The cumulative cost of additional wakefulness: Dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation
The cumulative cost of additional wakefulness: Dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation
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DOI：
10.1093/sleep/26.2.117
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发表时间：
2003-03-15
期刊：
影响因子：
5.6
通讯作者：
Dinges, DF
中科院分区：
文献类型：
--
作者：
Van Dongen, HPA;Maislin, G;Dinges, DF
目的：为了告知关于人类睡眠是否可以长期减少而不产生后果的争论，我们进行了一项剂量反应慢性睡眠限制实验，在该实验中监测了清醒时的神经行为和睡眠生理功能，并与完全睡眠剥夺进行了比较。设计：慢性睡眠限制实验包括随机分为三种睡眠剂量（每晚卧床4 h、6 h或8 h），连续14 d。总睡眠剥夺实验包括3个晚上不睡觉（在床上的时间为0小时）。每项研究还涉及3个基线设置：两项实验均在标准化实验室条件下进行，并进行连续的行为、生理和医学监测。干预措施：夜间睡眠时间限制为每天8 h、6 h或4 h，持续14 d，或0 h，持续3 d。所有其他sleeps.Results：慢性限制睡眠时间为4小时或6小时，每晚超过连续14天导致显着的累积，剂量依赖性的赤字在所有任务的认知性能。主观嗜睡评级显示出对睡眠限制的急性反应，但在随后的几天里只有小的进一步增加，并且没有显着区分6小时和4小时的条件。多导睡眠图变量和非快速眼动睡眠脑电图（睡眠稳态的假定标志物）中的δ功率显示了对睡眠限制的急性反应，在14个限制的夜晚中，进一步的变化可以忽略不计。长期睡眠限制与完全睡眠剥夺的比较表明，后者导致了与睡眠损失量相关的不成比例的清醒神经行为和睡眠δ功率反应。一个统计模型显示，无论睡眠剥夺的模式如何，行为警觉性的丧失与超过15.84小时的累积清醒时间（s.e.）几乎呈线性相关。0.73 h）.结论：由于长期限制睡眠至每晚6小时或更少所产生的认知能力缺陷相当于两个晚上的完全睡眠剥夺，因此即使相对适度的睡眠限制也会严重损害健康成年人的清醒神经行为功能。嗜睡评级表明，受试者在很大程度上没有意识到这些不断增加的认知缺陷，这可能解释了为什么长期睡眠限制对清醒认知功能的影响通常被认为是良性的。对慢性限制的生理睡眠反应并不反映清醒时的神经行为反应，但超过15.84小时的累积觉醒预测了所有四种实验条件下的表现失误，这表明睡眠债可能最好理解为导致额外的觉醒，其具有随时间积累的神经生物学“成本”。
Objectives: To inform the debate over whether human sleep can be chronically reduced without consequences, we conducted a dose-response chronic sleep restriction experiment in which waking neurobehavioral and sleep physiological functions were monitored and compared to those for total sleep deprivation.Design: The chronic sleep restriction experiment involved randomization to one of three sleep doses (4 h, 6 h, or 8 h time in bed per night), which were maintained for 14 consecutive days. The total sleep deprivation experiment involved 3 nights without sleep (0 h time in bed). Each study also involved 3 baseline (pre-deprivation) days and 3 recovery days.Setting: Both experiments were conducted under standardized laboratory conditions with continuous behavioral, physiological and medical monitoring.Participants: A total of n = 48 healthy adults (ages 21-38) participated in the experiments.Interventions: Nocturnal sleep periods were restricted to 8 h, 6 h or 4 h per day for 14 days, or to 0 h for 3 days. All other sleep was prohibited.Results: Chronic restriction of sleep periods to 4 h or 6 h per night over 14 consecutive days resulted in significant cumulative, dose-dependent deficits in cognitive performance on all tasks. Subjective sleepiness ratings showed an acute response to sleep restriction but only small further increases on subsequent days, and did not significantly differentiate the 6 h and 4 h conditions. Polysomnographic variables and delta power in the non-REM sleep EEG-a putative marker of sleep homeostasis-displayed an acute response to sleep restriction with negligible further changes across the 14 restricted nights. Comparison of chronic sleep restriction to total sleep deprivation showed that the latter resulted in disproportionately large waking neurobehavioral and sleep delta power responses relative to how much sleep was lost. A statistical model revealed that, regardless of the mode of sleep deprivation, lapses in behavioral alertness were near-linearly related to the cumulative duration of wakefulness in excess of 15.84 h (s.e. 0.73 h).Conclusions: Since chronic restriction of sleep to 6 h or less per night produced cognitive performance deficits equivalent to up to 2 nights of total sleep deprivation, it appears that even relatively moderate sleep restriction can seriously impair waking neurobehavioral functions in healthy adults. Sleepiness ratings suggest that subjects were largely unaware of these increasing cognitive deficits, which may explain why the impact of chronic sleep restriction on waking cognitive functions is often assumed to be benign. Physiological sleep responses to chronic restriction did not mirror waking neurobehavioral responses, but cumulative wakefulness in excess of a 15.84 h predicted performance lapses across all four experimental conditions, This suggests that sleep debt is perhaps best understood as resulting in additional wakefulness that has a neurobiological "cost" which accumulates over time.