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Erratum: The cumulative cost of additional wakefulness: Dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation (Sleep (March 2003) 26, 2 (117-126))

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... Sleep serves critical roles in brain functions including neurobehavioural, cognitive and safety related performance (Van Dongen et al., 2003;Belenky et al., 2003;Lim and Dinges, 2010), memory consolidation (Tononi & Cirelli, 2014), mood regulation (Minkel et al., 2012), nociception (Edwards et al., 2008) and clearance of brain metabolites (Mendelsohn and Larrick, 2013). Sleep is also critically involved in systematic physiology, including metabolism (Magee & Hale, 2012), appetite regulation (Spiegel et al., 2004), immune and hormone function (Prather et al., 2012) and cardiovascular systems (Yeo et al., 2013). ...
... Sleep is also critically involved in systematic physiology, including metabolism (Magee & Hale, 2012), appetite regulation (Spiegel et al., 2004), immune and hormone function (Prather et al., 2012) and cardiovascular systems (Yeo et al., 2013). The sleep-wake cycle is regulated in the body by a two-process model of sleep regulation (Van Dongen & Dinges, 2003;Durmer & Dinges, 2005). The two processes in the model, the circadian process (process C) and the homeostatic process (process S), interact to determine the timing and quality of sleep and the stability of waking neurocognitive function ( (Czeisler & Gooley, 2007). ...
... After sleep is achieved, this pressure dissipates exponentially (Durmer & Dinges, 2005). Higher homeostatic sleep drive results in impaired cognition, increased sleepiness and increased propensity for sleep (Van Dongen & Dinges, 2003; Akerstedt & Wright, 2009). ...
Thesis
The aim of the proposed research study was to improve our understanding of the relationship between occupational risk factors of fatigue and sleep deprivation in wildland firefighters. Firefighters continue to have a disproportionately high level of workplace injuries owing to a physically and psychologically demanding occupation in harsh working environments that can influence cognitive impairment. Given the high risks associated with fighting fires and the desire to maximize worker safety, we worked with the B.C. Wildfire Service (BCWS) to assess and describe fatigue amongst firefighters in a novel 17-day field-based study. This study made two important contributions. First, it provided an understanding of the relationship between determinants of fatigue and cognitive impairment in a forest firefighting environment in Canada. Second, the results from this study have the potential to guide future interventions to reduce fatigue and improve occupational health and safety in the workplace.
... Increasing evidence shows that sleep loss deteriorates basic neurobehavioral functions as working memory, attention or decision making, and contribute to negative health consequences related to circadian desynchrony 3 . Both partial (defined as a reduction in a sleep time over a 24-hour period, relative to individual sleep routine; also referred to as 'sleep restriction') and total (defined as a complete lack of sleep in a 24-hour period; also referred to as 'acute') sleep deprivation are linked with deficits in a cognitive performance 4 , higher risks of motor accidents 5,6 and medical errors 7 . Furthermore, insufficient sleep is also associated with ill health, such as higher risk of diabetes, obesity, heart problems, and even stroke 8 . ...
... Furthermore, insufficient sleep is also associated with ill health, such as higher risk of diabetes, obesity, heart problems, and even stroke 8 . Partial sleep reduction to 6 (or less) hours per night for 14 consecutive nights results in comparable cognitive deficits to those observed after 1-2 nights of total sleep deprivation 4 , and include problems with attention and working memory, as well as high subjective levels of sleepiness. ...
... While problems linked with partial and total sleep deprivation are, however, fairly well reported in the literature, only a handful of studies looked at the processes involved in the recovery following an extended period of sleep restriction, and a majority of those that did, only looked at a very limited period of recovery 4,[14][15][16][17][18] , typically between 1-3 days. ...
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The duration of sleep, wakefulness and dynamic changes in human performance are determined by neural and genetic mechanisms. Sleep deprivation and chronic restriction of sleep cause perturbations of circadian rhythmicity and degradation of waking alertness as reflected in attention, cognitive efficiency and memory. In this work we report on multiple neurobehavioral correlates of sleep loss in healthy adults in an unprecedented study comprising 21 consecutive days divided into periods of 4 days of regular life (a baseline), 10 days of chronic partial sleep restriction and 7 days of recovery. Throughout the whole experiment we continuously measured the spontaneous locomotor activity by means of actigraphy with 1-minute resolution in two acquisition modes (frequency and intensity of movement). Moreover, on daily basis the subjects were undergoing EEG measurements (64-electrodes with 500 Hz sampling frequency): resting state with eyes open and closed (RS; 8 minutes long each) followed by Stroop task (ST; 22 minutes). Altogether we analyzed actigraphy (distributions of rest and activity durations), behavioral measures (accuracy and reaction times from Stroop task) and EEG (amplitudes, latencies and scalp maps of event-related potentials from Stroop task and power spectra from resting states). The actigraphy measures clearly indicate rapid changes after sleep restriction onset, confirming our former investigations - the novel insight is a slow and incomplete relaxation to the original locomotor behavior. The pattern of partial recovery appears also in accuracy (in ST) and power of delta rhythm (in RS). The impact of sleep loss is also evident in reaction times (in ST), yet followed by complete recovery, and finally in ERP amplitudes and latencies, which however did not return to the baseline at all. The results indicate that short periods (a few days) of recovery sleep subsequent to prolonged periods of sleep restriction are overall insufficient to recover fully.
... To decrease the chance for a work-related accident to occur, it is necessary to prevent excessive sleepiness during work hours. It has been shown, in fact, that having sleep restricted to 6 h per day for an entire week leads to the same neurobehavioral performances observed in subjects sleep deprived for the whole night (8). This impairment is also comparable to the one recorded in someone considered alcohol intoxicated under the law limits permission (9). ...
... Given the relatively broad spectrum of physiological sleep duration in humans, there is no consensus in advising about a specific recommended sleep duration. Individuals do not show common SD related deficits when sleeping at least 8 h per day (8). Therefore, a similar amount of sleep is also recommended by the national sleep foundation guidelines for adults subjects (10). ...
... In normal subjects, the cumulative effects of even a mild chronic sleep restriction (6 h of time in bed per night) can lead to neurocognitive impairments comparable to those following two consecutive nights of total SD in less than 2 weeks (8). Moreover, it has been shown that the subjective capacity to evaluate the effects of SD is limited and suffers from ceiling effects in the perception, leading the subject to underestimate the extent of the detrimental effects of sleep curtailment (8,57). In this context, a study has been performed in order to investigate the effects of being on call for seven consecutive days (49). ...
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Sleep deprivation is an ordinary aspect in the global society and its prevalence is increasing. Chronic and acute sleep deprivation have been linked to diabetes and heart diseases as well as depression and enhanced impulsive behaviors. Surgeons are often exposed to long hour on call and few hours of sleep in the previous days. Nevertheless, few studies have focused their attention on the effects of sleep deprivation on surgeons and more specifically on the effects of sleep deprivation on surgical dexterity, often relying on virtual surgical simulators. A better understanding of the consequences of sleep loss on the key surgical skill of dexterity can shed light on the possible risks associated to a sleepy surgeon. In this paper, the authors aim to provide a comprehensive review of the relationship between sleep deprivation and surgical dexterity.
... It is widely accepted that vigilance is reliably lowered by total sleep deprivation (2, 3, 14-16) and chronic (3,14) and acute (2) sleep restriction, although there have been fewer studies on the effects of acute partial sleep loss. It is less well understood how sleep loss affects orienting and executive functions, and studies examining broader aspects of attention (e.g., using the ANT) have produced inconsistent results [e.g., (4,9,17)]. ...
... Based on consistent findings in the literature related to the effects of sleep loss on vigilance (2)(3)(4)14, 15), we predicted that vigilance performance would be significantly impaired following sleep restriction after controlling for possible practice effects. The less consistent literature related to effects of sleep loss on orienting and executive control (4,9,16,17) did not allow a prediction as to how the function of these networks would be affected. ...
... The SSS scores and POMS Fatigue and Confusion scores on Day 2 showed that restriction for a single night to 3 h TIB effectively increased subjective sleepiness and associated mood changes, as expected (2,14), while those with 9 h TIB showed no significant changes in these measures on Day 2. ...
Article
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Inadequate nightly sleep duration can impair daytime functioning, including interfering with attentional and other cognitive processes. Current models posit that attention is a complex function regulated by several separate, but interacting, neural systems responsible for vigilance, orienting, and executive control. However, it is not clear to what extent each of these underlying component processes is affected by sleep loss. The purpose of this study was to evaluate the effects of acute sleep restriction on these attentional components using the Dalhousie Computerized Attention Battery (DalCAB). DalCAB tasks were administered to healthy women (aged 19–25 years) on two consecutive mornings: once after a night with 9 h time in bed (TIB), and once again after either another night with 9 h TIB (control condition, n = 19) or after a night with 3 h TIB (sleep restriction condition, n = 20). Self-ratings of sleepiness and mood were also obtained following each sleep condition. Participants showed increases in self-reported sleepiness and fatigue after the second night only in the sleep restriction group. Sleep restriction primarily affected processing speed on tasks measuring vigilance; however, performance deficits were also observed on some measures of executive function (e.g., go/no-go task, flanker task, working memory). Tasks assessing orienting of attention were largely unaffected. These results indicate that acute sleep restriction has differential effects on distinct components of attention, which should be considered in modeling the impacts of sleep loss on the underlying attentional networks.
... Optimal sleep duration, consolidation and archi- tecture are important for restorative sleep and regeneration of the nervous and metabolic systems ( Spiegel et al. 1999;Van Dongen et al. 2003). Consequently, sleep is a basic human need and is recognised in sport science as important for ath- letic recovery and performance. ...
... Consequently, sleep is a basic human need and is recognised in sport science as important for ath- letic recovery and performance. In healthy adults, 8 h of sleep per 24 h is recommended to prevent deficits in neurobehavioural performance due to excessive wakefulness (Van Dongen et al. 2003). However, elite athletes habitually obtain less sleep than is recommended. ...
... Regardless of how time in bed was split, the athletes obtained similar total sleep time and sleep architecture compared to that obtained in the 9-h consolidated sleep period. Importantly, the amount of slow wave sleep and REM sleep stages, which con- tribute to nervous and metabolic restoration ( Spiegel et al. 1999;Van Dongen et al. 2003), were similar in the three conditions. In healthy adults, there is a linear relationship between time in bed and total sleep time, regardless of whether time in bed is split into two episodes or consolidated in one episode per 24 h ( Mollicone et al. 2007). ...
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This study examined the efficacy of daytime napping to supplement night-time sleep in athletes. Twelve well-trained male soccer players completed three conditions in a randomised, counterbalanced order: 9 h in bed overnight with no daytime nap (9 h + 0 h); 8 h in bed overnight with a 1-h daytime nap (8 h + 1 h); and 7 h in bed overnight with a 2-h daytime nap (7 h + 2 h). Sleep was assessed using polysomnography. The total amount of sleep obtained in the three conditions was similar, i.e. 8.1 h (9 h + 0 h), 8.2 h (8 h + 1 h), and 8.0 h (7 h + 2 h). Daytime napping may be an effective strategy to supplement athletes’ night-time sleep.
... To the authors' knowledge, no research has been conducted on the impact of call likelihood on cognitive performance following on-call periods. Cognitive functions that may be impaired by sleep loss or disruption include reac- tion time, constructive thinking, processing speed, reasoning abilities and vigilance (Van Dongen et al. 2003;Alhola and Polo-Kantola 2007). These cognitive decrements are associated with an increased risk of accident or injury, in addition to decrements in work performance and produc- tivity (Åkerstedt 1995). ...
... This increased REM may, to some extent, be displacing N2 sleep, particularly during the maybe condition, where N2 minutes were fewest. These REM increases may be linked with slight possible sleep debt associated with an 8 h time in bed (Van Dongen et al. 2003), though other research has demonstrated no changes to REM with similar (8.2 h) sleep opportunities ( Mollicone et al. 2007). Further, as the present study included just four nights in the laboratory, the observed changes to REM when on-call may be indicative of a heightened stress response to the on-call conditions, as increased REM can be an adaptive response to stressful situations ( Suchecki et al. 2012). ...
... Despite being statistically significant, it is important to note that the cognitive performance decrements in the present study are comparatively small when compared with performance under conditions of total sleep deprivation or restriction over multiple nights (Van Dongen et al. 2003;Lamond et al. 2007). For example, Lamond et al. (2007) found that after just one night of sleep deprivation, PVT performance was approximately 25% poorer than the most affected condition in the present study. ...
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On-call working arrangements are employed in a number of industries to manage unpredictable events, and often involve tasks that are safety- or time-critical. This study investigated the effects of call likelihood during an overnight on-call shift on self-reported pre-bed anxiety, sleep and next-day cognitive performance. A four-night laboratory-based protocol was employed, with an adaptation, a control and two counterbalanced on-call nights. On one on-call night, participants were instructed that they would definitely be called during the night, while on the other on-call night they were told they may be called. The State-Trait Anxiety Inventory form x-1 was used to investigate pre-bed anxiety, and sleep was assessed using polysomnography and power spectral analysis of the sleep electroencephalographic analysis. Cognitive performance was assessed four times daily using a 10-min psychomotor vigilance task. Participants felt more anxious before bed when they were definitely going to be called, compared with the control and maybe conditions. Conversely, participants experienced significantly less non-rapid eye movement and stage two sleep and poorer cognitive performance when told they may be called. Further, participants had significantly more rapid eye movement sleep in the maybe condition, which may be an adaptive response to the stress associated with this on-call condition. It appears that self-reported anxiety may not be linked with sleep outcomes while on-call. However, this research indicates that it is important to take call likelihood into consideration when constructing rosters and risk-management systems for on-call workers.
... Quality sleep is crucial for several cognitive areas (e.g., the transfer of memories from short to long-term storage and attention span) (Mander et al., 2017) and has been shown to affect undergraduate academic performance (Prichard, 2020). Interestingly, many do not recognize the cognitive impairment from sleep deprivation in themselves (van Dongen et al., 2003); therefore, an advisor or other member of their support system may be required for such recognition. The pre-health advisor may recognize poor cognition due to acute sleep deprivation and intervene, or they can tout the importance of sleep and sleep hygiene as prevention. ...
... Your circadian clock needs periodic maintenance just like an old clock that needs regular winding." You can also suggest the use of a light designed to mimic bright daytime sunlight, which has been shown to assist with Seasonal Affective Disorder (Sanassi, 2014;Tuunainen et al., 2004). Opening the curtains and getting as much natural light inside as possible is also helpful (Altena et al., 2020). ...
Chapter
The well-being (health and wellness) of the pre-health student directly contributes to their short-term academic success and their long-term professional and personal aspirations. The pre-health advisor has a role to play in fostering an environment in which the pre-health student can thrive, including supporting their well-being. This chapter addresses major contributing factors: stress management and mental clarity can be accomplished in many ways, e.g., mindfulness meditation. Cognition is dependent upon immune function, which is generally supported by a diverse, plant-rich diet. Physical activity (exercise and natural movement) supports mental health and cognition and are often limited in the pre-health student as well as healthcare professionals without intentional incorporation. Restorative sleep allows for healing and repair throughout the body (including the brain) as well as memory integration; simple steps can improve sleep quality and quantity. Ultimately, the pre-health advisor should utilize cross-campus partnerships to promote a culture of well-being.
... The four key factors that determine the magnitude of the HPA axis response to a mental/emotional stressor are its 1) novelty to the individual, 2) unpredictable nature, 3) threat to their person or ego, 4) sense of loss of control (Wheaton, 1997). Individual characteristics such as age, gender, hereditary predisposition, personality traits, and prenatal or early childhood experiences are also profoundly influential (Felitti et al., 1998;Dong et al., 2004). ...
... lost productivity, sleep medication, etc.). The deleterious effects of chronic sleep deprivation and the associated outcomes have potentially dangerous and expensive consequences as a result of impaired neuropsychological functions for individuals at work, at home, and on the roads (Pilcher and Huffcutt, 1996;Dongen et al., 2003). In addition, long-term health-related concerns include increased risk for metabolic and cardiovascular diseases (Cappuccio et al., 2011), as well as an overall decrease in the immune system (Bryant, Trinder and Curtis, 2004). ...
Thesis
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Over the last 30 years we have observed dramatic declines in mental health worldwide, with nearly 450 million people currently suffering from a mental or behavioral disorder. Globally, there is less than 1 mental health professional for every 10,000 people, with 76-85% of the population in low and middle-income countries without access to treatment. The overarching aim of this thesis is the identification of novel and cost-effective methods for measuring, detecting, and assessing well-being. In the first study of this research project, we validated the ability of a quick global scale to capture multidimensional well-being on 1,615 participants that participated in an online survey, identified some predictors of well-being, and observed improvements from online interventions. Mental health and individual well-being also influences the structure and function of our brains across the lifespan, which in turn, mediate well-being levels. While progress has been made regarding our understanding of the interacting relationships between well-being and brain function, much is still unknown. Recent technological advances have led to the development of affordable, light-weight, wearable, and wireless electroencephalography (EEG) technologies that offer fast preparation time, high mobility, and that facilitate the collection of EEG data over large and diversified populations by increasing access to populations that were previously difficult to study with conventional systems. The analysis of large datasets with robust statistical methods or advanced machine-learning algorithms can ease the identification of trends, the mediator role of covariables, and the classification of mental states. While low-cost, low-density EEG systems have presented significant challenges for conducting EEG research, here we validated a wearable system for recording spectral measures relevant to the study of well-being, by comparison with a state-of-the-art system (study 2). In study 3, we used the tools validated in studies 1 and 2 to examine the relation between EEG and multidimensional well-being in a large sample (N = 353). We found a potential EEG marker of well-being, consistent with some literature on anxiety and depression, with age as a mediator. We discuss interpretations and limitations related to the studies and the broader field, as well as future directions (e.g., real-world EEG monitoring, dyadic or multimodal applications, brain-computer interfaces, neurofeedback training) and ethical implications for the field. The broader applications of this line of research will hopefully help to reduce the prevalence of mental health disparities worldwide (e.g., chronic stress, anxiety disorder, depression, psychiatric conditions), and will also help to predict and prevent mental illness in the broader population.
... In the week prior to participating the drivers slept an average of 6.85hours per night. Chronic sleep restriction to 6-hours can cause a cognitive and vigilance deficit equivalent to two nights of sleep deprivation (Van Dongen et al., 2003). Impairment has also been observed with mild sleep restriction of 7 h per night across a week (Belenky et al., 2003). ...
... It is possible that truck drivers may be bias towards self-assessing as more alert as it is a fitness-for-duty requirement of their job. Alternatively, their perceptions of sleepiness may be impaired, which is a hallmark of chronic sleep restriction (Van Dongen et al., 2003); and warrants further study. ...
Article
Background: An inadequate rest break between shifts may contribute to driver sleepiness. This study assessed whether extending the major rest break between shifts from 7-hours (Australian industry standard) to 11-hours, improved drivers' sleep, alertness and naturalistic driving performance. Methods: 17 heavy vehicle drivers (16 male) were recruited to complete two conditions. Each condition comprised two 13-hour shifts, separated by either a 7- or 11-hour rest break. The initial 13-hour shift was the drivers' regular work. The rest break and following 13-hour shift were simulated. The simulated shift included 5-hours of naturalistic driving with measures of subjective sleepiness, physiological alertness (ocular and electroencephalogram) and performance (steering and lane departures). Results: 13 drivers provided useable data. Total sleep during the rest break was greater in the 11-hour than the 7-hour condition (median hours [25th to 75th percentile] 6.59 [6.23, 7.23] vs. 5.07 [4.46, 5.38], p = 0.008). During the simulated shift subjective sleepiness was marginally better for the 11-hour condition (mean Karolinska Sleepiness Scale [95th CI] = 4.52 [3.98, 5.07] vs. 5.12 [4.56, 5.68], p = 0.009). During the drive, ocular and vehicle metrics were improved for the 11-hour condition (p<0.05). Contrary to expectations, mean lane departures p/hour were increased during the 11-hour condition (1.34 [-0.38,3.07] vs. 0.63 [-0.2,1.47], p = 0.027). Conclusions: Extending the major rest between shifts substantially increases sleep duration and has a modest positive impact on driver alertness and performance. Future work should replicate the study in a larger sample size to improve generalisability and assess the impact of consecutive 7-hour major rest breaks.
... A recent meta-analysis reported sleep restriction significantly impairs cognitive functioning across a numerous cognitive domains (7). Insufficient sleep has been specifically linked to impairments in attention, reaction time, learning and memory, and decision-making (8)(9)(10)(11)(12)(13)(14)(15)(16)(17). These impairments are associated with altered functioning of the dorsolateral prefrontal cortex and parietal regions of the brain (18). ...
... Research has shown that even one night of insufficient sleep can alter the connectivity of neural networks to the detriment of cognitive processes (19). Numerous studies have reported that when sleep is reduced to <7 h cognitive performance is lower in tests for vigilance, alertness, reaction time, memory, and decision-making (11,12,20,21). ...
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Neurocognitive computerized assessment tools (NCATs) were developed to assist military clinicians with the tracking of recovery from injury and return to full duty decisions with a recent focus on the setting of post-concussion evaluations. However, there is limited data on the impact of deployment on neurocognitive functioning, sleepiness, and mood in healthy, non-concussed Service members. Automated Neuropsychological Assessment Metrics version 4 TBI Military (ANAM) data was obtained for a sample of active duty deployed personnel (n = 72) without recent history of mild traumatic brain injury (mTBI). A linear regression was conducted to examine the effects of sleepiness and mood state on neurocognitive performance. The overall multivariate regression was statistically significant. Negative mood states were the most salient predictors of neurocognitive performance with higher levels of endorsement associated with lower scores. The findings support measures of negative mood state, but not sleepiness, as relevant predictors of neurocognitive performance as measured by the ANAM. These results indicate that mood needs to be considered when reviewing neurocognitive data to ensure that appropriate clinical decisions are made; in particular for return-to-duty decisions in deployed settings after concussion recovery.
... A neurophysiological process to enable an optimal psychological functioning is sleep. Specifically, sufficient and restoring sleep is associated with a broad range of healthy cognitive (19)(20)(21)(22)(23), behavioral (24)(25)(26), and emotional processes (20,(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). With regard to emotion processing and affect, Bouwmans et al. (37) showed that sleep quality impacted on affect and mood the following day. ...
... Rather, it is claimed that further brain regions such as the amygdala, fusiform, superior colliculus, insular cortex, and hippocampus are involved in such processes (9, 40). Thus, while Motomura et al. (40) claimed that the subcortical and temporoparietal areas are important for FER and that these regions are sensitive to sleep loss, further imaging and metabolic studies might investigate why, despite the sensitivity to sleep loss of such regions, performance on FER remains broadly unaffected, if compared to dramatically impaired cognitive processes (22). Next, we know from studies on the cognitive performance of patients with Restless Legs Syndrome (RLS) that, despite their seriously impaired sleep quality, their performance on cognitive tests was not necessarily lower and could even be higher (83) than that of healthy controls (84-86), [but for contrary findings see, for instance, Fulda et al. (87, 88)]. ...
Article
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Background: Restoring sleep is associated with favorable cognitive, emotional, and behavioral adaptations. As regards the association between sleep duration and facial emotion recognition (FER), results are conflicting, and as regards the association between symptoms of insomnia and FER, no study has been performed so far. Accordingly, the aim of the present study was to investigate whether subjective sleep was associated with FER, along with perceived stress and mental toughness. Method: A total of 201 police officers (mean age = 38.5 years, 64.2% males) took part in the present cross-sectional study. They completed questionnaires covering socio-demographic data, subjective symptoms of insomnia, perceived stress, and mental toughness. Further, they underwent a computerized FER test, consisting of facial emotion labeling and facial emotion matching. Results: Performance of FER (accuracy, speed) was unrelated to subjective symptoms of insomnia. Lower FER was associated with higher age, but not to perceived stress or mental toughness. No gender differences were observed. Higher symptoms of insomnia were associated with higher stress scores and lower scores of mental toughness. Conclusions: The pattern of results suggests that FER was not associated with symptoms of insomnia, understood as a proxy of sleep quality, among adults. This observation replicates those studies showing a zero-association between sleep and FER.
... In addition to cognitive functioning, nighttime subjective sleepiness is an important outcome measure in shift-work research ( Zion et al. 2018), although the relationship between objective per- formance and subjective rating of sleepiness is still under debate. Laboratory (Van Dongen et al. 2003;Zhou et al. 2012) and field ( Reinke et al. 2015) studies have revealed a mismatch between sleepi- ness levels and cognitive performance on real and simulated night shifts. However, in their compre- hensive review, ?kerstedt and colleagues (2014) concluded that subjective sleepiness measured by the Karolinska Sleepiness Scale (KSS) may be con- sidered to be "a sensitive indicator of . . . ...
... The Letter Cancellation Task (LCT) is a paper-and-pencil task used to examine selective sustained attention, visual search ability and psychomotor speed ( Byrd et al. 2004). Both the LCT ( Casagrande et al. 1997;Porcu et al. 1998) and the DSST (Van Dongen et al. 2003;Wyatt et al. 1999) were found to be sensitive to circadian influences, sleep debt and extensive wakefulness. ...
Article
Decline in cognitive functioning in the workplace is a major concern for health care systems. Understanding factors associated with nighttime functioning is imperative for instituting organizational risk management policies and developing personalized countermeasures. The present study aims to identify individual factors associated with cognitive functioning during the night shift of hospital nurses working on irregular rotating-shift schedules. Ninety-two female nurses were recruited from 17 wards in two general hospitals, using convenience sampling by clusters. Inclusion criteria were working at least 28 h a week (75% of full time) and one night shift per week. Exclusion criteria were pregnancy, diagnosed sleep disorders or medical conditions that may affect sleep and/or function. Cognitive performance was measured during the middle (03:00 h) and at the end (07:00 h) of the night shift using the Digit Symbol Substitution Task (DSST) and the Letter Cancellation Task (LCT) over two night shifts. Subjective sleepiness was assessed by the Karolinska Sleepiness Scale (KSS) at the same time points. All participants completed a sociodemographic questionnaire, the Munich ChronoType Questionnaire for Shift-Workers (MCTQShift) and the Pittsburgh Sleep Quality Index (PSQI). Sleep duration 24 h before the night shift and time awake since last sleep opportunity were monitored by actigraphy. Univariate repeated measures ANOVA found main effects for clock time (p<0.001), age (p<0.05), time awake (p<0.05) and sleepiness (p<0.01) for DSST correct responses; main effects for clock time (p<0.001) and sleepiness (p<0.001) for LCT capacity; and main effects for clock time (p<0.001) and age (p<0.01) for LCT omission errors. All factors remained significant in a mixed-model analysis for DSST. Cognitive performance among hospital nurses is low during the middle of the night shift and increases at the end of the shift; decreased functioning is associated with increased subjective sleepiness, older age and prolonged time awake. Identifying factors contributing to performance during the night shift may provide a basis for the development of risk management policies and preventative interventions.
... Clinically, CSD should be suspected if a person's habitual daily sleep duration (usually the average of several weeks) is below the ageappropriate minimum daily sleep duration in accordance with the recommendations of the National Sleep Foundation ( Table 2) [9]. One important caveat is that subjective sleepiness can be mild or absent in CSD [10,11]. Therefore, subjective sleepiness is a reliable indicator of acute sleep deprivation, but not of CSD. ...
Article
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Chronic sleep deficiency (CSD) poses a threat to physical health, mental well-being, and social functioning. The concept of behaviorally induced CSD has not changed much since it was first introduced four decades ago. Behaviorally induced CSD is currently referred to as insufficient sleep syndrome (ISS). In the latest edition of the International Classification of Sleep Disorders (ICSD-3, 2014), ISS is considered a disorder of central hypersomnolence with diagnostic codes ICD-9-CM 307.44 and ICD-10-CM F51.12. In this review, we will describe the biological importance of sleep, the ramifications of CSD on the individual and society, the nosological status and diagnostic features of ISS, and the apparent lack of attention to ISS in contemporary medical practice and public health programs. The last three decades have seen a global rise in voluntary sleep curtailment such that ISS may already be the leading cause of CSD, not only in adults but also in school-aged children and adolescents. Acknowledging ISS as a public health priority is a necessary first step in our response to the global threat of CSD and CSD-related health consequences. It is only by confronting ISS directly that we can hope to develop and implement effective educational and advocacy programs, along with more responsible public health policies and regulations.
... Paradoxically, however, frequency of adopting the Switch Napper strategy was related to higher levels of self-reported adaptation. This type of contradiction has been reported in some comparisons of subjective sleepiness to other measures of performance, 46,47 and is also not uncommon in shiftwork studies -certain strategies, interventions, or countermeasures that may be beneficial for some aspects of health and performance, like alertness on shift, may result in other negative effects, like impaired sleep or reduced time with family. This highlights tradeoffs commonly observed for work-and sleep-scheduling choices in shiftworkers. ...
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Introduction Shiftwork causes circadian disruption and results in impaired performance, sleep, and health. Often, individuals on non-standard shifts cannot modify work schedules. At-home sleep schedules are a potentially modifiable point of intervention, yet sleep-scheduling strategies remain relatively understudied. Specifically, the adoption of multiple strategies and the employment of strategies for not only night shifts, but also early starts on days, have yet to be formally examined to our knowledge. We studied how adoption of specific and/or multiple sleep-scheduling strategies for day and night shifts relates to measures of adaptation to shiftwork, self-reported on-shift sleepiness, and individual characteristics (eg, age, chronotype, education in circadian and sleep health). We hypothesized: 1) strategies would differ by shift type, 2) individuals would adopt multiple strategies, 3) strategies better aligned with circadian principles would relate to measures of adaptation, and 4) individual characteristics, such as having dependents, would relate to strategy selection. Methods A retrospective, online questionnaire (including items from the Survey of Shiftworkers and items related to sleep-scheduling strategies) was administered to both permanent and rotating hospital staff in four wards working 12-h day and/or night shifts (n=89). Additionally, reasons for strategy selection were explored. Results Level of adaptation varied by sleep-scheduling strategy, with the least adaptation for those utilizing the Incomplete Shifter strategies. For night shifts, Night Stay and Switch Sleeper-N strategies were related to lower mid-shift sleepiness. Many night workers reported using strategies that restricted sleep, and most reported using multiple strategies, both of which also related to lower adaptation. Domestic considerations were the most common rationale for strategy selection. Strategies varied by several individual characteristics, including chronotype, dependents, and level of sleep education. Discussion Future work should investigate sleep strategies and circadian interventions to help mitigate the effects of circadian and sleep disruption in hospital staff.
... When ST was evaluated only on the last night of work, it was observed that G1-NC showed longer ST only in relation to G3-S. The literature demonstrates that long waking hours reduce the capacity and speed of conscious responses and, for this reason, increase the feeling of fatigue by restricting sleep time [35,36]. Dawson and Reid correlated sleep restriction with alcohol intake. ...
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Introduction: The reversal of the natural cycle of wakefulness and sleep may cause damage to the health of workers. However, there are few studies evaluating sleep, fatigue and quality of life of night shift workers considering the influence of small children on these variables. Aims: Evaluate the sleep time, fatigue and quality of life of night shift workers and verify the relationship between these variables with the presence or absence of children in different age groups. Methods: Were evaluated 78 mens shiftworkers, with or without children. Group 1, workers without children (G1-NC), group 2, workers with children pré-school age (G2-PS) and group 3, workers with children school age (G3-S). The sleep time (ST), sleep efficiency (SE), sleep latency (SL) and maximum time awake (MTA) were recorded by actigraphy. The risk of being fatigued at work was estimated by risk index for fatigue (RIF). Results: The G1-NC showed a longer ST on working days and when evaluated only the first nights shift, after day off (p<0,005). This sample, the age of the children did not influence the sleep time these workers. The MTA on day off was lower in the workers from G2-PS. The RIF was lower on G1-NC in the first nights shift compared to the other groups. Conclusion: In this research, workers without children had higher sleep time during the working days. These workers also were less likely to feel fatigued during night work than workers with children, regardless of age these children.
... Jarraya and colleagues found that partial sleep deprivation significantly affected neuropsychological functions such as verbal instant memory, attention, and alertness (Thomas, 2003). Furthermore, some studies have revealed that the cumulative effects of partial sleep deprivation could severely impair cognitive function and behavior (Van Dongen, 2004;Scott et al., 2006;Jarraya et al., 2013). ...
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Working memory is very sensitive to acute sleep deprivation, and many studies focus on the brain areas or network activities of working memory after sleep deprivation. However, little is known about event-related potential (ERP)-related changes in working memory after sleep loss. The purpose of this research was to explore the effects of 36 h of total sleep deprivation (TSD) on working memory through ERPs. Sixteen healthy college students performed working memory tasks while rested and after 36 h of TSD, and electroencephalography (EEG) data were simultaneously recorded while the subjects completed working memory tasks that included different types of stimulus materials. ERP data were statistically analyzed using repeated measurements analysis of variance to observe the changes in the working memory-related N2-P3 components. Compared with baseline before TSD, the amplitude of N2-P3 components related to working memory decreased, and the latency was prolonged after TSD. However, the increased amplitude of the P2 wave and the prolonged latency were found after 36 h of TSD. Thus, TSD can impair working memory capacity, which is characterized by lower amplitude and prolonged latency.
... In addition, our attention span, which is governed by our cognitive ability to serve ongoing goal-directed behavior, is especially susceptible to sleep loss (Durmer & Dinges, 2005). For instance, in a dose-dependent study which analyzed the performance on attentional tasks, a significant deterioration was observed with the amount of accrued time awake, due to increased sleep pressure (Van Dongen, Maislin, Mullington, & Dinges, 2003). ...
Thesis
Sleep is an essential and critical component of an athlete’s preparation towards optimal physical performance. Despite this notion, studies that have analyzed the sleep habits in athletes suggest a significant decrease in both quality and quantity of sleep. The aim of this thesis, therefore, was to investigate the effects of sleep deprivation on physical performance among athletes. Through a systematic review following the “PRISMA” guidelines, eight studies met this thesis inclusion criteria. The results suggest sleep deprivation to negatively affect endurance among athletes, however, due to conflicting research designs and statistical power, no conclusive statement can be made. For the anerobic/strength outcomes, no significant findings were observed following one night of sleep deprivation. Future research is thus warranted as the results regarding sleep deprivation’s effect on physical performance, appear conflicting and poorly understood. Key words: sleep, sleep deprivation, sleep restriction, physical performance, athletes, systematic review
... [5][6][7][8][9] Daytime impairment in psychomotor vigilance has been observed in patients with insomnia undergoing sleep restriction therapy, 10 but it is not clear whether this impairment is any different from what has been observed in healthy normals subjected to sleep restriction. 11,12 The lack of clarity regarding the cognitive consequences of chronic insomnia may stem, in part, from failure to differentiate stable insomnia subtypessleep-onset insomnia and sleepmaintenance insomnia. 13 In particular, individuals with sleeponset insomnia have been reported to be able to compensate effectively for psychomotor vigilance performance impairment during the normal day, 14 even though they may in fact have latent performance deficits. ...
Article
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Purpose Individuals with primary insomnia frequently report cognitive impairment as a next-day consequence of disrupted sleep. Studies attempting to quantify daytime impairment objectively in individuals with insomnia have yielded mixed results, with evidence suggesting impairments in aspects of executive functioning but not psychomotor vigilance. It has been suggested that persons with insomnia may have latent performance deficits for which they would be able to compensate effectively under normal daytime circumstances – suggesting that any such deficits may be exposed through perturbation. In this context, we used a laboratory-based total sleep deprivation (TSD) paradigm to investigate psychomotor vigilance performance in individuals with chronic sleep-onset insomnia as compared to healthy normal controls. Participants and methods Fourteen participants, seven individuals with chronic sleep-onset insomnia (ages 24–40y) and seven age-matched, healthy normal sleepers completed a highly controlled in-laboratory study involving 38 h of TSD. A 10 min and a 3 min version of the psychomotor vigilance test (PVT) were administered every 3 h during TSD. Results In both the individuals with sleep-onset insomnia and the age-matched normal sleepers, lapses of attention and false starts on the PVT were relatively infrequent during the first 16 h of the TSD period, but increased significantly when wakefulness was extended beyond 16 h. However, the effects of TSD on PVT performance were considerably exacerbated in the sleep-onset insomnia group, which showed about twice as many lapses of attention, more than twice as many false starts, and approximately twice as big a time-on-task effect on the 10 min PVT as the age-matched normal sleepers group, with similar findings on the 3 min PVT. Conclusion These findings indicate that daytime impairment reported by individuals with sleep-onset insomnia has an objective performance component that is exposed during TSD. Thus, persons with sleep-onset insomnia could be at increased risk of performance impairment in settings that involve extended wakefulness. This underscores the importance of treating insomnia and suggests that laboratory sleep deprivation studies could serve to document the effectiveness of treatment approaches.
... In addition, the physiological consequences of social jetlag may affect daytime functioning and mental health in a negative manner. Social jetlag implies chronic weekday sleep curtailment, which causes sleepiness as well as impaired physiological and neurobehavioral functioning (Van Dongen et al., 2003;Banks and Dinges, 2007). Moreover, due to the synchrony effect (circadian variations in performance and alertness), early work/school hours appear to be sub-optimal for performance in late chronotypes, who tend to perform better later in the day compared to earlier chronotypes (Carrier and Monk, 2000;Goldstein et al., 2007). ...
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The aim of this study was to explore habitual sleep, social jetlag, and day-to-day variations in sleep (measured as intra-individual standard deviation, ISD) in youths with delayed sleep–wake phase disorder (DSWPD), compared to healthy controls. We also aimed to investigate time of day effects in performance. The sample comprised 40 youths with DSWPD (70.0% female, mean age 20.7 ± 3.1 years) and 21 healthy controls (71.4% female, mean age 21.2 ± 2.2 years). Subjective and objective sleep were measured over 7 days on a habitual sleep schedule by sleep diary and actigraphy recordings. Performance was tested twice with a 12-h interval (22:00 in the evening and 10:00 the following morning) using a simple, 10-min sustained reaction time test (RTT). The results showed later sleep timing in the DSWPD group compared to the controls, but sleep duration, social jetlag, and ISD in sleep timing did not differ between the groups. Still, participants with DSWPD reported longer sleep onset latency (SOL) and poorer sleep efficiency (SE), sleep quality, and daytime functioning, as well as larger ISD in SOL, sleep duration, and SE. The groups had similar evening performances on the RTT, but the DSWPD group performed poorer (slower with more lapses) than the controls in the morning. The poor morning performance in the DSWPD group likely reflects the combined impact of sleep curtailment and circadian variations in performance (synchrony effect), and importantly illustrates the challenges individuals with DSWPD face when trying to adhere to early morning obligations.
... Epidemiological data have shown that, over the last decades, we are seeing a concerning decrease in both the duration and the quality of sleep in developed and developing countries (Dinges, 1995;Broman et al., 1996;Dinges et al., 1997; Liu and Zhou, 2002;Krueger and Friedman, 2009;Maric et al., 2017). The progressive shift toward "24-h societies" has been accompanied by an increase in "sleepiness" and its associated detrimental effects on the individual's performance, cognition, emotions, and general health ( Dinges et al., 1997;Van Dongen et al., 2003a;Chee and Choo, 2004;Banks and Dinges, 2007;Bernert and Joiner, 2007;Knutson et al., 2007;Goel et al., 2009Goel et al., , 2014Couyoumdjian et al., 2010;Grandner et al., 2010;Krause et al., 2017). Thus, understanding the regulatory mechanisms of sleepiness and their implications for human health is urgent and of utmost importance ( Garbarino et al., 2016). ...
Article
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Sleep occupies a third of our life and is a primary need for all animal species studied so far. Nonetheless, chronic sleep restriction is a growing source of morbidity and mortality in both developed and developing countries. Sleep loss is associated with the subjective feeling of sleepiness and with decreased performance, as well as with detrimental effects on general health, cognition, and emotions. The ideas that small brain areas can be asleep while the rest of the brain is awake and that local sleep may account for at least some of the cognitive and behavioral manifestations of sleepiness are making their way into the scientific community. We herein clarify the different ways sleep can intrude into wakefulness, summarize recent scientific advances in the field, and offer some hypotheses that help framing sleepiness as a local phenomenon.
... One of the most important recommendations of these sleep extension studies is to employ sleep hygiene-related strategies to ensure adequate sleep after performing exercise and competitions sessions close to bedtime (53). 7-8 hours of sleep per night are required for psychological well-being, mood, and alertness and reduce susceptibility to respiratory infections (10,52,55). However, it is plausible that the optimum amount of sleep for athletes is an individual value and not a given number of hours of sleep per night (3). ...
Article
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The prevention of infectious diseases is particularly important in athletes who need a good all-season health status to be optimally prepared for competition. › Since the immune system is highly responsive to exercise, periods of intensified training induce a transient immune dysfunction. Athletes regularly encounter additional challenges, such as low energy availability, oxidative stress, psychological stress, sleep disruption, long-haul travel, overreaching periods and an imbalance of exercise and recovery. Moreover, exercise training performed in specific environments, such as high altitude, cold or heat, represents an even higher than usual threat to the immune function. › This review summarizes various recommendations which should help to reduce the athlete’s immune disturbances and the risk of infection. An appropriate management of external and internal exercise loads, adequate recovery, as well as maintaining energy homeostasis by sufficient energy, fluid, and macronutrient intake is recommended. The observance of sleep hygiene strategies, general vaccination advice and instructions for exercising in specific environments is beneficial. Compliance with fundamental hygiene strategies can also reduce pathogen exposure in athletes and thus contribute to maintaining health. › It is concluded that these main strategies of protection against infection should be included in the early education of coaches and young athletes, leading to more professional management of disease prevention.
... Sleepiness can be induced by acutely staying awake for extended periods of time or by the fragmented sleep that occurs chronically with many health conditions including sleep apnea and autoimmune diseases (202,203). Evidence suggests that there is a dose-dependent impact whereby greater amounts of sleep loss correlate with enhanced sleepiness and poor performance (204). Nevertheless, sleepiness varies over the time of day (205), which can impair an individual's ability to sleep or the effectiveness of naps in preventing detriments of sleepiness in functional tasks such as cognition (206). ...
Article
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Profound and debilitating fatigue is the most common complaint reported among individuals with autoimmune disease, such as systemic lupus erythematosus, multiple sclerosis, type 1 diabetes, celiac disease, chronic fatigue syndrome, and rheumatoid arthritis. Fatigue is multi-faceted and broadly defined, which makes understanding the cause of its manifestations especially difficult in conditions with diverse pathology including autoimmune diseases. In general, fatigue is defined by debilitating periods of exhaustion that interfere with normal activities. The severity and duration of fatigue episodes vary, but fatigue can cause difficulty for even simple tasks like climbing stairs or crossing the room. The exact mechanisms of fatigue are not well-understood, perhaps due to its broad definition. Nevertheless, physiological processes known to play a role in fatigue include oxygen/nutrient supply, metabolism, mood, motivation, and sleepiness—all which are affected by inflammation. Additionally, an important contributing element to fatigue is the central nervous system—a region impacted either directly or indirectly in numerous autoimmune and related disorders. This review describes how inflammation and the central nervous system contribute to fatigue and suggests potential mechanisms involved in fatigue that are likely exhibited in autoimmune and related diseases.
... These considerations are especially critical to issues of equity, as children from underprivileged backgrounds are disproportionately exposed to harmful physiological factors, and disproportionately live in environments that do not adequately support beneficial health-related routines and behaviors ( Levy et al., 2016;Tessum et al., 2019). For example, both physical and mental health and the ability to think well and manage emotions and moods depend on getting an adequate amount of quality sleep ( Ackermann et al., 2012;Van Dongen, Maislin, Mullington, & Dinges, 2003;Walker & Stickgold, 2006). Sleep is fundamental for neural plasticity and the consolidation of memories (Potkin & Bunney, 2012;Rasch & Born, 2013), as well as for removing toxic proteins that build up in the brain over waking hours ( Xie et al., 2013). ...
Article
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New advances in neurobiology are revealing that brain development and the learning it enables are directly dependent on social-emotional experience. Growing bodies of research reveal the importance of socially triggered epigenetic contributions to brain development and brain network configuration, with implications for social-emotional functioning, cognition, motivation, and learning. Brain development is also impacted by health-related and physical developmental factors, such as sleep, toxin exposure, and puberty, which in turn influence social-emotional functioning and cognition. An appreciation of the dynamic interdependencies of social-emotional experience, health-related factors, brain development and learning underscores the importance of a “whole child” approach to education reform and leads to important insights for research on social-emotional learning. To facilitate these interdisciplinary conversations, here we conceptualize within a developmental framework current evidence on the fundamental and ubiquitous biological constraints and affordances undergirding social-emotional learning–related constructs and learning more broadly. Learning indeed depends on how nature is nurtured.
... In addition, mindfulness-based treatments such as MBSR place a large emphasis on engaging attention and "mindful awareness" (Kabat-Zinn, 1990). However, because alertness and vigilance are the cognitive capacities most consistently and severely affected by poor sleep (Gobin et al., 2015;Goel, Rao, Durmer, & Dinges, 2009;Lim & Dinges, 2008;McCarthy & Waters, 1997;Van Dongen, Maislin, Mullington, & Dinges, 2003), it also seems likely that individuals experiencing poor sleep quality may have difficulty cultivating the focused attention and awareness that are central to mindfulness-based treatment modalities. Other important mechanisms of treatment for SAD that may be affected by poor sleep include memory and learning; sleep has been shown to be important in supporting memory consolidation processes (Diekelmann & Born, 2010), and poor sleep likely interferes with the fear extinction learning that takes place in the exposure exercises integral to treatments like CBGT (e.g., Craske et al., 2008;Silvestri & Root, 2008). ...
Article
Background and Objectives: Poor sleep is prevalent among individuals with social anxiety disorder (SAD) and may affect treatment outcome. We examined whether: (1) individuals with SAD differed from healthy controls (HCs) in sleep quality, (2) baseline sleep quality moderated the effects of treatment (Cognitive–behavioral group therapy [CBGT] vs. mindfulness-based stress reduction [MBSR] vs. waitlist [WL]) on social anxiety, (3) sleep quality changed over treatment, and (4) changes in sleep quality predicted anxiety 12-months post-treatment. Design: Participants were 108 adults with SAD from a randomized controlled trial of CBGT vs. MBSR vs. WL and 38 HCs. Methods: SAD and sleep quality were assessed pre-treatment and post-treatment; SAD was assessed again 12-months post-treatment. Results: Participants with SAD reported poorer sleep quality than HCs. The effect of treatment condition on post-treatment social anxiety did not differ as a function of baseline sleep quality. Sleep quality improved in MBSR, significantly more than WL, but not CBGT. Sleep quality change from pre- to post-treatment in CBGT or MBSR did not predict later social anxiety. Conclusions: MBSR, and not CBGT, improved sleep quality among participants. Other results were inconsistent with prior research; possible explanations, limitations, and implications for future research are discussed. ClinicalTrials.gov identifier: NCT02036658.
... Participants were scanned twice with a week between the scans. The order of the two scanning sessions was randomized and counterbalanced (31,32). The two sessions were conducted 1 week apart to minimize the possible residual effects of SD. ...
Article
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Sleep deprivation (SD) has been reported to severely affect executive function, and interindividual differences in these effects may contribute to the SD-associated cognition impairment. However, it is unclear how individual differences in chronotypes (morning-type, MT; evening-type, ET) influence neurobehavioral functions after SD. To address this question, we used functional magnetic resonance imaging (fMRI) to evaluate whether 24 h of SD differentially affect response inhibition, a core component of executive function, in MT and ET individuals. Accordingly, MT and ET participants were instructed to follow their preferred 7–9-h sleep schedule for 2 weeks at home both prior to and throughout the course of the study, and then performed a go/no-go task during fMRI scanning at 08:00 a.m. both at rested wakefulness (RW) and following SD. We also examined whether the neurobehavioral inhibition differences in the chronotypes in each session can be predicted by subjective ratings (sleepiness, mood, and task) or objective attention. Behaviorally, SD led to an increased response time of go trials (hit RT), more attentional lapses, higher subjective sleepiness, and worse mood indices, but it did not impair the accuracy of go trials (hit rate) and no-go trials (stop rate). Regardless of the presence of SD, ET individuals exhibited a lower stop rate, higher subjective ratings of sleepiness, exhausted mood, and task difficulty in comparison with MT individuals. On the neural level, SD resulted in decreased inhibition-related activation of the right lateral inferior frontal gyrus (rIFG) in MT individuals and increased rIFG activation in ET individuals. Moreover, the rIFG activation in ET individuals after SD was positively correlated to the subjective ratings of sleepiness and effort put into the task, which was considered as a compensatory response to the adverse effects of SD. These findings suggest that individual differences in inhibition-related cerebral activation after SD are influenced by chronotypes. In addition, ET individuals may be vulnerable to response inhibition. Thus, it is essential to take into consideration the chronotype in SD research and sleep medicine.
... However, the empirical literature has conclusively demonstrated that cognitive functioning is degraded significantly in humans by as little as one night without sleep (e.g., Williamson and Feyer, 2000). In addition, there is clear evidence that the negative impacts of inadequate sleep on cognition and performance accumulate over time, potentially leading to substantial decrements even when some sleep is obtained on a daily basis (e.g., Van Dongen et al., 2003). ...
Chapter
Research on fatigue often involves foundational research in service of addressing real-world problems. In the research discussed in this paper, we discuss this interplay between basic and applied science to highlight the contributions of basic science to informing policy and decision making to reduce risk and improve safety in this domain. We describe three areas of research—ground combat, flight operations, and fatigue countermeasures—where laboratory studies provide critical evidence regarding the causes and consequences of fatigue in applied settings, and discuss the role of that research in addressing real-world challenges. We close by offering some thoughts on the relationship between basic and applied research in this domain, and the synergistic potential between research on sleep loss and cognitive neuroscience.
... Here, we showed that such a transition resulted in a shortened average sleep duration and reduced cognitive effectiveness. Laboratory research has demonstrated that succes- sive days of 6 hours or less per night (chronic sleep restriction) can produce performance impairments equivalent to up to 2 nights of total sleep deprivation (Van Dongen, Maislin, Mullington, & Dinges, 2003). These types of impairments, such as decreased mean reaction times and increased frequency of attentional lapses, could produce serious errors in emergency med- ical situations. ...
Article
National Guard personnel remain largely unstudied within the sleep research community, despite their unique and important role. In response, the purpose of this study was to investigate the extent of sleep deprivation in National Guard medical personnel from two separate Air Force Bases (AFBs) responding to simulated disaster-training exercises. National Guard medical personnel (N = 77) were fitted with wrist activity monitors (actigraphy) to objectively measure their sleep for 4 days of their civilian time (baseline), followed by a 4-day transition period from civilian to military duty, and a 3–5-day disaster-training exercise. Differences in sleep quantity, quality, and “cognitive effectiveness” were analyzed using generalized linear mixed models. Participants’ sleep quantity was significantly reduced from civilian to disaster-training periods, and their cognitive effectiveness also dropped significantly. National Guard medical personnel were sleep-deprived during a simulated disaster-training exercise, which, although a valid proxy for real-world disasters, is likely to be a conservative approximation of the stress and fatigue National Guard personnel experience during crisis response. As such, the need for targeted fatigue-related interventions to safeguard our service members during these critical times is clear.
... In addition, sleep deprivation in athletes leads to perception of fatigue being heightened, while vigor decreases significantly (Sinnerton & Reilly, 1992). This is also true for the general population, in which studies of sleep deprivation showed a detrimental influence on cognitive function (Van Dongen, Maislin, Mullington, & Dinges, 2003); mood, specifically subjective vigor, fatigue and depression (Scott, McNaughton, & Polman, 2006); and daytime sleepiness (Carskadon & Dement, 1981). ...
Article
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The current study investigated whether athletes with negatively charged psychological reactivity that includes worry and negative affect experience more sleep disturbance in comparison with athletes whose psychological reactivity involves positive affect. Objective sleep monitoring for a period of 3-4 months was utilized in 32 junior elite athletes. Athletes completed the Positive and Negative Affect Scale, and the Penn State Worry Questionnaire before and after the sleep-monitoring period. Results showed changes and disturbances in sleep as a result of a specific psychological reactivity involving high worry and negative affect. On the other hand, positive affect was associated with normal sleep/wake patterns.
... Sleep deprivation is clearly associated with poorer cognitive processes (Pilcher and Huffcutt, 1966;Thomas et al., 2000;Van Dongen et al., 2003), and studies have also found poor communication, decreased concentration and cognitive performance, unintended sleeps, decreased motor performance, increased risk taking and changes in mood pattern, specifically depression Wulff, 2005: Kelley et al., 2015). These factors directly or indirectly impact negatively on learning and memory processes ( Curcio et al., 2006: Diekelmann and Born, 2010;Escribano et al., 2012). ...
Article
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In the last decade advances in human neuroscience have identified the critical importance of time in creating long-term memories. Circadian neuroscience has established biological time functions via cellular clocks regulated by photosensitive retinal ganglion cells and the suprachiasmatic nuclei. Individuals have different circadian clocks depending on their chronotypes that vary with genetic, age, and sex. In contrast, social time is determined by time zones, daylight savings time, and education and employment hours. Social time and circadian time differences can lead to circadian desynchronization, sleep deprivation, health problems, and poor cognitive performance. Synchronizing social time to circadian biology leads to better health and learning, as demonstrated in adolescent education. In-day making memories of complex bodies of structured information in education is organized in social time and uses many different learning techniques. Research in the neuroscience of long-term memory (LTM) has demonstrated in-day time spaced learning patterns of three repetitions of information separated by two rest periods are effective in making memories in mammals and humans. This time pattern is based on the intracellular processes required in synaptic plasticity. Circadian desynchronization, sleep deprivation, and memory consolidation in sleep are less well-understood, though there has been considerable progress in neuroscience research in the last decade. The interplay of circadian, in-day and sleep neuroscience research are creating an understanding of making memories in the first 24-h that has already led to interventions that can improve health and learning.
... An obvious impact of on- call work is disrupted sleep due to the widespread use of on-call personnel out of "standard" work hours. Inadequate or disrupted sleep is associated with immediate negative changes in performance (Van Dongen et al. 2003;Belenky et al. 2003). Chronic exposure to sleep disruption can impact resilience ( Seelig et al. 2016) as well as physical and mental health outcomes ( Kecklund and Axelsson 2016). ...
Article
Background: The unpredictable, “on-call” component of the emergency services (ES) may be difficult to navigate in the context of domestic and work responsibilities, and especially difficult for women, given they tend to take on a greater household burden than do men. Our aim was to understand women’s experiences in the ES, particularly the impact of being on-call and related coping strategies. Methods: Twenty-four women were recruited from two ES agencies in Australia. Participation involved a brief questionnaire and a 45–60-min interview. Interviews were recorded, and audio files were transcribed before analysis using nVIVO software. Results: Interview data identified two major themes: impact and management. Women talked about the impact of on-call for themselves (e.g. disturbed? sleep, fatigue and the relentlessness of the role) but also discussed the, largely negative, impact for their family/household. In terms of management, support (family, social and work) and planning and preparation were identified as important in helping women manage their multiple roles in the context of on-call unpredictability. Conclusion: The negative impacts of on-call work on women’s sleep supports existing quantitative and qualitative data in the broader on-call area. For those women with children, managing their care presents one of the biggest challenges to being able to manage the on-call component of their work. Future research should to focus on quantifying the impact of on-call for both men and women, particularly the “relentlessness” of the work identified in this study and whether this toll changes based on other factors such as experience, role or gender.
... 39 However, it has since been established that shift A c c e p t e d M a n u s c r i p t 5 work and insufficient sleep are associated with greater fatigue and sleepiness, acute and chronic health problems, changes in mood, and performance impairment. 5,7,13,24,25,27,30,36,37 In policing, these factors can also increase injury and accident risk; increase officer misconduct; impair officers' judgment and ability to respond quickly in challenging situations; and, have economic and community consequences. 15,23,24,39,42,[45][46][47][48] Recent experimental research has also established a substantial impact of fatigue on how well officers manage their encounters with the public and officers' ability to reduce or deescalate conflict. ...
Article
Introduction Police officers respond to emergencies, patrol neighborhoods, and handle citizen complaints around-the-clock, and their sleep opportunities are frequently reduced by extended duty hours and secondary employment. Twenty-five percent of U.S. protective services (including police) also work shifts. Shift work and sleep loss increase fatigue, sleepiness, and accident risk, and are associated with changes in mood. These stressors have economic and community consequences. We examined associations between unscheduled work hours, fatigue and sleepiness, and public complaints and on-duty accidents. Methods Officers at four police departments reported work hours, and reported public complaints (2 departments) and on-duty accidents from 2–29 weeks. Peak FAID/KSS scores (i.e. max scores while on shift) were predicted using FAID Quantum, and were tested as predictors of complaints and accidents. Odds ratios determined fatigue/sleepiness benchmarks that were predictive of complaints and on-duty accidents (2-levels: benchmark met/not met; FAID range tested: 60–100; KSS range tested: 1–9). Results 379 officers and 32,712 work shifts were studied. Nightshifts and court appearances were more prevalent prior to days with complaints, though this was not observed for accidents. Nightshifts preceded 75% of complaints; nightshifts and court appearances preceded 43.2% of complaints. Average FAID/KSS scores were 47.88 ± 22.09 and 5.63 ± 1.34, respectively. FAID/KSS scores were higher on nightshifts and incident days (F>4.09, p<0.04). A FAID benchmark of 80 best predicted accidents (OR=2.30, p=0.02) and complaints (OR=5.44, p<0.01). KSS benchmarks of 5 and 8 best predicted accidents (OR=2.00, p=0.04) and complaints (OR=7.69, p<0.01), respectively. Conclusion Nightshifts and court appearances predicted complaints. Nightshift work requires daytime sleep. Court appearances can result in sleep loss due to reduced sleep opportunity. FAID will overestimate sleep and underestimate fatigue on court days. A FAID benchmark of 80 was best at distinguishing the odds of an accident or complaint. The KSS benchmark differed by incident-type. Support (If Any) DOJ Award #96-IJ-CX-0046.
... The severity of the negative effects of chronic sleep deprivation has a high and stable indivi- dual variability, which implies the contribution of genetic factors to it (Bliese et al. 2006;Spaeth et al. 2012;Van Dongen et al. 2003). One of the genes that determines circadian rhythms is the Clock (Circadian Locomotor Output Cycles Protein Kaput) gene, which encodes the posi- tive transcription factor CLOCK and contains a variety of polymorphic sites in both the trans- lated and untranslated regions ( Palagini et al. 2014). ...
Article
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A comparative analysis of melatonin circadian rhythms in Caucasian (incoming population) and Asian (indigenous population) menopausal women with/without sleep disorders depending on the genotype of Clock 3111T/C gene polymorphism was realized.The melatonin level in the saliva was determined four times a day (6:00–7:00, 12:00–13:00, 18:00–19:00, 23:00–00:00 h). The Caucasian women—carriers of the TT-genotype with insomnia as compared to control group—had a higher morning melatonin level and a lower night melatonin level. The Asian women with TT-genotype and insomnia had a lower levels of melatonin as compared to control at daytime, evening and night. A significantly higher melatonin level in the early morning hours was detected in the Caucasian women—carriers of the TT-genotype with insomnia as compared to group womencarriers of the minor 3111C-allele. There were no statistically significant differences in the circadian rhythms of melatonin in the Asian women depending on the genotype of the Clock 3111T/C polymorphism. An assumption with respect to the protective role of the minor allele 3111C in the development of insomnia associated with the displacement of melatonin circadian rhythms in the representatives of the incoming population was made.
... When vulnerability to sleep loss and individual sleep need were included as parameters, the variance explained by the model increased from 22% to 82%. A non-linear mixed effects model fitting PVT lapses as a function of cumulative wakefulness, with parameters to model inter-individual differences in the rate of PVT lapse accumulation during SR as well as critical wake duration (maximum period of stable performance following wake), accounted for 83% of the variance in performance data.63 Average critical wake duration was estimated to be approximately 15.84 hours, with an estimated standard deviation among subjects of 3.58 ± 1.2 hours. ...
Article
Stable trait-like responding is well established for neurobehavioral performance measures across repeated exposures to total sleep deprivation and partial chronic sleep restriction. These observed phenotypes are task-dependent, suggesting that there are distinct cognitive profiles of responding with differential vulnerability to sleep loss within the same individual. Numerous factors have been investigated as potential markers of phenotypic vulnerability to the effects of sleep loss but none fully account for this phenomenon. Observed interindividual differences in performance during extended wakefulness may be driven by underlying deficits in the wake-promoting system resulting in greater performance instability due to failure to counteract increased homeostatic pressure. Further work would benefit from a systems approach to the study of interindividual vulnerability in which behavioral, neurobiological, and genetic data are integrated in a larger framework delineating the relationships between genes, proteins, neurobiology, and behavior.
Article
Picotements dans les yeux, bâillements, engourdissement, vagabondage de l’esprit… Dans nos sociétés contemporaines en proie à une épidémie de privation de sommeil, une grande part de la population fait régulièrement l’expérience de la somnolence. Chez l’enfant, cet état peut se manifester sous la forme d’une hyperactivité, d’une labilité émotionnelle, de troubles du comportement ou de la concentration. Si les effets néfastes du manque de sommeil sont désormais bien connus, évaluer de manière fiable la somnolence permet de comprendre comment l’attention, la mémoire et les apprentissages peuvent être influencés par un mauvais équilibre veille-sommeil. Dans la population pédiatrique, les différentes composantes de la somnolence (i.e. sensation subjective d’éveil non satisfaisant, changements (neuro)physiologiques et répercussions cognitivo-comportementales), peuvent être évaluées via différentes méthodes. Cet article propose une description détaillée (i) des outils francophones classiquement utilisés et (ii) des outils récemment développés pour évaluer la somnolence dans cette population.
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Background The main objective of this study was to describe the relationship between working conditions, sleep and psycho-affective variables and medical errors. Methods This was an observational, analytical and cross-sectional study in which 661 medical residents answered questionnaires about working conditions, sleep and psycho-affective variables. Actigraphic sleep parameters and peripheral temperature circadian rhythm were measured in a subgroup of 38 subjects. Bivariate and multivariate predictors of medical errors were assessed. Results Medical residents reported working 66.2 ± 21.9 weekly hours. The longest continuous shift was of 28.4 ± 10.9 h. They reported sleeping 6.1 ± 1.6 h per day, with a sleep debt of 94 ± 129 min in workdays. A high percentage of them reported symptoms related to psycho-affective disorders. The longest continuous shift duration (OR = 1.03 [95% CI, 1.00–1.05], p = 0.01), working more than six monthly on-call shifts (OR = 1.87 [95% CI, 1.16–3.02], p = 0.01) and sleeping less than six hours per working day (OR = 1.66 [95% CI, 1.10–2.51], p = 0.02) were independently associated with self-reported medical errors. The report of medical errors was associated with an increase in the percentage of diurnal sleep (2.2% [95% CI, 0.1–4.3] vs 14.5% [95% CI, 5.9–23.0]; p = 0.01) in the actigraphic recording. Conclusions Medical residents have a high working hour load that affect their sleep opportunities, circadian rhythms and psycho-affective health, which are also related to the report of medical errors. These results highlight the importance of implementing multidimensional strategies to improve medical trainees’ sleep and wellbeing, increasing in turn their own and patients’ safety.
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Background: Shift work is essential in society but can be detrimental to health and quality of life and is associated with decreased productivity and increased risk of accidents. Interventions to reduce these consequences are needed, but the extent and range of trial evidence for interventions for those most affected by their shift-work schedules is unclear. We therefore carried out a scoping review to assess the availability of evidence to inform the development and evaluation of future interventions. Methods: We aimed to identify clinical trials of any intervention for shift work-related sleep disturbance that included a comparator group, where the intervention was delivered in an occupational setting. We searched Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL, EMBASE, Medline and Science Citation Index from inception to 30 th March 2020 for relevant citations. Citations were screened by two independent reviewers, a third reviewer resolved disagreements. Data were extracted by two independent reviewers. Results: From 1250 unique citations, 14 studies met inclusion criteria for comparative trials of treatment in an occupational setting. There were five trials of hypnotics, five trials of stimulants, and four trials of non-pharmacological therapies (cognitive behavioural therapy, light therapy, aromatherapy and herbal medicine). Outcomes included sleep parameters, day-time sleepiness, and quality of life. There were no consistently reported outcomes across trials. Conclusions: Interventions fell into three distinct groups investigated in distinct time periods without progression from efficacy trials to wider-scale interventions. The lack of consistent patient-reported outcome measures limits synthesising findings. Some trials focussed on optimising sleep, others on reducing wake-time sleepiness. Adequately powered trials of existing interventions are needed, with the development and testing of novel combination treatments in patients with well-defined shift work sleep disorder. A core set of clinically relevant outcomes will develop and standardise the evidence-base for shift work sleep disorder.
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Aim: To understand why some parents are less sensitive to infant cues than others, we need to understand how healthy parents respond, and how this is influenced by factors such as sleep deprivation. Here, we examined whether sleep deprivation alters the self-infant-prioritisation effect in a population of first-time mothers within their first year of motherhood. Methods: The study took place at Aarhus University Hospital in Denmark from August 2018 until February 2020. First-time mothers were recruited through Midwife clinics, national and social media. All women completed a perceptual matching task including an infant category. The mothers were divided into two groups depending on their sleep status: below or above 7 hours of average night-time sleep, measured with actigraphy. Results: Forty-eight first-time mothers at the age of 29.13 ± 3.87 years were included. In the sleep-deprived group, the infant category was statistically significantly higher in accuracy (p=0.005) and faster in reaction time (p<0.001) than all other categories. In contrast, in the non-sleep-deprived group, there was no statistically significant difference between self and infant, neither in accuracy, nor reaction time. Conclusion: Sleep-deprived new mothers strongly prioritised infants over self, while non-sleep-deprived new mothers showed no prioritisation of the self over the infant.
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Introduction: Modafinil is an eugeroic drug that has been examined to maintain or recover wakefulness, alertness, and cognitive performance when sleep deprived. In a nonmilitary context, the use of modafinil as a nootropic or smart drug, i.e., to improve cognitive performance without being sleep deprived, increases. Although cognitive performance is receiving more explicit attention in a military context, research into the impact of modafinil as a smart drug in function of operationality is lacking. Therefore, the current review aimed at presenting a current state-of-the-art and research agenda on modafinil as a smart drug. Beside the question whether modafinil has an effect or not on cognitive performance, we examined four research questions based on the knowledge on modafinil in sleep-deprived subjects: (1) Is there a difference between the effect of modafinil as a smart drug when administered in repeated doses versus one single dose?; (2) Is the effect of modafinil as a smart drug dose-dependent?; (3) Are there individual-related and/or task-related impact factors?; and (4) What are the reported mental and/or somatic side effects of modafinil as a smart drug? Method: We conducted a systematic search of the literature in the databases PubMed, Web of Science, and Scopus, using the search terms "Modafinil" and "Cognitive enhance*" in combination with specific terms related to the research questions. The inclusion criteria were studies on healthy human subjects with quantifiable cognitive outcome based on cognitive tasks. Results: We found no literature on the impact of a repeated intake of modafinil as a smart drug, although, in users, intake occurs on a regular basis. Moreover, although modafinil was initially said to comprise no risk for abuse, there are now indications that modafinil works on the same neurobiological mechanisms as other addictive stimulants. There is also no thorough research into a potential risk for overconfidence, whereas this risk was identified in sleep-deprived subjects. Furthermore, eventual enhancing effects were beneficial only in persons with an initial lower performance level and/or performing more difficult tasks and modafinil has an adverse effect when used under time pressure and may negatively impact physical performance. Finally, time-on-task may interact with the dose taken. Discussion: The use of modafinil as a smart drug should be examined in function of different military profiles considering their individual performance level and the task characteristics in terms of cognitive demands, physical demands, and sleep availability. It is not yet clear to what extent an improvement in one component (e.g., cognitive performance) may negatively affect another component (e.g., physical performance). Moreover, potential risks for abuse and overconfidence in both regular and occasional intake should be thoroughly investigated to depict the trade-off between user benefits and unwanted side effects. We identified that there is a current risk to the field, as this trade-off has been deemed acceptable for sleep-deprived subjects (considering the risk of sleep deprivation to performance) but this reasoning cannot and should not be readily transposed to non-sleep-deprived individuals. We thus conclude against the use of modafinil as a cognitive enhancer in military contexts that do not involve sleep deprivation.
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Background: Shift work is essential in society but can be detrimental to health and quality of life and is associated with decreased productivity and increased risk of accidents. Interventions to reduce these consequences are needed, but the extent and range of trial evidence for interventions for those most affected by their shift-work schedules is unclear. We therefore carried out a scoping review to assess the availability of evidence to inform the development and evaluation of future interventions. Methods: We aimed to identify clinical trials of any intervention for shift work-related sleep disturbance that included a comparator group, where the intervention was delivered in an occupational setting. We searched Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL, EMBASE, Medline and Science Citation Index from inception to 30 th March 2020 for relevant citations. Citations were screened by two independent reviewers, a third reviewer resolved disagreements. Data were extracted by two independent reviewers. Results: From 1250 unique citations, 14 studies met inclusion criteria for comparative trials of treatment in an occupational setting. There were five trials of hypnotics, five trials of stimulants, and four trials of non-pharmacological therapies (cognitive behavioural therapy, light therapy, aromatherapy and herbal medicine). Outcomes included sleep parameters, day-time sleepiness, and quality of life. There were no consistently reported outcomes across trials. Conclusions: Interventions fell into three distinct groups investigated in distinct time periods without progression from efficacy trials to wider-scale interventions. The lack of consistent patient-reported outcome measures limits synthesising findings. Some trials focussed on optimising sleep, others on reducing wake-time sleepiness. Adequately powered trials of existing interventions are needed, with the development and testing of novel combination treatments in patients with well-defined shift work sleep disorder. A core set of clinically relevant outcomes will develop and standardise the evidence-base for shift work sleep disorder.
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Interindividual differences in neurobehavioral response to sleep loss are ubiquitous and unexplained. Numerous factors have been examined as potential predictors of phenotypic response to sleep loss but none have yielded a comprehensive view of the phenomenon. This dissertation examines the impact of baseline factors, habitual sleep patterns, and homeostatic response to sleep loss on accrued deficits in psychomotor vigilance during chronic partial sleep restriction, using the largest study sample to date. A total of 306 healthy adults completed controlled isolated laboratory protocols for 11-20 days and were randomized to either chronic partial sleep restriction (five consecutive nights of four hours time in bed) or control condition (ten hours time in bed on all nights). Findings indicate no significant impact of personality, academic intelligence, subjective reports of chronotype, sleepiness and fatigue, performance on working memory, and demographic factors such as sex, ethnicity, and body mass index, on vulnerability to the negative effects of sleep loss on psychomotor vigilance. Superior baseline performance on the PVT, older age, and ability to sustain wakefulness on the MWT were associated with relative resilience to decrements in vigilant attention during sleep restriction. Interindividual differences in vulnerability to the effects of sleep loss were not accounted for by prior sleep history, habitual sleep patterns outside of the laboratory, baseline sleep architecture, or homeostatic sleep response during chronic partial sleep restriction. Variability in a modulatory drive responsible for integrating competing signals for wakefulness and sleep may partially account for phenotypic vulnerability to the effects of sleep loss.
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Event-based prospective memory (PM) involves carrying out intentions when specific events occur and is ubiquitous in everyday life. It consists of a prospective component (remembering that something must be done) and a retrospective component (remembering what must be done and when). Subjective sleep-related variables may be related to PM performance and an attention-demanding prospective component. In two studies, the relationship of subjective sleepiness and subjective sleep quality with both PM components was investigated with a laboratory PM task and separation of its components via Bayesian multinomial processing tree modeling. In Study 1, neither component of PM was related to naturally occurring subjective sleepiness or sleep quality. In Study 2, sleepiness was experimentally increased by placing some participants in a supine body posture. Testing participants in upright vs. supine posture affected neither PM component. However, body posture moderated the relationship between subjective sleep quality and the prospective component: In supine posture, subjective sleep quality tended to be more positively related to the prospective component. Overall, neither subjective sleepiness nor subjective sleep quality alone was related to PM.
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Sleep inertia, or the grogginess felt upon awakening, is associated with significant cognitive performance decrements that dissipate as time awake increases. This impairment in cognitive performance has been observed in both tightly controlled in-laboratory studies and in real-world scenarios. Further, these decrements in performance are exaggerated by prior sleep loss and the time of day in which a person awakens. This review will examine current insights into the causes of sleep inertia, factors that may positively or negatively influence the degree of sleep inertia, the consequences of sleep inertia both in the laboratory and in real-world settings, and lastly discuss potential countermeasures to lessen the impact of sleep inertia.
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Background: Sleep disruption during the first postpartum year is associated with several negative health outcomes including postpartum depression. Such disruption may be a greater issue for parents of preterm neonates, yet literature on this subject has not been critically reviewed. Objective: To synthesize literature on sleep quantity, sleep quality, and factors influencing sleep among parents of preterm infants during infant hospitalization and following discharge. Design: A systematic review. Data sources: Medline, EMBASE, CINAHL, PsycINFO, Scopus, and Cochrane Database of Systematic Reviews were searched from their inception to February 2017. Methods: Potentially eligible citations were reviewed by two independent reviewers. Both quantitative and qualitative studies were eligible for inclusion. Data on eligible studies and review outcomes were extracted using a customized form. Findings: Eighteen reports from 16 studies met inclusion criteria. Four studies included a control group of parents of full-term infants. Three studies reported sleep quantity means, of which only one provided values for an exclusive sample of mothers of preterm infants and found on average, mothers obtained 6.3 h of sleep/day in the first 5–10 days. Twelve studies reported on sleep quality; most (n = 10) relied on self-reported measures and identified poor subjective sleep quality whereas two studies objectively measured sleep of poor quality. Parental stress was the most consistent factor associated with sleep quality. Conclusion and implications: Quality and quantity of sleep among parents of preterm infants is inadequate and may negatively influence family health outcomes. Further research on correlates and changes in sleep is required to identify at-risk parents and inform targeted clinical recommendations and interventions aimed at maximizing sleep for parents of preterm infants.
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Study Objectives: Recent experimental research indicates a substantial impact of fatigue on police officers’ encounters with the public. In recent years, biomathematical models of fatigue have provided a new way to identify potential relationships between working time arrangements and job performance. This study focused on public complaints against police officers and determined whether the odds of a public complaint were associated with work schedules and/or a biomathematical model’s predictions of fatigue and sleepiness. Methods: N=144 police officers from two municipal police departments in the United States reported shift start times, shift hours, court hours, and public complaints each duty day during study participation. A biomathematical model of fatigue (FAID Quantum) predicted sleep duration and sleep timing and inferred fatigue and sleepiness for 15,744 shifts. Fatigue, sleepiness, 24-hour sleep estimates, and work schedule were tested as predictors of public complaints. Results: Greater fatigue, greater sleepiness, and less sleep in the 24-hours prior to a shift increased the odds of a public complaint (F≥9.14, p<0.01). Working back-to-back night shifts increased the odds of a public complaint (OR=4.27, p<0.01), particularly when off-duty court hours were worked between the night shifts (OR=4.73, p<0.01). Conclusions: On-duty fatigue and sleepiness, sleep obtained prior to a shift, and working night shifts were strongly associated with public complaints. Off-duty court appearances reduced sleep between night shifts and further increased the odds of a public complaint. The results suggest that off-duty court hours should be limited between night shifts and duty schedules should be considered when scheduling court appearances.
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We explored existing research to inform the prospect of using physical exercise interventions for emerging adults (ages 18-25) with attention-deficit/hyperactivity disorder (ADHD). We synthesized (a) possible mechanisms of change for physical exercise as an intervention for ADHD, (b) existing physical exercise research with children and adolescents with ADHD, and (c) physical exercise interventions for adults with depression to inform developmental implications and recommendations. Physical exercise research in child and adolescent samples provide preliminary support of physical exercise on ADHD symptomatology and common areas of impairment. However, variability in research methods (e.g., exercise modalities, outcome measures) precludes us from comparing physical exercise interventions to each other (e.g., aerobic exercise versus resistance training) and prevailing pharmacological and psychosocial treatments. In reviewing the more substantive physical exercise research of adults with depression, mild-to-moderate intensity aerobic physical exercise and high-intensity interval aerobic physical exercise are most likely to yield the greatest improvements in affect, resulting in improved long-term engagement for emerging adults. We discuss that, despite the limited research documenting the effectiveness of physical exercise for ADHD in emerging adulthood, there are numerous reasons for mental health providers to recommend it as an adjunct to psychosocial and pharmacological treatments. We reviewed several promising prospects for research into physical exercise interventions for emerging adults with ADHD. Limitations of existing research and avenues for future investigation are discussed.
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Background: Going without sleep for long periods of time can produce a range of experiences, including perceptual distortions and hallucinations. Many questions, however, remain unanswered regarding the types of symptoms which are most reliably elicited, the time of symptom onset, and whether symptoms worsen over time toward psychotic decompensation. Since sleep deprivation exceeding 48 h is considered unethical today, an examination of historical studies with extreme sleep-loss duration is needed to obtain information about what happens during prolonged sleep loss. Methods: A systematic-review approach was used to identify experimental and observational studies of sleep deprivation in healthy people which describe the effects of prolonged sleep loss on psychopathological symptoms, without any date restriction. Results: A total of 476 articles were identified. Of these, 21 were eligible for inclusion. Duration of sleep loss ranged between 24 h and 11 nights (total 760 participants; average 72–92 h without sleep). All studies except one reported perceptual changes, including visual distortions (i.e., metamorphopsias), illusions, somatosensory changes and, in some cases, frank hallucinations. The visual modality was the most consistently affected (in 90% of the studies), followed by the somatosensory (52%) and auditory (33%) modalities. Symptoms rapidly developed after one night without sleep, progressing in an almost fixed time-dependent way. Perceptual distortions, anxiety, irritability, depersonalization, and temporal disorientation started within 24–48 h of sleep loss, followed by complex hallucinations and disordered thinking after 48–90 h, and delusions after 72 h, after which time the clinical picture resembled that of acute psychosis or toxic delirium. By the third day without sleep, hallucinations in all three sensory modalities were reported. A period of normal sleep served to resolve psychotic symptoms in many—although not all—cases. Conclusions: Psychotic symptoms develop with increasing time awake, from simple visual/somatosensory misperceptions to hallucinations and delusions, ending in a condition resembling acute psychosis. These experiences are likely to resolve after a period of sleep, although more information is required to identify factors which can contribute to the prevention of persistent symptoms.
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Sufficient sleep plays an important role in neurocognitive function, yet, problematic sleep is ubiquitous in the general population. It is also frequently predictive of, and concurrent with, internalizing psychopathologies (IPs) such as anxiety and depression suggesting sleep quality is dimensional and transdiagnostic. Along with problematic sleep, IPs are characterized by negative affectivity, therefore, prominent neurobiological models of internalizing conditions involve the amygdala, a region central to emotion. In resting-state studies (independent of sleep considerations), abnormalities in amygdala-frontal functional connectivity are commonly observed suggesting emotion dysregulation may contribute to clinically-relevant phenotypes. In a separate line of research, studies of sleep deprivation, and insomnia disorder suggest sleep loss may alter amygdala-frontal connectivity. Taken together, findings point to shared neurobiology between sleep and emotion systems, however, the impact of sleep quality on the amygdala circuit in anxiety or depression is unclear. Therefore, we evaluated variance in naturalistic sleep quality on amygdala-based circuity in individuals with and without psychiatric illness. Resting-state fMRI data was collected in 87 un-medicated, treatment-seeking adults diagnosed with a primary anxiety disorder (n = 68) or primary depressive disorder (n = 19) in addition to healthy individuals (n = 40). Regression analysis was conducted with bilateral anatomical amygdala as seed regions and self-reported sleep quality was indexed with a validated self-report measure, the Pittsburgh Sleep Quality Index (PSQI). Post-hoc analysis was performed to evaluate whether diagnostic status (primary anxiety, primary depression, healthy) significantly explained functional connectivity results. Whole-brain regression analysis, controlling for anxiety and depression symptoms, revealed worse sleep quality (i.e., higher PSQI total scores) predicted increased left amygdala-subgenual anterior cingulate functional connectivity and reduced connectivity with posterior cerebellar lobe and superior temporal gyrus. For right amygdala, increased coupling with postcentral gyrus corresponded with worse sleep. Post-hoc analysis did not detect a significant relationship between diagnostic status and whole-brain findings. Results expand on previous studies and indicate variance in sleep quality tracks brain pathways involved in cognitive-emotion functions implicated in the neurobiology of IPs that may extend to individuals at risk for clinical anxiety or depression. Altogether, the clinical relevance of identifying phenotypes to improve our understanding of psychopathology may be improved by incorporating sleep quality.
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Objetivo: Determinar los comportamientos de sueño en estudiantes de Medicina a través de un cuestionario que mide los ritmos circadianos de sueño y del Índice de Calidad del Sueño de Pittsburgh.Tipo de estudio: Estudio descriptivo de tipo corte transversal.Metodología: Se aplicó una encuesta a 300 estudiantes de una facultad de Medicina en Bogotá, Colombia, que indaga sobre comportamientos de sueño conjuntamente con preguntas sobre edad, sexo, estrato, semestre cursado, percepción del ánimo y estructura familiar. A través del test de Pittsburgh se identificó a los participantes como buenos o malos dormidores y se compararon con las demás variables.Resultados: Promedio de edad 19,8 (DS 2,5). El 71 % eran mujeres y el 46 % de los semestres 1°, 2° y 3°. De acuerdo con el Índice de Calidad de Sueño de Pittsburgh, el 47, 6 % se clasificó como malos dormidores. No se encontraron diferencias estadísticas al compararlos con las variables de género, estado de ánimo y semestre.Conclusiones: Existe un porcentaje importante de estudiantes con malos hábitos de sueño por lo que se debe promover una buena higiene del sueño dadas las funciones cognitivas afectadas y los riesgos para la salud física.
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