rapid eye movement (NREM) sleep and a marked increase in EEG slow-wave activity (SWA; mean power density 0.75–4.0 Hz) within NREM sleep in the first hours of recovery. T_CRT was lower in the light period than in the dark period. It decreased at transitions from either waking or rapid eye movement (REM) sleep to NREM sleep, and increased at the transition from NREM sleep to waking or REM sleep. After SD, T_CRT was lower in all vigilance states.In conclusion, the sleep-wake pattern, EEG spectrum, and time course of T_CRT in the Djungarian hamster are similar to other nocturnal rodents. Also in the Djungarian hamster the time course of SWA seems to reflect a homeostatically regulated process as was formulated in the two-process model of sleep regulation.Abbreviations EEG electroencephalogram - EMG electromyogram - N NREM sleep - NREM non-rapid eye movement - R REM sleep - REM rapid eye movement - SD sleep deprivation - SWA slow-wave activity - T_CRT cortical temperature - TST total sleep time - VS vigilance state - W waking     

Mood,Alertness, and Performance in Response to Sleep Deprivation and Recovery Sleep in Experienced Shiftworkers Versus Non-Shiftworkers

Previous studies have shown increased sleepiness and mood changes in shiftworkers, which may be due to sleep deprivation or circadian disruption. Few studies, however, have compared responses of experienced shiftworkers and non-shiftworkers to sleep deprivation in an identical laboratory setting. The aim of this laboratory study, therefore, was to compare long-term shiftworkers and non-shiftworkers and to investigate the effects of one night of total sleep deprivation (30.5?h of continuous wakefulness) and recovery sleep on psychomotor vigilance, self-rated alertness, and mood. Eleven experienced male shiftworkers (shiftwork ≥5 yrs) were matched with 14 non-shiftworkers for age (mean?±?SD: 35.7?±?7.2 and 32.5?±?6.2 yrs, respectively) and body mass index (BMI) (28.7?±?3.8 and 26.6?±?3.4?kg/m², respectively). After keeping a 7-d self-selected sleep/wake cycle (7.5/8?h nocturnal sleep), both groups entered a laboratory session consisting of a night of adaptation sleep and a baseline sleep (each 7.5/8?h), a sleep deprivation night, and recovery sleep (4-h nap plus 7.5/8?h nighttime sleep). Subjective alertness and mood were assessed with the Karolinska Sleepiness Scale (KSS) and 9-digit rating scales, and vigilance was measured by the visual psychomotor vigilance test (PVT). A mixed-model regression analysis was carried out on data collected every hour during the sleep deprivation night and on all days (except for the adaptation day), at .25, 4.25, 5.25, 11.5, 12.5, and 13.5?h after habitual wake-up time. Despite similar circadian phase (melatonin onset), demographics, food intake, body posture, and environmental light, shiftworkers felt significantly more alert, more cheerful, more elated, and calmer than non-shiftworkers throughout the laboratory study. In addition, shiftworkers showed a faster median reaction time (RT) compared to non-shiftworkers, although four other PVT parameters did not differ between the groups. As expected, both groups showed a decrease in subjective alertness and PVT performance during and following the sleep deprivation night. Subjective sleepiness and most aspects of PVT performance returned to baseline levels after a nap and recovery sleep. The mechanisms underlying the observed differences between shiftworkers and non-shiftworkers require further study, but may be related to the absence of shiftwork the week prior to and during the laboratory study as well as selection into and out of shiftwork. (Author correspondence: sophie.wehrens@surrey.ac.uk)     

Can a Shorter Psychomotor Vigilance Task Be Usedas a Reasonable Substitute for the Ten‐Minute Psychomotor Vigilance Task?

The 10 min psychomotor vigilance task (PVT) is commonly used in laboratory studies to assess the impact of sleep loss, sustained wakefulness, and/or time of day on neurobehavioral performance. In field settings, though, it may be impractical for participants to perform a test of this length. The aim of this study was to identify a performance measure that is sensitive to the effects of fatigue but less burdensome than a 10 min test. Sixteen participants (11 female, 5 male; mean age=21.7 years) slept in the sleep laboratory overnight then remained awake for 28 h from 08:00 h. During every second hour, participants completed three PVTs of differing duration (10 min, 5 min, 90 sec). For the 5 min/10 min comparison, ANOVA indicated that response time was significantly affected by test length (F_1,14=26.9, p<.001) and hours of wakefulness (F_13,182=46.1, p<.001) but not by their interaction (F_13,182=1.7, ns). There was a strong correlation between response time on the 5 and 10 min PVTs (r=.88, p<.001). For the 90 sec/10 min comparison, ANOVA indicated that response time was significantly affected by test length (F_1,14=65.9, p<.001) and hours of wakefulness (F_13,182=29.7, p<.001) as well as by their interaction (F_13,182=6.0, p<.001). There was a strong correlation between response time on the 90 sec and 10 min PVTs (r=.77, p<.001). The effects of hours of wakefulness on neurobehavioral performance were similar for the 5 min and 10 min PVTs. In contrast, performance on the 90 sec PVT was less affected by hours of wakefulness than on the 10 min PVT. In addition, performance on the 10 min PVT was more highly correlated with the 5 min PVT than the 90 sec PVT. These data indicate that the 5 min PVT may provide a reasonable substitute for the 10 min PVT in circumstances where a test shorter than 10 min is required.     

Can a shorter psychomotor vigilance task be used as a reasonable substitute for the ten-minute psychomotor vigilance task?

The 10 min psychomotor vigilance task (PVT) is commonly used in laboratory studies to assess the impact of sleep loss, sustained wakefulness, and/or time of day on neurobehavioral performance. In field settings, though, it may be impractical for participants to perform a test of this length. The aim of this study was to identify a performance measure that is sensitive to the effects of fatigue but less burdensome than a 10 min test. Sixteen participants (11 female, 5 male; mean age = 21.7 years) slept in the sleep laboratory overnight then remained awake for 28 h from 08:00 h. During every second hour, participants completed three PVTs of differing duration (10 min, 5 min, 90 sec). For the 5 min/10 min comparison, ANOVA indicated that response time was significantly affected by test length (F1,14 = 26.9, p < .001) and hours of wakefulness (F13,182 = 46.1, p < .001) but not by their interaction (F13,182 = 1.7, ns). There was a strong correlation between response time on the 5 and 10 min PVTs (r = .88, p < .001). For the 90 sec/10 min comparison, ANOVA indicated that response time was significantly affected by test length (F1,14 = 65.9, p < .001) and hours of wakefulness (F13,182 = 29.7, p < .001) as well as by their interaction (F13,182 = 6.0, p < .001). There was a strong correlation between response time on the 90 sec and 10 min PVTs (r = .77, p < .001). The effects of hours of wakefulness on neurobehavioral performance were similar for the 5 min and 10 min PVTs. In contrast, performance on the 90 sec PVT was less affected by hours of wakefulness than on the 10 min PVT. In addition, performance on the 10 min PVT was more highly correlated with the 5 min PVT than the 90 sec PVT. These data indicate that the 5 min PVT may provide a reasonable substitute for the 10 min PVT in circumstances where a test shorter than 10 min is required.     

Restricted and unrestricted sleep schedules of Asian adolescent,high-level student athletes: effects on sleep durations,marksmanship and cognitive performance

The present study sought to compare the effects of a restricted and unrestricted sleep schedule on shooting, cognitive performance and measures of sleepiness and fatigue of Asian, adolescent high-level student athletes. Twenty-four (12 female; 14.1 ± 1.4 years) athletes performed assessments of shooting and cognitive performance (psychomotor vigilance and working memory) at the start and end of five-day restricted or unrestricted sleep (two conditions). Restricted sleep during a five-day training week resulted in no significant performance changes in cognitive or shooting performance compared with unrestricted sleep during a five-day training week, despite there being moderate-to-strong associations between increases in total sleep time and certain aspects of shooting performance. Daytime fatigue levels during the unrestricted sleep period were significantly lower than during sleep restriction. These findings highlight the relationships between nocturnal sleep extension and shooting performance amongst high-level athletes.     

Spectral EEG indicator of pressure to enter into deep sleep: its responsiveness to closing the eyes for just a few minutes exhibits a pure exponential buildup during sleep deprivation

According to the two-process model of sleep–wake regulation, a homeostatic sleep pressure, i.e. a pressure to enter into deep non-rapid eyes movement (NREM) sleep, must exhibit a purely exponential buildup during prolonged wakefulness. However, this pressure is usually measured indirectly, i.e. during the following episode of actual deep NREM sleep. The purpose of this paper was to show that, despite a prominent circadian modulation of time course of any waking EEG index, the model-postulated purely exponential buildup of the homeostatic sleep pressure can be directly confirmed. During two days of sleep deprivation experiments, the EEG of healthy adults (N = 30) was recorded every other hour throughout 5-min eyes closed relaxation. Sixteen ln-transformed single-Hz power densities (from 1 to 16 Hz) were computed for each of 5 one-min intervals. Differences between these densities obtained for the first and the following intervals were calculated and averaged. The obtained 16 values were used as the frequency weighting curve for weighting densities of each set of 16 single-Hz power densities. Summing-up of these weighted densities provided a single measure that was found to co-vary with self-rated sleepiness throughout two-day interval of sleep deprivation, thus reflecting the joint influence of the circadian and homeostatic processes. However, two-day time course of responsiveness of this measure to closing the eyes for just a few minutes exhibited a purely exponential buildup. It was concluded that this result provided a direct experimental confirmation of the model-predicted exponential buildup of the homeostatic sleep pressure across prolonged episode of wakefulness.     

Simulation of human sleep: ultradian dynamics of electroencephalographic slow-wave activity

The typical declining trend of electroencephalographic (EEG) slow-wave activity (SWA) within a sleep period is represented in the two-process model of sleep regulation by an exponentially decaying process (Process S). The model has been further elaborated to simulate not only the global changes of SWA, but also the dynamics within non-rapid-eye-movement (non-REM) sleep episodes. In this new model, the initial intraepisodic buildup of SWA is determined by the combined action of an exponentially increasing process and a saturation process, whereas its fall at the end of an episode is due to an exponentially decreasing process. The global declining trend of SWA over consecutive episodes results from the monotonic decay of the intraepisodic saturation level. In contrast to Process S in the two-process model, this decay is not represented by an exponential function, but is proportional to the momentary level of SWA. REM sleep episodes are triggered by an external function. The model allows one to simulate the ultradian pattern of SWA for baseline nights as well as changes induced by a prolonged waking period, a daytime nap, a partial slow-wave sleep deprivation, or an antidepressant drug.     

D1 receptor activation in the mushroom bodies rescues sleep-loss-induced learning impairments in Drosophila

BACKGROUND: Extended wakefulness disrupts acquisition of short-term memories in mammals. However, the underlying molecular mechanisms triggered by extended waking and restored by sleep are unknown. Moreover, the neuronal circuits that depend on sleep for optimal learning remain unidentified. RESULTS: Learning was evaluated with aversive phototaxic suppression. In this task, flies learn to avoid light that is paired with an aversive stimulus (quinine-humidity). We demonstrate extensive homology in sleep-deprivation-induced learning impairment between flies and humans. Both 6 hr and 12 hr of sleep deprivation are sufficient to impair learning in Canton-S (Cs) flies. Moreover, learning is impaired at the end of the normal waking day in direct correlation with time spent awake. Mechanistic studies indicate that this task requires intact mushroom bodies (MBs) and requires the dopamine D1-like receptor (dDA1). Importantly, sleep-deprivation-induced learning impairments could be rescued by targeted gene expression of the dDA1 receptor to the MBs. CONCLUSIONS: These data provide direct evidence that extended wakefulness disrupts learning in Drosophila. These results demonstrate that it is possible to prevent the effects of sleep deprivation by targeting a single neuronal structure and identify cellular and molecular targets adversely affected by extended waking in a genetically tractable model organism.     

Vigilance levels during and after bright light exposure in the first half of the night

Fourteen healthy subjects (8 women, 6 men, aged 22-35 yr) were recruited. Each subject was exposed, in a counterbalanced order, to bright white light (BWL: 3000 lux) and to dim red light (DRL: <15 lux) at a 1-week interval. Light treatments were administered from 00:30 to 04:30 h during sleep deprivation. Salivary melatonin and urinary cortisol concentrations were measured as was core body temperature. Vigilance levels were evaluated by subjective estimates, maintenance of wakefulness tests (MWT), waking EEG recordings, and three performance tests. Under BWL melatonin secretion was suppressed and core body temperature was significantly higher than under DRL. The BWL and DRL conditions produced no difference in cortisol secretion. Significant effects of BWL treatment were found for the MWT and theta-alpha and beta-1 frequency bands of the waking EEG. There was no significant effect of BWL on subjective alertness and performance. Vigilance measures were similar under the two conditions for the tests performed 1.5 h after the end of light treatments. Overall, the findings suggest that bright light (BL) exposure in the first half of the night decreases EEG-defined sleep propensity but has only modest effects on other aspects of vigilance.     

The effects of a split sleep–wake schedule on neurobehavioural performance and predictions of performance under conditions of forced desynchrony

Extended wakefulness, sleep loss, and circadian misalignment are factors associated with an increased accident risk in shiftwork. Splitting shifts into multiple shorter periods per day may mitigate these risks by alleviating prior wake. However, the effect of splitting the sleep–wake schedule on the homeostatic and circadian contributions to neurobehavioural performance and subjective assessments of one’s ability to perform are not known. Twenty-nine male participants lived in a time isolation laboratory for 13?d, assigned to one of two 28-h forced desynchrony (FD) schedules. Depending on the assigned schedule, participants were provided the same total time in bed (TIB) each FD cycle, either consolidated into a single period (9.33?h TIB) or split into two equal halves (2?×?4.67?h TIB). Neurobehavioural performance was regularly assessed with a psychomotor vigilance task (PVT) and subjectively-assessed ability was measured with a prediction of performance on a visual analogue scale. Polysomnography was used to assess sleep, and core body temperature was recorded to assess circadian phase. On average, participants obtained the same amount of sleep in both schedules, but those in the split schedule obtained more slow wave sleep (SWS) on FD days. Mixed-effects ANOVAs indicated no overall difference between the standard and split schedules in neurobehavioural performance or predictions of performance. Main effects of circadian phase and prior wake were present for both schedules, such that performance and subjective ratings of ability were best around the circadian acrophase, worst around the nadir, and declined with increasing prior wake. There was a schedule by circadian phase interaction for all neurobehavioural performance metrics such that performance was better in the split schedule than the standard schedule around the nadir. There was no such interaction for predictions of performance. Performance during the standard schedule was significantly better than the split schedule at 2?h of prior wake, but declined at a steeper rate such that the schedules converged by 4.5–7?h of prior wake. Overall, the results indicate that when the total opportunity for sleep per day is satisfactory, a split sleep–wake schedule is not detrimental to sleep or performance. Indeed, though not reflected in subjective assessments of performance capacity, splitting the schedule may be of some benefit, given its reduction of neurobehavioural impairment at night and its association with increased SWS. Therefore, for some industries that require operations to be sustained around the clock, implementing a split work–rest schedule may be of assistance.     

Biogenic amines in the regulation of wakefulness and sleep

Neurophysiological, neurochemical and neuropharmacological evidence indicates that cerebral monoamines are important regulators of wakefulness and sleep besides cerebral amino acid-ergic and peptidergic systems. The cerebral monoamines noradrenaline, dopamine and acetylcholine are positively involved in electroencephalographic aspects of waking and paradoxical or REM sleep. A high level of noradrenergic transmission facilitates waking, and a lower, moderate level facilitates REM sleep. Serotonin is involved in the regulation of synthesis, storage and release of sleep inducing factors, and in the gating mechanisms of REM sleep. Histamine neurons play a role in the regulation of vigilance during waking state. These neurotransmitter systems are important targets for drug actions.     

Sleep Loss and Performance of Anaesthesia Trainees and Specialists

Fatigue risk associated with work schedules of hospital doctors is coming under increasing scrutiny, with much of the research and regulatory focus on trainees. However, provision of 24 h services involves both trainees and specialists, who have different but interdependent work patterns. This study examined work patterns, sleep (actigraphy, diaries) and performance (psychomotor vigilance task pre‐ and post‐duty) of 28 anaesthesia trainees and 20 specialists across a two‐week work cycle in two urban public hospitals. Trainees at one hospital worked back‐to‐back 12 h shifts, while the others usually worked 9 h day shifts but periodically worked a 14 h day (08:00–22:00 h) to maintain cover until arrival of the night shift (10 h). On 11% of day shifts and 23% of night shifts, trainees were working with ≥2 h of acute sleep loss. However, average sleep loss was not greater on night shifts, possibly because workload at night in one hospital often permitted some sleep. Post‐night shift performance was worse than post‐day shift performance for the median (t₍₁₃₁₎=3.57, p<0.001) and slowest 10% of reaction times (t₍₁₃₄₎=2.91, p<0.01). At the end of night shifts, poorer performance was associated with longer shift length, longer time since waking, greater acute sleep loss, and more total work in the past 24 h. Specialists at both hospitals had scheduled clinical duties during the day and were periodically scheduled on call to cover after‐hours services. On 8% of day shifts and 14% of day+call schedules, specialists were working with ≥2 h of acute sleep loss. They averaged 0.6 h less sleep when working day shifts (t_(23.5)=2.66, p=0.014) and 0.8 h less sleep when working day shifts+call schedules (t_(26.3)=2.65, p=0.013) than on days off. Post‐duty reaction times slowed linearly across consecutive duty days (median reaction time, t₍₁₃₁₎=?3.38, p<0.001; slowest 10%, t₍₁₆₀₎=?3.33, p<0.01; fastest 10%, t₍₁₃₈₎=?2.67, p<0.01). Poorer post‐duty performance was associated with greater acute sleep loss and longer time since waking, but better performance was associated with longer day shifts, consistent with circadian improvement in psychomotor performance across the waking day. This appears to be the first study to document sleep loss among specialist anaesthetists. Consistent with observations from experimental studies, the sleep loss of specialists across 12 consecutive working days was associated with a progressive decline in post‐duty PVT performance. However, this decline occurred with much less sleep restriction (< 1 h per day) than in laboratory studies, suggesting an exacerbating effect of extended wakefulness and/or cumulative fatigue associated with work demands. For both trainees and specialists, robust circadian variation in PVT performance was evident in this complex work setting, despite the potential confounds of variable shift durations and workloads. The relationship between PVT performance of an individual and the safe administration of anaesthesia in the operating theater is unknown. Nevertheless, the findings reinforce that any schedule changes to reduce work‐related fatigue need to consider circadian performance variation and the potential transfer of workload and fatigue risk between trainees and specialists.