To determine whether a cumulative sleep debt (in a range commonly experienced) would result in cumulative changes in measures of waking neurobehavioral alertness, 16 healthy young adults had their sleep restricted 33% below habitual sleep duration, to an average 4.98 hours per night [standard deviation (SD) = 0.57] for seven consecutive nights. Subjects slept in the laboratory, and sleep and waking were monitored by staff and actigraphy. Three times each day (1000, 1600, and 2200 hours) subjects were assessed for subjective sleepiness (SSS) and mood (POMS) and were evaluated on a brief performance battery that included psychomotor vigilance (PVT), probed memory (PRM), and serial-addition testing, Once each day they completed a series of visual analog scales (VAS) and reported sleepiness and somatic and cognitive/emotional problems. Sleep restriction resulted in statistically robust cumulative effects on waking functions. SSS ratings, subscale scores for fatigue, confusion, tension, and total mood disturbance from the POMS and VAS ratings of mental exhaustion and stress were evaluated across days of restricted sleep (p = 0.009 to p = 0.0001). PVT performance parameters, including the frequency and duration of lapses, were also significantly increased by restriction (p = 0.018 to p = 0.0001). Significant time-of-day effects were evident in SSS and PVT data, but time-of-day did not interact with the effects of sleep restriction across days. The temporal profiles of cumulative changes in neurobehavioral measures of alertness as a function of sleep restriction were generally consistent. Subjective changes tended to precede performance changes by 1 day, but overall changes in both classes of measure were greatest during the first 2 days (P1, P2) and last 2 days (P6, P7) of sleep restriction. Data from subsets of subjects also showed: 1) that significant decreases in the MSLT occurred during sleep restriction, 2) that the elevated sleepiness and performance deficits continued beyond day 7 of restriction, and 3) that recovery from these deficits appeared to require two full nights of sleep. The cumulative increase in performance lapses across days of sleep restriction correlated closely with MSLT results (r = -0.95) from an earlier comparable experiment by Carskadon and Dement (1). These findings suggest that cumulative nocturnal sleep debt had a dynamic and escalating analog in cumulative daytime sleepiness and that asymptotic or steady-state sleepiness was not achieved in response to sleep restriction.

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Cumulative sleepiness, mood disturbance, and psychomotor vigilance performance decrements during a week of sleep restricted to 4-5 hours per night

A MUCH debated question is whether sex differences exist in the functional organization of the brain for language1–4. A long-held hypothesis posits that language functions are more likely to be highly lateralized in males and to be represented in both cerebral hemispheres in females5,6, but attempts to demonstrate this have been inconclusive7–17. Here we use echo-planar functional magnetic resonance imaging18–21 to study 38 right-handed subjects (19 males and 19 females) during orthographic (letter recognition), phonological (rhyme) and semantic (semantic category) tasks. During phonological tasks, brain activation in males is lateralized to the left inferior frontal gyrus regions; in females the pattern of activation is very different, engaging more diffuse neural systems that involve both the left and right inferior frontal gyrus. Our data provide clear evidence for a sex difference in the functional organization of the brain for language and indicate that these variations exist at the level of phonological processing.

Sex differences in the functional organization of the brain for language

Collection of exhaled breath condensate (EBC) is a noninvasive method for obtaining samples from the lungs. EBC contains large number of mediators including adenosine, ammonia, hydrogen peroxide, isoprostanes, leukotrienes, nitrogen oxides, peptides and cytokines. Concentrations of these mediators are influenced by lung diseases and modulated by therapeutic interventions. Similarly EBC pH also changes in respiratory diseases. The aim of the American Thoracic Society/European Respiratory Society Task Force on EBC was to identify the important methodological issues surrounding EBC collection and assay, to provide recommendations for the measurements and to highlight areas where further research is required. Based on the currently available evidence and the consensus of the expert panel for EBC collection, the following general recommendations were put together for oral sample collection: collect during tidal breathing using a noseclip and a saliva trap; define cooling temperature and collection time (10 min is generally sufficient to obtain 1-2 mL of sample and well tolerated by patients); use inert material for condenser; do not use resistor and do not use filter between the subject and the condenser. These are only general recommendations and certain circumstances may dictate variation from them. Important areas for future research involve: ascertaining mechanisms and site of exhaled breath condensate particle formation; determination of dilution markers; improving reproducibility; employment of EBC in longitudinal studies; and determining the utility of exhaled breath condensate measures for the management of individual patients. These studies are required before recommending this technique for use in clinical practice.

https://erj.ersjournals.com/content/erj/26/3/523.full.pdf

Exhaled breath condensate: methodological recommendations and unresolved questions

Statistical Methods in Medical Research.

Daytime Sleepiness, Snoring, and Obstructive Sleep Apnea: The Epworth Sleepiness Scale

Studies consistently show that total sleep deprivation (TSD) and measures of performance are negatively correlated. However, an accurate quantitative summary of the relationship between these variables has not yet been reported. After collection of the data from 27 relevant studies, meta-analytic techniques were used to test several hypotheses. The correlations were found to be highest for TSD of greater than or equal to 45 h, speed rather than accuracy measures of performance, and work-paced rather than self-paced tasks. These findings are consistent with the "lapse hypothesis" that posits microsleeps during long hours of sleep deprivation.

Meta-analysis of the relationship between total sleep deprivation and performance

Computerized self-report sleepiness scales were administered before and after cognitive testing in a 72-hour sleep deprivation study. The cognitive test battery was administered every 2 hours and took approximately 1-1.25 hours. Two computerized measures of subjective sleepiness were used, one a visual analog scale, the other a Hebrew version of the Stanford sleepiness scale. The results indicated that both accumulated sleep loss, circadian and ultradian (2 cycles/day) factors were significant in determining subjective estimates of sleepiness. The extent of the differences between subjective sleepiness ratings before cognitive testing and after testing was dependent upon the phase of the circadian cycle. These differences were greatest at approximately 0200-0600 hours and least around 1000 hours. A second low point occurred at 1800-2000 hours. Analysis by complex demodulation of the individual subjects' sleepiness rating curves indicated that the amount of variance accounted for by the circadian component increased significantly after cognitive testing.

Subjective sleepiness ratings: the effects of sleep deprivation, circadian rhythmicity and cognitive performance.

Sleep inertia is a brief period of inferior task performance and/or disorientation immediately after sudden awakening from sleep. Normally sleep inertia lasts < 5 min and has no serious impact on conducting routine jobs. This preliminary study examined whether there are best and worst times to wake up stemming from circadian effects on sleep inertia. Since the process of falling asleep is strongly influenced by circadian time, the reverse process of awakening could be similarly affected. A group of nine subjects stayed awake for a 64-h continuous work period, except for 20-min sleep periods (naps) every 6 h. Another group of 10 subjects stayed awake for 64 h without any sleep. The differences between these two groups in performance degradation are expected to show sleep inertia on the background of sleep deprivation. Sleep inertia was measured with Baddeley's logical reasoning task, which started within 1 min of awakening and lasted for 5 min. There appeared to be no specific circadian time when sleep inertia is either maximal or minimal. An extreme form of sleep inertia was observed, when the process of waking up during the period of the circadian body temperature trough became so traumatic that it created "sleep (nap) aversion." The findings lead to the conclusion that there are no advantages realized on sleep inertia by waking up from sleep at specific times of day.

Sleep Inertia: Best Time Not to Wake Up?

A study was conducted on the effects of 72 hours of sleep loss and modified continuous operations on performance and psychological variables. This paper presents the results of self-report data of 12 subjects for the following psychological variables: sleepiness, affect, motivation, cognitive difficulties, and waking dreams. The relationship between the self-report measures and performance in a visual search and memory task is also examined. Most of the psychological variables are significantly affected by the number of days of sleep deprivation, all are significantly affected by hour of day; but only sleepiness, affect and motivation are also significantly affected by the interaction between these variables. The peak hours for self-reported psychological complaints are generally between 0400 and 0800, while the lowest number of complaints are usually reported in the afternoon/early evening, between 1600 and 2000. In addition, the results showed that (a) the amplitude of the circadian component of the psychological data increased over the period of sleep loss, and (b) psychological data were more highly correlated with a measure of general performance than with accuracy. The mechanisms of sleep deprivation underlying its effects on psychological and performance measures are discussed.

The effects of 72 hours of sleep loss on psychological variables.

Three levels of working memory load of a visual search (Memory and Search) task were tested in a 72-hour sleep deprivation paradigm. General performance and accuracy decrease over time with monoton...

Harvey Babkoff

Papers

Meta-analysis of the relationship between total sleep deprivation and performance

Subjective sleepiness ratings: the effects of sleep deprivation, circadian rhythmicity and cognitive performance.

Sleep Inertia: Best Time Not to Wake Up?

The effects of 72 hours of sleep loss on psychological variables.

The topology of performance curves during 72 hours of sleep loss: A memory and search task