Orienting and alerting: effect of 24 h of prolonged wakefulness

Sleep Quality and Aging: A Systematic Review on Healthy Older People, Mild Cognitive Impairment and Alzheimer’s Disease

Aging is characterized by changes in the structure and quality of sleep. When the alterations in sleep become substantial, they can generate or accelerate cognitive decline, even in the absence of overt pathology. In fact, impaired sleep represents one of the earliest symptoms of Alzheimer’s disease (AD). This systematic review aimed to analyze the studies on sleep quality in aging, also considering mild cognitive impairment (MCI) and AD. The review process was conducted according to the PRISMA statement. A total of 71 studies were included, and the whole sample had a mean age that ranged from 58.3 to 93.7 years (62.8–93.7 healthy participants and 61.8–86.7 pathological populations). Of these selected studies, 33 adopt subjective measurements, 31 adopt objective measures, and 10 studies used both. Pathological aging showed a worse impoverishment of sleep than older adults, in both subjective and objective measurements. The most common aspect compromised in AD and MCI were REM sleep, sleep efficiency, sleep latency, and sleep duration. These results underline that sleep alterations are associated with cognitive impairment. In conclusion, the frequency and severity of sleep disturbance appear to follow the evolution of cognitive impairment. The overall results of objective measures seem more consistent than those highlighted by subjective measurements.

Age-Related Changes in Hemispherical Specialization for Attentional Networks

Many cognitive functions face a decline in the healthy elderly. Within the cognitive domains, both attentional processes and executive functions are impaired with aging. Attention includes three attentional networks, i.e., alerting, orienting, and executive control, showing a hemispheric lateralized pattern in adults. This lateralized pattern could play a role in modulating the efficiency of attentional networks. For these reasons, it could be relevant to analyze the age-related change of the hemispheric specialization of attentional networks. This study aims to clarify this aspect with a lateralized version of the Attentional Network Test for Interaction (ANTI)-Fruit. One hundred seventy-one participants took part in this study. They were divided in three age groups: youth (N = 57; range: 20-30); adults (N = 57; range 31-64), and elderly/older people (N = 57; range: 65-87). The results confirmed the previous outcomes on the efficiency and interactions among attentional networks. Moreover, an age-related generalized slowness was evidenced. These findings also support the hypothesis of a hemispheric asymmetry reduction in elderly/older adults.

Assessing the Three Attentional Networks and Vigilance in the Adolescence Stages

Attention involves three functionally and neuroanatomically distinct neural networks: alerting, orienting, and executive control. This study aimed to assess the attentional networks and vigilance in adolescents aged between 10 and 19 years using the attentional network test for interaction and vigilance (ANTI-V). One hundred and eighty-two adolescents divided into three groups (early adolescents, middle adolescents, late adolescents) participated in the study. The results indicate that after age 15, adolescents adopt a more conservative response strategy and increase the monitoring of self-errors. All the attentional networks seem to continue to develop during the age range considered in this study (10–19 y). Performance improved from early adolescence to middle adolescence and began to stabilize in late adolescence. Moreover, a low level of vigilance seems to harm alerting and orienting abilities.

No effect of cold pressor test-induced arousal on attentional benefits and costs in an endogenous spatial orienting paradigm

Previous studies have shown that arousal can influence hemispatial bias, suggesting that changes in arousal affect the neural networks involved in spatial attention control. The goal of the present study was to measure the effects of increased arousal on endogenous attentional orienting. We used a Spatial Orienting Paradigm to quantify attentional benefits and costs as measures of attentional orienting and re-orienting responses and exposed participants (N = 25; Experiment 1) to a bilateral feet Cold Pressor Test (CPT) to manipulate arousal. Increases in subjective distress ratings and blood pressure confirmed the effect of CPT on arousal. Although no overall effects of CPT on reaction times in the Spatial Orienting Paradigm were detected, an exploratory analysis of sex-specific effects revealed a left-lateralised decrease in benefits and increase in costs after CPT exposure in the male subsample (N = 11). To confirm these preliminary results, we repeated the experiment in a larger sample (N = 29, all male), but found no effect of CPT on orienting, with moderate to strong evidence in favour of a model excluding all (interaction) effects of CPT exposure (all BF_Incl < 0.3). Instead, our replicated results indicate that voluntary orienting is unaffected by CPT-induced increases of arousal. In the light of previous studies, and keeping in mind the interpretative challenges of null results, we discuss how and why our findings may be specific to endogenous as opposed to exogenous orienting and how arousal could possibly lead to the previously established effects on visuospatial bias without simultaneously affecting orienting and the underlying attention control networks.

Sleep regulates visual selective attention in Drosophila

Although sleep deprivation is known to impair attention in humans and other mammals, the underlying reasons are not well understood, and whether similar effects are present in non-mammalian species is not known. We therefore sought to investigate whether sleep is important for optimizing attention in an invertebrate species, the genetic model Drosophila melanogaster We developed a high-throughput paradigm to measure visual attention in freely walking Drosophila, using competing foreground/background visual stimuli. We found that whereas sleep-deprived flies could respond normally to either stimulus alone, they were more distracted by background cues in a visual competition task. Other stressful manipulations such as starvation, heat exposure and mechanical stress had no effects on visual attention in this paradigm. In contrast to sleep deprivation, providing additional sleep using the GABA-A agonist 4,5,6,7-tetrahydroisoxazolo-[5,4-c]pyridine-3-ol (THIP) did not affect attention in wild-type flies, but specifically improved attention in the learning mutant dunce Our results reveal a key function of sleep in optimizing attention processes in Drosophila, and establish a behavioral paradigm that can be used to explore the molecular mechanisms involved.

Acute Sleep Restriction Has Differential Effects on Components of Attention

Inadequate nightly sleep duration can impair daytime functioning, including interfering with attentional and other cognitive processes. Current models posit that attention is a complex function regulated by several separate, but interacting, neural systems responsible for vigilance, orienting, and executive control. However, it is not clear to what extent each of these underlying component processes is affected by sleep loss. The purpose of this study was to evaluate the effects of acute sleep restriction on these attentional components using the Dalhousie Computerized Attention Battery (DalCAB). DalCAB tasks were administered to healthy women (aged 19-25 years) on two consecutive mornings: once after a night with 9 h time in bed (TIB), and once again after either another night with 9 h TIB (control condition, n = 19) or after a night with 3 h TIB (sleep restriction condition, n = 20). Self-ratings of sleepiness and mood were also obtained following each sleep condition. Participants showed increases in self-reported sleepiness and fatigue after the second night only in the sleep restriction group. Sleep restriction primarily affected processing speed on tasks measuring vigilance; however, performance deficits were also observed on some measures of executive function (e.g., go/no-go task, flanker task, working memory). Tasks assessing orienting of attention were largely unaffected. These results indicate that acute sleep restriction has differential effects on distinct components of attention, which should be considered in modeling the impacts of sleep loss on the underlying attentional networks.

The Yin and Yang of Sleep and Attention

Sleep is not a single state, but a complex set of brain processes that supports several physiological needs. Sleep deprivation is known to affect attention in many animals, suggesting that a key function of sleep is to regulate attention. Conversely, tasks that require more attention drive sleep need and sleep intensity. Attention involves the ability to filter incoming stimuli based on their relative salience, and this is likely to require coordinated synaptic activity across the brain. This capacity may have only become possible with the evolution of related neural mechanisms that support two key sleep functions: stimulus suppression and synaptic plasticity. We argue here that sleep and attention may have coevolved as brain states that regulate each other.

Inhibition of return, but not facilitation, disappears under vigilance decrease due to sleep deprivation

In this study, we assessed whether unspecific attention processes signaled by general reaction times (RTs), as well as specific facilitatory (validity or facilitation effect) and inhibitory (inhibition of return, IOR) effects involved in the attentional orienting network, are affected by low vigilance due to both circadian factors and sleep deprivation (SD). Eighteen male participants performed a cuing task in which peripheral cues were nonpredictive about the target location and the cue-target interval varied at three levels: 200 ms, 800 ms, and 1,100 ms. Facilitation with the shortest and IOR with the longest cue-target intervals were observed in the baseline session, thus replicating previous related studies. Under SD condition, RTs were generally slower, indicating a reduction in the participants' arousal level. The inclusion of a phasic alerting tone in several trials partially compensated for the reduction in tonic alertness, but not with the longest cue-target interval. With regard to orienting, whereas the facilitation effect due to reflexive shifts of attention was preserved with sleep loss, the IOR was not observed. These results suggest that the decrease of vigilance produced by SD affects both the compensatory effects of phasic alerting and the endogenous component involved in disengaging attention from the cued location, a requisite for the IOR effect being observed.

Effects of sleep loss on emotion recognition: a dissociation between face and word stimuli

Short-term sleep deprivation, or extended wakefulness, adversely affects cognitive functions and behavior. However, scarce research has addressed the effects of sleep deprivation (SD) on emotional processing. In this study, we investigated the impact of reduced vigilance due to moderate sleep deprivation on the ability to recognize emotional expressions of faces and emotional content of words. Participants remained awake for 24 h and performed the tasks in two sessions, one in which they were not affected by sleep loss (baseline; BSL), and other affected by SD, according to a counterbalanced sequence. Tasks were carried out twice at 10:00 and 4:00 am, or at 12:00 and 6:00 am. In both tasks, participants had to respond to the emotional valence of the target stimulus: negative, positive, or neutral. The results showed that in the word task, sleep deprivation impaired recognition irrespective of the emotional valence of words. However, sleep deprivation impaired recognition of emotional face expressions mainly when they showed a neutral expression. Emotional face expressions were less affected by the sleep loss, but positive faces were more resistant than negative faces to the detrimental effect of sleep deprivation. The differential effects of sleep deprivation on recognition of the different emotional stimuli are indicative of emotional facial expressions being stronger emotional stimuli than emotional laden words. This dissociation may be attributed to the more automatic sensory encoding of emotional facial content.

Poor vigilance affects attentional orienting triggered by central uninformative gaze and arrow cues

Behaviour and neuroimaging studies have shown that poor vigilance (PV) due to sleep deprivation (SD) negatively affects exogenously cued selective attention. In the current study, we assessed the impact of PV due to both partial SD and night-time hours on reflexive attentional orienting triggered by central un-informative eye-gaze and arrow cues. Subjective mood and interference performance in emotional Stroop task were also investigated. Twenty healthy participants performed spatial cueing tasks using central directional arrow and eye-gaze as a cue to orient attention. The target was a word written in different coloured inks. The participant's task was to identify the colour of the ink while ignoring the semantic content of the word (with negative or neutral emotional valence). The experiment took place on 2 days. On the first day, each participant performed a 10-min training session of the spatial cueing task. On the second day, half of participants performed the task once at 4:30 p.m. (BSL) and once at 6:30 a.m. (PV), whereas the other half performed the task in the reversed order. Results showed that mean reaction times on the spatial cueing tasks were worsened by PV, although gaze paradigm was more resistant to this effect as compared to the arrow paradigm. Moreover, PV negatively affects attentional orienting triggered by both central un-informative gaze and arrow cues. Finally, prolonged wakefulness affects self-reported mood but does not influence interference control in emotional Stroop task.

Asymmetric sleep in apneic human patients

Unilateral sleep in marine mammals has been considered to be a defense against airway obstruction, as a sentinel for pod maintenance, and as a thermoregulatory mechanism. Birds also show asymmetric sleep, probably to avoid predation. The variable function of asymmetric sleep suggests a general capability for independence between brain hemispheres. Patients with obstructive sleep apnea share similar problems with diving mammals, but their eventual sleep asymmetry has received little attention. The present report shows that human sleep apnea patients also present temporary interhemispheric variations in dominance during sleep, with significant differences when comparing periods of open and closed airways. The magnitude of squared coherence, an index of interhemispheric EEG interdependence in phase and amplitude, rises in the delta EEG range during apneic episodes, while the phase lag index, a measure of linear and nonlinear interhemispheric phase synchrony, drops to zero. The L index, which measures generalized nonlinear EEG interhemispheric synchronization, increases during apneic events. Thus, the three indexes show significant and congruent changes in interhemispheric symmetry depending on the state of the airways. In conclusion, when confronted with a respiratory challenge, sleeping humans undergo small, but significant, breathing-related oscillations in interhemispheric dominance, similar to those observed in marine mammals. The evidence points to a relationship between cetacean unihemispheric sleep and their respiratory challenges.

Twenty-four hours of total sleep deprivation selectively impairs attentional networks

Performance decrements after sleep loss have been extensively studied and are usually attributed to generic attentional deficits. This claim, however, is based on the view of attention as a unitary construct, despite evidence that it should be considered a multidimensional cognitive ability. The aim of the present study was to evaluate the impact of one night of sleep deprivation on the efficiency of three attentional networks, defined by Posner and Raichle (1994) in anatomical and functional terms, as alerting, orienting, and executive control. Thirty participants performed the Attention Network Test at 9:00 a.m. following two different sleep conditions: baseline (a normal night of sleep) and deprivation (24 hrs of wakefulness). Results showed an overall slowing in reaction times and a significant decrease in accuracy after sleep deprivation. Sleep deprivation selectively affected the three attentional networks, given that only executive control efficacy significantly decreased after sleep deprivation. By contrast, phasic alerting and orienting showed no differences in the two sleep conditions. Thus, performance deficits following sleep deprivation do not reflect global attentional deficits.

The effects of sleep deprivation on the attentional functions and vigilance

The study of sleep deprivation is a fruitful area of research to increase our knowledge of cognitive functions and their neural basis. In the current work, 26 healthy young adults participated in a sleep deprivation study, in which the Attentional Networks Test for Interactions and Vigilance (ANTI-V) was performed at 10a.m. after a night of normal sleep and again at 10 a.m. after 25.5-27.5 h of total sleep deprivation. The ANTI-V is an experimental task that provides measures of alerting, orienting and executive control attentional functions. Compared with previous versions, the ANTI-V includes a vigilance task, more reliable auditory alerting signals, non-predictive peripheral orienting cues, and also a neutral no-cue condition allowing the analysis of reorienting costs and orienting benefits. Thus, new evidence to evaluate the influence of sleep deprivation on attentional functioning is provided. Results revealed differences in both tonic and phasic alertness after sleep deprivation. Vigilance performance was deteriorated, while a warning tone was more helpful to increase participants' alertness, resulting in slightly faster RT and, in particular, fewer errors. The reorienting costs of having an invalid spatial cue were reduced after sleep loss. No sleep deprivation effect on the executive control measure was found in this study. Finally, since no control group was used, particular precautions were taken to reduce the influence of potential practice effects.

Minimizing sleep deprivation effects in healthy adults by differential outcomes

Sleep deprivation reduces vigilance or arousal levels, affecting the efficiency of certain cognitive functions such as learning and memory. Here we assessed whether the differential outcomes procedure (DOP), a learning procedure that has proved useful to ameliorate episodic memory deficits, can also improve memory performance in sleep-deprived participants. Photographs were presented as sample faces. A probe face was then presented for recognition after either short or long delays. In the differential outcomes condition a unique reinforcer followed correct responses. In the non-differential outcomes condition reinforcers were provided in a random manner. The results indicated that the DOP prevented the recognition memory to decrement during the long delay in the control group, replicating previous findings. The sleep-deprived group showed DOP benefits mainly with the short delay, when working memory could be affected by low arousal. These findings confirm that the DOP can overcome impaired recognition memory due to sleep deprivation conditions.

Selective modulations of attentional asymmetries after sleep deprivation

Pseudoneglect is a slight but consistent misplacement of attention toward the left visual field, commonly observed in young healthy subjects. This leftward attentional bias is thought to result from a right hemispheric dominance in visuospatial processing. Changes in endogenous levels of alertness may modulate attentional asymmetries and pseudoneglect in particular. In line with this hypothesis, it has been shown that sleep deprived shift-workers present a reversal of their attentional bias in a landmark (LDM) task (Manly, T., Dobler, V. B., Dodds, C. M., & George, M. A. (2005). Rightward shift in spatial awareness with declining alertness. Neuropsychologia, 43(12), 1721-1728). However, circadian disturbances and fatigue effects at the end of a shift work may have contributed to this reversal effect. In a first experiment, we show that sleep deprivation (SD) under controlled conditions does not markedly change the leftward bias, observable both at 21:00 and at 07:00 after SD. In a second experiment, we tested the hypothesis that a drastic reduction or inversion in the attentional bias would be present only when both the circadian drive for sleep propensity is maximal (i.e. around 05:00) and homeostatic sleep pressure is high. Thus participants were tested at 21:00 and under SD conditions at 05:00 and 09:00. Additionally, we used the greyscales (GS) task well-known to evidence a leftward bias in luminance judgments. Although results evidenced a consistent leftward bias both in the LDM and GS, we found a suppression of the leftward bias at the circadian nadir of alertness (05:00) after SD only for the GS, but not for the LDM. Noticeably, the leftward bias in the GS vanished at 05:00 after SD but reappeared at 09:00 despite continued SD, suggesting a predominant circadian influence on attentional asymmetries in the GS. Additionally, inter-sessions correlations evidenced a reproducible, consistent bias both in the LDM and GS, with no consistent relationship between the two tasks, suggesting independence of the neural networks subtending performance in LDM and GS. Overall, our results suggest that SD per se does not impede the leftward bias both in LDM and GS, whereas circadian-related variations in vigilance may impact attentional asymmetries in luminance judgments.

Alerting, orienting and executive control: the effects of sleep deprivation on attentional networks

Sleep deprivation alters attentional functions like vigilance or tonic alerting (i.e., sustaining an alert state over a period of time). However, the effects of sleep loss on both orienting and executive control are still not clear, and no study has assessed whether sleep deprivation might affect the relationships among these three attentional systems. In order to investigate the efficiency of the three attentional networks--alerting, orienting and executive control--within a single task, we used the Attention Network Test (ANT). Eighteen right-handed male participants took part in the experiment, which took place on two consecutive days. On the first day, each participant performed a 20 min training session of the ANT. On the second day, participants remained awake for 24 h during which time the ANT was performed once at 5:00 p.m. and once at 4:00 a.m. Results showed an overall slowing of reaction times in the nocturnal session, indicating a strong decrease in vigilance. Furthermore, sleep deprivation did affect attentional orienting and executive control. Results are consistent with the hypothesis that the tonic component of alerting interacts with both attentional orienting and executive functions.

Visual attention, reaction time, and self-reported alertness upon awakening from sleep bouts of varying lengths

The aim of the present study was to examine visual attention, especially the executive control functions that deal with conflict, when participants were in a low arousal state shortly after a nighttime awakening. Fifteen participants spent four consecutive nights at a laboratory and performed a flankers task using two levels of target-distractor spacing (0.75 degrees and 1.50 degrees) and three trial types (compatible, incompatible, and neutral). The first night was a habituation night. For the next three nights, participants went to sleep at 2300 hours and were then awakened at either 2400 hours (1-h sleep bout), 0300 hours (4-h sleep bout), or 0600 hours (7-h sleep bout) and were administered a flankers task and a self-report questionnaire that measured arousal level. These testing times were counter-balanced across participants, and a 2100 hours (pre-sleep) flankers task was also randomly assigned to be completed on one of the testing nights. Response time on neutral-flanker trials was increased if participants were awakened from a sleep bout and was slowest at 0300 hours, appearing to parallel circadian body temperature. In contrast, failures of selective attention, as indexed by the difference between compatible and incompatible trials, increased linearly as a function of the length of the sleep bout. Compared to the 2100 hours pre-sleep condition, self-reported energy was lower and Tiredness was higher after awakening from a sleep bout. Taken together, the current data suggest a dissociation between the processes that perform a non-conflict task and the executive control of attention. Specifically, longer sleep bouts seem to be associated with greater difficulty in inhibiting task-irrelevant information, perhaps due to a sleep inertia effect affecting the anterior cingulate cortex.