Cognitive consequences of sleep and sleep loss

Changes in sleep as a function of adolescent development

Adolescence is marked by dramatic changes in sleep. Older adolescents go to bed later, have an increased preference for evening activities, and sleep less than younger adolescents. This behavior change is driven by external factors, notably increased pressures from academic, social, and extracurricular activities and by biological circadian factors. There are also substantial changes in sleep architecture across adolescence, with dramatic declines in slow wave sleep, and slow wave activity (delta, ~ 0.5-4.5 Hz). These changes are associated with underlying changes in brain structure and organization, with a decrease in synaptic density likely underlying the reduction in high amplitude slow waveforms. While changes in sleep across adolescence are a normal part of development, many adolescents are getting insufficient sleep and are consequently, less likely to perform well at school, more likely to develop mood-related disturbances, be obese, and are at greater risk for traffic accidents, alcohol and drug abuse.

Sleep loss and accidents--work hours, life style, and sleep pathology

A very important outcome of reduced sleep is accidents. The present chapter will attempt to bring together some of the present knowledge in this area. We will focus on the driving situation, for which the evidence of the link between sleep loss and accidents is quite well established, but we will also bring up working life in general where evidence is more sparse. It should be emphasized that reduced sleep as a cause of accidents implies that the mediating factor is sleepiness (or fatigue). This link is discussed elsewhere in this volume, but here we will bring in sleepiness (subjective or physiological) as an explanatory factor of accidents. Another central observation is that many real life accident studies do not link accidents to reduced sleep, but infer reduced sleep and/or sleepiness from the context, like, for example, from work schedules, life styles, or sleep pathology. Reduced sleep is mainly due to suboptimal work schedules (or to a suboptimal life style) or to sleep pathology. We have divided the present chapter into two areas.

Contribution of sedative-hypnotic agents to delirium via modulation of the sleep pathway

Purpose

To review the mechanisms of sedative-hypnotic action with respect to the risk of delirium imparted by drugs that act on γ-amino-butyric-acid type A receptors or α₂ adrenoceptors.

Source

MEDLINE was searched for relevant articles.

Principal findings

Development of the acute confusional state of delirium is associated with longer intensive care unit (ICU) and hospital lengths of stay, significantly higher risk of functional decline, and increased mortality. Disruption of sleep is a modifiable risk factor that may contribute to delirium and cognitive dysfunction in ICU patients. Among the functions of sleep are repair of defective processes and restoration of the brain to a state in which it is ready to acquire new knowledge. It is logical that disruption of these processes may produce acute confusion. Delirium develops through a complex interaction between the patient’s baseline vulnerability (patient’s predisposing risk factors before hospitalization) and precipitating factors or insults (modifiable events that occur during hospitalization). The latter factors include both sleep disruption and sedation. We present a hypothesis that these two factors are causally linked through effects on memory. Our hypothesis explains why patients randomized to receive an α₂ adrenoceptor agonist are less likely to develop delirium (and the attendant cognitive dysfunction) than those randomized to receive benzodiazepines.

Conclusion

Herein we present our hypothesis that alternate mechanisms of hypnotic action may differentiate the deleriogenic properties of the two classes of sedatives. Future studies should focus on whether a causal relationship can be established between sedative administration, sleep disruption, and delirium.

Sleep deprivation impairs contextual fear conditioning and attenuates subsequent behavioural, endocrine and neuronal responses

Sleep deprivation (SD) affects hippocampus-dependent memory formation. Several studies in rodents have shown that brief SD immediately following a mild foot shock impairs consolidation of contextual fear memory as reflected in a reduced behavioural freezing response during re-exposure to the shock context later. In the first part of this study, we examined whether this reduced freezing response is accompanied by an attenuated fear-induced activation of the hypothalamic-pituitary-adrenal (HPA) axis. Results show that 6h of SD immediately following the initial shock results in a diminished adrenal corticosterone (CORT) response upon re-exposure to the shock context the next day. In the second part, we established whether the attenuated freezing response in SD animals is associated with reduced activation of relevant brain areas known to be involved in the retrieval and expression of fear memory. Immunohistochemical analysis of brain slices showed that the normal increase in phosphorylation of the transcription factor 3',5'-cyclic AMP response-element binding protein (CREB) upon re-exposure to the shock context was reduced in SD animals in the CA1 region of the hippocampus and in the amygdala. In conclusion, brief SD impairs the consolidation of contextual fear memory. Upon re-exposure to the context, this is reflected in a diminished behavioural freezing response, an attenuated HPA axis response and a reduction of the normal increase of phosphorylated CREB expression in the hippocampus and amygdala.

Effects of sleep on the postictal state

The postictal state can be particularly confusing when occurring in association with sleep. Some seizures tend to occur predominantly or exclusively during sleep; as the patient may be unaware of the seizure itself, the postictal state may be the only observed manifestation. Seizures and postictal phenomena occurring during sleep can also lead to diagnostic confusion particularly with parasomnias. Confusion or apparent sleepwalking, for example, could be a postictal phenomenon or could be an independent parasomnia. Awareness of the various manifestations of sleep disorders, seizures, and postictal phenomena during sleep is critical to optimal diagnosis and treatment of patients with epilepsy.