Análisis experimental de la capacidad de vigilancia: efecto de la privación parcial de sueño y dificultad de la tarea / Experimental analysis of vigilance: effects of partial privation of sleep and task difficulty

Uno de los factores más relevantes en la capacidad para mantener un apropiado nivel de alerta es la duración del período de sueño. Se han realizado numerosos trabajos, ya clásicos, sobre el efecto de la privación total o selectiva de alguna de las fases del sueño en relación con diferentes funciones fisiológicas y psicológicas. En el trabajo que presentamos, analizamos experimentalmente el efecto de la privación parcial de sueño sobre el nivel de alerta subjetivo y el rendimiento obtenido en dos tareas de vigilancia o atención sostenida, que difieren en el nviel de dificultad, así como el nivel de carga de trabajo mental (mental workload) experimentado durante su realización. El rendimiento en dichas tareas se evaluará en términos de precisión y velocidad, con los índices nivel de vigilancia y función decremento de vigilancia. Los resultados relativos al rendimiento no son consistentes con las hipótesis formuladas. (AU)

Jet lag: clinical features, validation of a new syndrome-specific scale, and lack of response to melatonin in a randomized, double-blind trial.

OBJECTIVE: The goals of this study were to validate a new rating scale for measuring severity of jet lag and to compare the efficacy of contrasting melatonin regimens to alleviate jet lag. METHOD: This was a randomized, double-blind trial of placebo and three alternative regimens of melatonin (5.0 mg at bedtime, 0.5 mg at bedtime, and 0.5 mg taken on a shifting schedule) for jet lag. The subjects were 257 Norwegian physicians who had visited New York for 5 days. Jet lag ratings were made on the day of travel from New York back to Oslo (6 hours eastward) and for the next 6 days in Norway. The main outcome measures were scale and item scores from a new, syndrome-specific instrument, the Columbia Jet Lag Scale, that identifies prominent daytime symptoms of jet lag distress. RESULTS: There was a marked increase in total jet lag score in all four treatment groups on the first day at home, followed by progressive improvement over the next 5 days. However, there were no significant group differences or group-by-time interactions. In addition, there was no group effect for sleep onset, time of awakening, hours slept, or hours napping. Ratings on a summary jet lag item were highly correlated with total jet lag scores (from a low of r = 0.54 on the day of travel to a high of r = 0.80 on day 3). The internal consistency of the total jet lag score was high on each day of the study. CONCLUSIONS: The use of melatonin for preventing jet lag needs further study.

Influence of a functional polymorphism within the promoter of the serotonin transporter gene on the effects of total sleep deprivation in bipolar depression.

OBJECTIVE: A functional polymorphism in the transcriptional control region upstream of the coding sequence of the 5-hydroxytryptamine transporter (5-HTT) has been reported. This polymorphism has been shown to influence the antidepressant response to fluvoxamine and paroxetine. The authors tested the hypothesis that the allelic variation of the 5-HTT-linked polymorphic region (5-HTTLPR) could influence the response of depressed patients to total sleep deprivation. METHOD: Sixty-eight drug-free inpatients with bipolar depression underwent a night of total sleep deprivation. 5-HTTLPR was genotyped in these patients. Changes in perceived mood were rated on a visual analogue scale and analyzed by using repeated measures analysis of covariance. RESULTS: Patients who were homozygotic for the long variant of 5-HTTLPR showed a significantly better mood amelioration after total sleep deprivation than those who were heterozygotic and homozygotic for the short variant. CONCLUSIONS: The influence of 5-HTTLPR on response to total sleep deprivation is similar to its observed influence on response to serotonergic drug treatments. This finding supports the hypothesis of a major role for serotonin in the mechanism of action of total sleep deprivation in depression.

A new visual performance test offers new variables for assessing daytime vigilance: short pauses in performance.

A new visual performance test, VigiMouse, was evaluated with the aid of 6 volunteering pediatry residents. The results were compared with a visual analogue scale in differentiating four different states: mild sleep deprivation, low blood alcohol level, a combination of both, and the normal state. A normal night shift at a busy pediatric ward was chosen to represent sleep deprivation. A new set of parameters based on short pauses in performance proved to be more sensitive in detecting small changes in performance than parameters based on reaction times.

Changes in sleep-wake cycle during the period from late pregnancy to puerperium identified through the wrist actigraph and sleep logs.

The purpose of this study was to understand the sleep-wake cycle during the period from late pregnancy to about 3 months of postpartum by evaluating the number of actigraphic activities in four women (one multipara and three primi gravidae), and to compare the results with the findings from sleep logs. An irregularity of the sleep-wake cycle with increased number of wakings at night was notable during about 1 month after delivery, compared to the late pregnancy period, and subsequently this number tended to decrease. These results were indicative of the association between the lactation cycle to neonates and the sleep-wake cycle.

Poor recovery sleep after sleep deprivation in delayed sleep phase syndrome.

To clarify disturbances in sleep regulation in patients with delayed sleep phase syndrome (DSPS), we studied three patients with DSPS and seven healthy controls. Sleep propensity and melatonin rhythms after 24-h sleep deprivation were investigated under dim light condition by using the ultra-short sleep-wake schedule. The sleep propensity curves displayed clear differences between DSPS patients and the controls. During the subjective day when melatonin was not produced, recovery sleep after the sleep deprivation did not occur in DSPS patients, while recovery sleep occurred during the subjective day in controls. This suggests that DSPS may involve problems related to the homeostatic regulation of sleep after sleep deprivation.

Effects of sleep deprivation: the phosphorus metabolism in the human brain measured by 31P-magnetic resonance spectroscopy.

Sleep deprivation (SD) has an antidepressant effect in some, but not all, patients with depression, although its biological mechanisms have not yet been characterized. We previously reported altered brain phosphorus metabolism measured by phosphorus-31 magnetic resonance spectroscopy (31P-MRS) in patients with bipolar depression. We preliminarily examined effects of SD on phosphorus metabolism in the frontal lobes of 15 normal subjects using 31P-MRS. No significant differences of membrane phospholipid metabolism, high-energy phosphate metabolism and intracellular pH were found between before and after SD in these subjects. Further studies will be necessary to elucidate the physiological mechanism of SD for depressive patients.

Correlation between the circadian sleep propensity rhythm and hormonal rhythms under ultra-short sleep-wake cycle.

The aim of this study was to clarify effects of hormonal and temperature rhythms on circadian fluctuations of sleep propensity. Ten healthy females underwent 24-h sleep deprivation and entered the circadian sleep propensity assessment setting under the ultra-short sleep-wake schedule. During the experiment, sleep propensity rhythm, rectal temperature, and 24-h serum hormone profiles (melatonin, cortisol and thyroid-stimulating hormone) were investigated. The circadian sleep propensity rhythms had two apparent peaks (afternoon and nocturnal peaks) and a trough (nocturnal sleep gate). The timings of the nocturnal sleep gate and the nocturnal peak were correlated exclusively with temperature and melatonin rhythms (P < 0.05), while that of the afternoon peak was significantly correlated with habitual wake time and melatonin rhythm. These results indicate that the circadian sleep propensity rhythm is influenced not only by the circadian pacemaker, but also by sleep habit.

Control of REM sleep: an aspect of the regulation of physiological homeostasis.

Since REM sleep is characterized by a suspension of the hypothalamic integration of homeostatic regulations, it has been assumed that the duration of both REM sleep episodes and of the time interval between the end of one episode and the beginning of the following episode may be regulated according to sleep related processes and the homeostatic needs of the organism. A series of studies performed on the rat has shown that REM sleep episodes occur as two basic types: single REM sleep episodes, that are separated by intervals > 3 min and sequential episodes, that are separated by intervals < or = 3 min and appear in a cluster. Moreover, it has been observed that, in this species, a change in REM sleep occurrence is caused by a modification in the number of episodes and not in their duration. With respect to this, sleep deprivation and recovery are characterized by a decrease and an increase, respectively, in the number of sequential REM sleep episodes, but the number of single episodes tends to be kept constant. The central aspects of this kind of regulation have been examined biochemically in the preoptic-anterior hypothalamus, an area involved in the control of autonomic and sleep related processes. The results show that the accumulation of adenosine 3':5'-cyclic monophosphate (cAMP) is impaired, in this region, during sleep deprivation and appears to return to the control levels, during the recovery, with a rate inversely related to the degree of the previous deprivation. Moreover, it has been observed that the systemic administration of DL-propranolol and LiCl reduces cAMP accumulation mainly in the preoptic-anterior hypothalamus; this condition is concomitant with a reduction in REM sleep occurrence.

Prion protein: a role in sleep regulation?

The prion protein (PrP) is a glycoprotein anchored to cell membranes and expressed in most cell types. Its structural features indicate possible relations to signal peptidases (Glockshuber et al. 1998). Since mutations in this protein lead to severe neurodegeneration and death in humans and animals, it is possible that the loss of its normal function contributes to the development of the pathology. Little is known about its normal function, but there are indications that it may play a role in circadian rhythm and sleep regulation in mice. We explored further whether PrP plays a role in sleep regulation by comparing sleep and the effects of 6 h sleep deprivation in PrP knockout mice and isogenic wild-type mice of the 129/Ola strain. The mice did not differ in the amount and distribution of the vigilance states or in the power spectra. The most remarkable difference was the larger and long-lasting increase of slow-wave activity (mean EEG power density 0.75-4.0 Hz) in non-rapid-eye-movement (NREM) sleep during recovery from sleep deprivation in the null mice. The results confirm our previous findings in mice with a mixed background. This observation applies also to slow-wave activity in NREM sleep episodes following spontaneous waking bouts of different duration. Sleep fragmentation in both genotypes was larger than in mice with the mixed background. A new aspect was revealed by the spectral analysis of the EEG, where the null mice had a lower peak frequency within the theta band in REM sleep and waking, and not in NREM sleep. Behavioural observations concomitant with the EEG indicated that the EEG difference in waking may be attributed to the smaller amount of exploratory behaviour in the null mice. The difference between the genotypes in theta peak frequency was not an overall effect on the EEG, since it was absent in NREM sleep. PrP therefore may be affecting the theta-generating mechanisms in the hippocampus during waking and REM sleep. It remains unresolved whether PrP plays a role in sleep consolidation, nevertheless the data suggest that it is involved in sleep regulation. A passive avoidance test showed a difference between the genotypes. It is not probable that this was due to memory differences, since the genotypes reacted similarly in a delayed T-maze alternation procedure. The behavioural differences need to be pursued further.

Differences in brain gene expression between sleep and waking as revealed by mRNA differential display and cDNA microarray technology.

The consequences of sleep and sleep deprivation at the molecular level are largely unexplored. Knowledge of such molecular events is essential to understand the restorative processes occurring during sleep as well as the cellular mechanisms of sleep regulation. Here we review the available data about changes in neural gene expression across different behavioural states using candidate gene approaches such as in situ hybridization and immunocytochemistry. We then describe new techniques for systematic screening of gene expression in the brain, such as subtractive hybridization, mRNA differential display, and cDNA microarray technology, outlining advantages and disadvantages of these methods. Finally, we summarize our initial results of a systematic screening of gene expression in the rat brain across behavioural states using mRNA differential display and cDNA microarray technology. The expression pattern of approximately 7000 genes was analysed in the cerebral cortex of rats after 3 h of spontaneous sleep, 3 h of spontaneous waking, or 3 h of sleep deprivation. While the majority of transcripts were expressed at the same level among these three conditions, 14 mRNAs were modulated by sleep and waking. Six transcripts, four more expressed in waking and two more expressed in sleep, corresponded to novel genes. The eight known transcripts were all expressed at higher levels in waking than in sleep and included transcription factors and mitochondrial genes. A possible role for these known transcripts in mediating neural plasticity during waking is discussed.

Comparison of MK-801 and sleep deprivation effects on NREM, REM, and waking spectra in the rat.

In previous studies, we showed that blockade of the cation channel gated by NMDA glutamate receptors with ketamine or MK-801 massively stimulates NREM delta. We now test whether this NREM delta stimulation is physiological by comparing the EEG response following MK-801 to the EEG response following sleep deprivation (SD). Our previous studies measured only NREM 1-4 Hz EEG with period-amplitude analysis (PAA). Here we extended the analysis of MK-801 effects on sleep EEG by applying power spectral analysis (PSA) to examine delta and higher frequency spectra (.2-100 Hz) in NREM and by including REM and waking spectra. The changes in EEG spectra following MK-801 and SD were remarkably similar. Both SD and MK-801 produced their largest changes in NREM delta and REM 10-20 Hz power. There were some differences in the high frequency EEG, but the overall similarity of the PSA spectra in all three vigilance states after MK-801 and SD supports the possibility that MK-801 stimulated physiologic sleep, perhaps by increasing the need for homeostatic recovery from the metabolic effects of NMDA channel blockade.

Long distance driving and self-induced sleep deprivation among automobile drivers.

OBJECTIVE: To evaluate the sleep hygiene and prevalence of sleep deprivation among a large sample of automobile drivers. DESIGN: From the 15th of June to the 4th of August 1996, with the help of the French highway patrol, we randomly stopped automobile drivers at the toll booths of Bordeaux and Biarritz. All subjects completed a validated questionnaire on sleep/wake habits during the year. After answering the questionnaire, subjects completed a graphic travel and sleep log of the three days preceding the interview. PARTICIPANTS: We randomly stopped 2196 automobile drivers. Ninety-one percent of the sample (mean age 43 +/- 13 years) agreed to participate in the survey. RESULTS: Fifty percent of the drivers decreased their total sleep time in the 24 hours before the interview compared with their regular self-reported sleep time. 12.5% presented a sleep debt > 180 minutes, and 2.7% presented a sleep debt > 300 minutes. Being young, commuting to work, driving long distances, starting the trip at night, being an "evening" person, being a long sleeper during the week, and sleeping in on the week-end were risk factors significantly associated with sleep debt. CONCLUSION: The results of the study highlight variables (long-distance driving, youth, sleep restriction) that are frequently associated with sleep-related accidents.

Regional differences in the dynamics of the cortical EEG in the rat after sleep deprivation.

OBJECTIVE: To investigate regional changes of the cortical sleep EEG in the rat, recordings were obtained from a frontal and an occipital derivation, on a baseline day (n = 14 male rats, Sprague-Dawley strain) and after 24 h sleep deprivation (SD, n = 7). METHODS: Spectral analysis of the vigilance states revealed state and frequency specific differences in EEG power by two-way ANOVA and post-hoc t tests. RESULTS: In the theta band (6.25-9.0 Hz) occipital power was larger than frontal power in waking and REM sleep, whereas frontal power was larger in the frequency range between 10.25-16.0 Hz in non-REM sleep and REM sleep. After SD frontal power in the 2-4 Hz band in non-REM sleep was increased more than occipital power and frontal power in the 10.25-16.0 Hz range was more attenuated. In REM sleep frontal power in the theta band and in the 10.25-16.0 Hz range was more increased than occipital power. Power in the waking EEG did not differ between the two derivations after SD. CONCLUSIONS: The differential responses to SD may reflect regional use-dependent aspects of sleep regulation. These observations support the notion that sleep is not only a global phenomenon but has also local, use-dependent features.

Periodicity of a noninvasive measure of cardiac vagal tone during non-rapid eye movement sleep in non-sleep deprived and sleep-deprived normal subjects.

Cyclic alternating pattern (CAP) of microarousals reported in EEG studies is now regarded as an integrating mechanism for the different parts of the central nervous system including the autonomic system. A recently developed continuous index of cardiac parasympathetic activity (CIPA) can be time locked to the EEG allowing the relationship between EEG and autonomic changes to be studied in sleep. Eleven normal subjects were studied for evidence of periodicity in CIPA in non-REM sleep, five of whom had been sleep deprived. Fast Fourier's transformation of the CIPA data confirmed its periodicity with four frequency peaks in the range of 0.015 to 0.3 Hz. The frequency peaks previously reported as caused by respiration, Mayer waves and vasomotor thermoregulatory activity, were within what we called the alpha and beta rhythms of CIPA. There was an additional very slow peak not previously described and we called it the gamma rhythm. It covered the frequency range below 0.03 Hz. The gamma rhythm was the largest of all peaks in CIPA rhythms and its magnitude increased further in sleep-deprived subjects, but it invariably decreased during stage 4 sleep in both groups. Bursts of alpha waves in the EEG recorded concomitantly with CIPA in stage 1 sleep were associated with both peaks and troughs of the gamma rhythm. These results support previous proposals that cyclic alternating pattern in the EEG may be an integrating mechanism associated with functions of the central nervous system, and we have shown here its relationship with CIPA. Because cyclic alternating pattern can also be measured in CIPA, clinical exploitation of this phenomenon could include monitoring of epilepsy, studies of the effects of drug therapy, and assessment of other sleep disorders. All these are known to affect cyclic patterns of sleep EEG.

The moon and madness reconsidered.

Belief that the full moon is associated with psychiatric disturbance persists despite 50 years research showing no association. This article traces the historical roots of belief in the power of the moon to cause disorders the mind, especially insanity and epilepsy. Putative mechanisms of lunar action are critiqued. It is proposed that modern findings showing lack of lunar effect can be reconciled with pre-modern beliefs in the moon's power through a mechanism of sleep deprivation. Prior to the advent of modern lighting the moon was a significant source of nocturnal illumination that affected sleep-wake cycle, tending to cause sleep deprivation around the time of full moon. This partial sleep deprivation would have been sufficient to induce mania/hypomania in susceptible bipolar patients and seizures in patients with seizure disorders. The advent of modern lighting attenuated this lunar effect, especially in modern urban areas, where most 20th century studies of lunar effects on the mind have been conducted. The hypothesis presented in this article is open to empirical validation or falsification. Potential tests for the sleep-deprivation hypothesis of lunar action are discussed.

Effects of sleep and sleep deprivation on catecholamine and interleukin-2 levels in humans: clinical implications.

The objective of this study was to evaluate the effects of nocturnal sleep, partial night sleep deprivation, and sleep stages on catecholamine and interleukin-2 (IL-2) levels in humans. Circulating levels of catecholamines and IL-2 were sampled every 30 min during 2 nights: undisturbed, baseline sleep and partial sleep deprivation-late night (PSD-L; awake from 0300-0600 h) in 17 healthy male volunteers. Sleep was monitored somnopolygraphically. Sleep onset was associated with a significant (P < 0.05) decline of circulating concentrations of norepinephrine and epinephrine, with a nocturnal nadir that occurred 1 h after nocturnal sleep. On the PSD-L night, levels of norepinephrine and epinephrine significantly (P < 0.05) increased in association with nocturnal awakening. During stage 3-4 sleep, levels of norepinephrine, but not epinephrine, were significantly lower (P < 0.05) compared to average levels during the awake period, stages 1-2 sleep, and rapid eye movement sleep. Nocturnal levels of circulating IL-2 did not change with sleep onset or in relation to PSD-L or the various sleep stages. We conclude that sleep onset is associated with changes in levels of circulating catecholamines. Loss of sleep and disordered sleep with decreases in slow wave sleep may serve to elevate nocturnal catecholamine levels and contribute to cardiovascular disease.

Impairment of driving performance caused by sleep deprivation or alcohol: a comparative study.

A study was conducted to assess the relative impact of partial sleep deprivation (restriction to 4 h sleep before testing) and full sleep deprivation (no sleep on the night before testing) on 2 h of simulated driving, compared with an alcohol treatment (mean blood alcohol content = 0.07%). Data were collected from the 64 male participants on the primary driving task, psychophysiology (0.1 Hz heart rate variability), and subjective self-assessment. The results revealed that the full sleep deprivation and alcohol group exhibited a safety-critical decline in lane-keeping performance. The partial sleep deprivation group exhibited only noncritical alterations in primary task performance. Both sleep-deprived groups were characterized by subjective discomfort and an awareness of reduced performance capability. These subjective symptoms were not perceived by the alcohol group. The findings are discussed with reference to the development of systems for the online diagnosis of driver fatigue. Potential applications of this research include the formulation of performance criteria to be encompassed within a driver impairment monitoring system.

Galanin has REM-sleep deprivation-like effects on the sleep EEG in healthy young men.

Rapid eye movement (REM) sleep deprivation leads to an induction of galanin gene expression in the rat brain, especially in the hypothalamus. Galanin affects neuroendocrine systems that are involved in sleep regulation, i.e. the growth hormone-releasing hormone-dependent system of the hypothalamus and the locus coeruleus. In the study reported here we investigated the effects of 4 x 50 microg galanin (n = 10) and of 4 x 150 microg galanin (n = 8) administered hourly between 22.00 and 01.00 h as intravenous boluses on the sleep EEG and nocturnal hormone secretion in healthy young men. Galanin administration significantly increased REM sleep in the third sleep cycle with no difference between the two doses. Spectral analysis revealed a significant increase in the EEG power in the delta and theta frequency range for the total night after the lower dose of galanin, but not after the higher dose. The secretion of growth hormone, cortisol and prolactin remained unchanged during sleep in both cases. Our data are consistent with the assumption of a functional resemblance between the effect of galanin and that of REM sleep deprivation, which is known to have antidepressive efficacy.

Causes of ICU psychosis: the environmental factors.

ICU psychosis is common amongst patients admitted to critical care settings. ICU psychosis is the result of a complex interaction between physiological and psychological factors. Environmental factors will contribute to ICU psychosis (including sleep deprivation, excessive noise, separation, poor communication and immobilisation). These environmental factors can be manipulated to reduce the incidence of ICU psychosis.