Anastasi Kosmadopoulos

Simulated driving under the influence of extended wake, time of day and sleep restriction.

Around a fifth of all road accidents can be attributed to fatigued drivers. Previous studies indicate that driving performance is influenced by time of day and decreases with sustained wakefulness. However, these influences occur naturally in unison, confounding their effects. Typically, when people drive at a poor time of day and with extended wake, their sleep is also restricted. Hence, the aim of the current study was to determine the independent effects of prior wake and time of day on driving performance under conditions of sleep restriction. The driving performance of fourteen male participants (21.8 ± 3.8 years, mean ± SD) was assessed during a 10 min simulated driving task with speed/lane mean, variability and violations (speeding and crashes) measured. Participants were tested at 2.5h intervals after waking, across 7 × 28 h days with a sleep:wake ratio of 1:5. By forced desynchrony each driving session occurred at 9 doses of prior wake and within 6 divisions of the circadian cycle based on core body temperature. A mixed models ANOVA revealed significant main effects of circadian phase, prior wake and sleep debt on lane violations. In addition, three significant two-way interactions (circadian phase × prior wake, prior wake × sleep debt, sleep debt × circadian phase) and one three-way interaction (circadian × prior wake × sleep debt) were identified. The presence of the large interaction effects shows that the influence of each factor is largely dependent on the magnitude of the other factors. For example, the presence of the time of day influence on driving performance is dependent on the length of prior wake or the presence of sleep debt. The findings suggest that people are able to undertake a low-difficulty simulated drive safely, at least for a short period, during their circadian nadir provided that they have had sufficient sleep and have not been awake too long.

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

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

The efficacy of objective and subjective predictors of driving performance during sleep restriction and circadian misalignment.

Fatigue is a significant contributor to motor-vehicle accidents and fatalities. Shift workers are particularly susceptible to fatigue-related risks as they are often sleep-restricted and required to commute around the clock. Simple assays of performance could provide useful indications of risk in fatigue management, but their effectiveness may be influenced by changes in their sensitivity to sleep loss across the day. The aim of this study was to evaluate the sensitivity of several neurobehavioral and subjective tasks to sleep restriction (SR) at different circadian phases and their efficacy as predictors of performance during a simulated driving task. Thirty-two volunteers (M±SD; 22.8±2.9 years) were time-isolated for 13-days and participated in one of two 14-h forced desynchrony protocols with sleep opportunities equivalent to 8h/24h (control) or 4h/24h (SR). At regular intervals during wake periods, participants completed a simulated driving task, several neurobehavioral tasks, including the psychomotor vigilance task (PVT), and subjective ratings, including a self-assessment measure of ability to perform. Scores transformed into standardized units relative to baseline were folded into circadian phase bins based on core body temperature. Sleep dose and circadian phase effect sizes were derived via mixed models analyses. Predictors of driving were identified with regressions. Performance was most sensitive to sleep restriction around the circadian nadir. The effects of sleep restriction around the circadian nadir were larger for simulated driving and neurobehavioral tasks than for subjective ratings. Tasks did not significantly predict driving performance during the control condition or around the acrophase during the SR condition. The PVT and self-assessed ability were the best predictors of simulated driving across circadian phases during SR. These results show that simple performance measures and self-monitoring explain a large proportion of the variance in driving when fatigue-risk is high.

Using interstimulus interval to maximise sensitivity of the Psychomotor Vigilance Test to fatigue.

There is some evidence that short interstimulus intervals (ISIs) on the Psychomotor Vigilance Test (PVT) are associated with longer and more varied reaction times (RTs). Preparation processes may impede RT following short ISIs, resulting in additional unexplained variance. The aims of this study were to investigate whether there is an effect of ISI on RT and errors within the PVT, and whether such an effect changes with three elements of fatigue: time of day, prior wake and time on task. Twelve male participants completed 49 PVTs across 7× 28h periods of forced desynchrony. For analysis, RTs, reciprocal reaction times (1/RT), false starts and lapse responses within each 10min session were assigned to a 1-s ISI group, a 2-min time of task group, a 2.5-h PW level and a 60° phase of the circadian rhythm of core body temperature (as a measure of time of day). Responses following short ISIs (2-5s) were significantly slower and more varied than responses following longer ISIs (5-10s). The likelihood of a lapse was also higher for short ISIs, while the probability of a false start increased as a function of ISI. These effects were independent of the influences of time of day, prior wake and time on task. Hence, mixed model ANOVAs comprising only long ISIs (5-10s) contained stronger effect sizes for fatigue than a model of all ISIs (2-10s). Including an ISI variable in a model improved the model fit and explained more variance associated with fatigue. Short ISIs resulted in long RTs both in the presence and absence of fatigue, possibly due to preparation processes or ISI conditioning. Hence, omitting short ISI trials from RT means or including an ISI variable in analysis can reduce unwanted variance in PVT data, improving the sensitivity of the PVT to fatigue.

Are two halves better than one whole? A comparison of the amount and quality of sleep obtained by healthy adult males living on split and consolidated sleep-wake schedules

The aim of this study was to compare the quantity/quality of sleep obtained by people living on split and consolidated sleep-wake schedules. The study had a between-groups design, with 13 participants in a consolidated condition (all males, mean age of 22.5yr) and 16 participants in a split condition (all males, mean age of 22.6yr). Both conditions employed forced desynchrony protocols with the activity:rest ratio set at 2:1, but the consolidated condition had one sleep-wake cycle every 28h (9.33+18.67), while the split condition had one sleep-wake cycle every 14h (4.67+9.33). Sleep was assessed using polysomnography. Participants in the split and consolidated conditions obtained 4.0h of sleep per 14h and 7.6h of sleep per 28h, respectively. Some differences between the groups indicated that sleep quality was lower in the split condition than the consolidated condition: the split sleeps had longer sleep onset latency (9.7 vs. 4.3min), more arousals (7.4 vs. 5.7 per hour in bed), and a greater percentage of stage 1 sleep (4.1% vs. 3.1%), than the consolidated sleeps. Other differences between the groups indicated that sleep quality was higher in the split condition than the consolidated condition: the split sleeps had a lower percentage of wake after sleep onset sleep (11.7% vs. 17.6%), and a greater percentage of slow wave sleep (30.2% vs. 23.8%), than the consolidated sleeps. These results indicate that the split schedule was not particularly harmful, and may have actually been beneficial, to sleep. Split work-rest schedules can be socially disruptive, but their use may be warranted in work settings where shiftworkers are separated from their normal family/social lives (e.g., fly-in fly-out mining) or where the need for family/social time is secondary to the task (e.g., emergency response to natural disasters).

Do split sleep/wake schedules reduce or increase sleepiness for continuous operations?

This study compared the impact of split and consolidated sleep/wake schedules on subjective sleepiness during the biological day and biological night. This was achieved using a between-group design involving two forced desynchrony protocols: consolidated sleep/wake and split sleep/wake. Both protocols included 7×28-h days with 9.33h in bed and 18.67h of wake each day. While the consolidated sleep/wake protocol had 1×9.33-h sleep opportunity and 1×18.67-h wake period each day, the split sleep/wake protocol had 2×4.67-h sleep opportunities and 2×9.33-h wake periods each day. For both protocols, subjective sleepiness was measured using the Karolinska Sleepiness Scale every 2.5h during wake. A total of 29 healthy adult males participated, with 13 in the consolidated sleep/wake group (mean age=22.5 yrs) and 16 in the split sleep/wake group (mean age=22.6 yrs). On average, subjective sleepiness during wake periods of the split condition was significantly higher than that during the first half of wake periods of the consolidated condition, but was similar to the level during the second half. These findings were observed for wake periods that occurred during both the biological day and biological night. Previous data have shown that cognitive impairment at night is lower for split schedules than consolidated schedules, but the current data indicate that feelings of sleepiness are greater for split schedules than consolidated schedules for at least half of the time awake. Thus, it should be explained to people operating split sleep/wake schedules that although they may perform well, they are likely to feel sleepy.

Is it on? An algorithm for discerning wrist-accelerometer non-wear times from sleep/wake activity

ABSTRACT The accuracy of sleep/wake estimates derived with actigraphy is often dependent on researchers being able to discern non-wear times from sleep or quiescent wakefulness when confronted by discrepancies in a sleep log. Without knowing when an accelerometer is being worn, non-wear could be inferred from periods of inactivity unlikely to occur while in bed. Data collected in our laboratory suggest that more than 50% of inactive periods during time in bed are <8 min in duration. This duration may be an appropriate minimum threshold for routine non-wear classification during self-reported wake. Higher thresholds could be chosen to derive non-wear definitions for self-reported bedtimes depending on the desired level of certainty. To determine non-wear at thresholds of 75%, 95% and 99%, for example, would require periods of inactivity lasting ≥18 min, ≥53 min and ≥85 min, respectively.