Effects of sleep deprivation on spontaneous eye blink rate and alpha EEG power

Utilizing EEG and fNIRS for the detection of sleep-deprivation-induced fatigue and its inhibition using colored light stimulation

Drowsy driving is a common, but underestimated phenomenon in terms of associated risks as it often results in crashes causing fatalities and serious injuries. It is a challenging task to alert or reduce the driver's drowsy state using non-invasive techniques. In this study, a drowsiness reduction strategy has been developed and analyzed using exposure to different light colors and recording the corresponding electrical and biological brain activities. 31 subjects were examined by dividing them into 2 classes, a control group, and a healthy group. Fourteen EEG and 42 fNIRS channels were used to gather neurological data from two brain regions (prefrontal and visual cortices). Experiments shining 3 different colored lights have been carried out on them at certain times when there is a high probability to get drowsy. The results of this study show that there is a significant increase in HbO of a sleep-deprived participant when he is exposed to blue light. Similarly, the beta band of EEG also showed an increased response. However, the study found that there is no considerable increase in HbO and beta band power in the case of red and green light exposures. In addition to that, values of other physiological signals acquired such as heart rate, eye blinking, and self-reported Karolinska Sleepiness Scale scores validated the findings predicted by the electrical and biological signals. The statistical significance of the signals achieved has been tested using repeated measures ANOVA and t-tests. Correlation scores were also calculated to find the association between the changes in the data signals with the corresponding changes in the alertness level.

Patterns of eye blinks are modulated by auditory input in humans

Previous studies could elaborate a link between attentional processes and eye blinking in both visual and auditory attention tasks. Here we show that this link is active at a fundamental level of perception: presentation of a series of bare sine tones is sufficient to induce a modulation of temporal blink patterns, allowing to determine which series was presented to participants even when they are not required to interactively engage in processing the auditory input. In particular, we monitored eye blinking during an auditory attention task using two series of sine tones, differing in the predictability of the timing of tone onsets. Whereas inter-onset intervals in one tone series corresponded to uncorrelated samples from a normal distribution, they were distributed according to a Gaussian random walk in the other tone series. We find that blink patterns are dynamically modulated by both purely auditory inputs. The magnitude, form, and coherence of the temporal associations between tone onsets and blink events depend strongly on the requirement to respond to the presented stimuli. The predictability of the tone series appears to modulate pre-stimulus blink inhibition given that a response is required. Altogether, these findings suggest eye blink as a readily available, non-invasive behavioral marker for context-sensitive, moment-to-moment allocation of attention.

Spontaneous eye blink rate mediates the relationship between sleepiness and impulsivity to negative stimuli

Previous studies have demonstrated that sleep deprivation results in a negativity bias, especially in the context of impaired response inhibition. In the present study we investigated spontaneous eye blink rate (EBR), a correlate of dopamine function, as a mediator of the relationship between subjective sleepiness and impulsivity toward negative stimuli on a Go/NoGo task. Participants rated their sleepiness on a number of measures including the Epworth Sleepiness Scale (ESS), the Karolinska Sleepiness Scale (KSS) and subscales of the Chronic Sleep Reduction Questionnaire (CSRQ). The findings revealed that EBR mediated the relationship between sleepiness as measured by the Karolinska Sleepiness Scale (KSS) and commission errors on negatively valanced stimuli. These findings suggest that reduced inhibition in responding to negative stimuli can be found as a function of subjective sleepiness and that changes in dopamine function may be one contributing factor explaining this relationship.

Effect of distance vision and refractive error on the spontaneous eye blink activity in human subjects in primary eye gaze

PURPOSE

To evaluate whether visual target character and visibility affects spontaneous eye blink rate (SEBR) in primary eye gaze and silence.

METHODS

Video recordings were made of young healthy adults who were either emmetropic (n=32) or who wore spectacles for refractive error (range -4.75D and +4.50D (n=31). Emmetropes had 5min recordings made whilst seated and looking towards a distant whiteboard. For spectacle wearers, recordings were made whilst looking towards the whiteboard with a 35mm sized cross, and repeated after spectacle removal. The average number of eye blinks over 5min was assessed, and its intra-subject variability as the coefficient of variation (COV).

RESULTS

Over 5min without a distance target, an average SEBR of 10.4blinks/min was observed in emmetropes with a of COV=38.1%, and a significant increase in SEBR over the 5th minute to 13.6blinks/min. Hyperopes being asked to look towards a distant target showed the essentially same blinking rate of 11.1/min with or without spectacle wear with the intra-subject variability (COV) being 21.3%. Myopic subjects showed a slightly higher SEBR if looking towards a target without their spectacles (12.4 vs. 11.0blinks/min), with the COV being 18.8%.

CONCLUSIONS

The studies indicate that some form of visual target could be useful to promote constancy of spontaneous eye blink activity over time, but that a distance visual target (when provided) does not need to be seen clearly.

Seasonal variation of spontaneous blink rate and beta EEG activity

Seasonal variations of the photoperiod have been shown to regulate biological and behavioral functions, with also effects on clinical symptom and course of several psychiatric conditions. Although melatonin is considered the principal signal used to transmit informations about the light and dark cycle, a dopamine (DA) role in regulating seasonal changes has been suggested. Few studies have addressed a seasonal pattern of dopamine, and human studies have been conducted on inter-subject differences, comparing measures obtained during fall-winter with those of spring-summer. We studied within-subject seasonal changes of blink rate (BR), a indirect marker of central DA activity, in 26 normal subjects (15 females and 11 males, mean age: 24.7 ± 4.0) during winter, spring, summer and fall. Occipital EEG activity and subjective measures of vigilance and mood were also assessed to account for variations on arousal and fatigue. A significant seasonal effect was found for BR, with higher rate in summer, and for EEG beta activity, with higher activity in spring and summer. Subjective fatigue was found higher in winter. According to our data, it is possible that higher BR and increased EEG beta activity result by an arousal activation sustained by dopamine systems during the months with a long photoperiod.

Sleep Deprivation Triggers Cognitive Control Impairments in Task-Goal Switching

STUDY OBJECTIVES

This study investigates the impact of sleep deprivation (SD) on task-goal switching, a key component of cognitive flexibility.

METHODS

Task-goal switching performance was tested after one night of regular sleep (n = 17 participants) or of total SD (n = 18). To understand the relationships between task-switching performance and other cognitive processes following SD, participants were tested for other key attentional (alertness and vigilance) and executive (inhibition and working memory) functions. Spontaneous eye blink rate (EBR) was also measured as an indirect marker of striatal dopaminergic function.

RESULTS

SD negatively affects task-goal switching as well as attentional and inhibition measures, but not working memory. Changes in task-goal switching performance were not significantly correlated with changes in objective and subjective markers of fatigue and sleepiness, response inhibition, or spontaneous EBR.

CONCLUSIONS

Altogether, our results show differentiated effects of SD on key executive functions such as working memory, inhibition, and task-goal switching.

Striatal Dopamine, Externalizing Proneness, and Substance Abuse: Effects on Wanting and Learning during Reward-Based Decision Making

We examined whether striatal dopamine moderates the impact of externalizing proneness (disinhibition) on reward-based decision-making. Participants completed disinhibition and substance abuse subscales of the brief form Externalizing Spectrum Inventory, and then performed a delay discounting task to assess preference for immediate rewards along with a dynamic decision-making task that assessed long-term reward learning (i.e., inclination to choose larger delayed versus smaller immediate rewards). Striatal tonic dopamine levels were operationalized using spontaneous eyeblink rate. Regression analyses revealed that high disinhibition predicted greater delay discounting among participants with lower levels of striatal dopamine only, while substance abuse was associated with poorer long-term learning among individuals with lower levels of striatal dopamine, but better long-term learning in those with higher levels of striatal dopamine. These results suggest that disinhibition is more strongly associated with the wanting component of reward-based decision-making, whereas substance abuse behavior is associated more with learning of long-term action-reward contingencies.

Spontaneous eye blink rate as predictor of dopamine-related cognitive function-A review

An extensive body of research suggests the spontaneous eye blink rate (EBR) is a non-invasive indirect marker of central dopamine (DA) function, with higher EBR predicting higher DA function. In the present review we provide a comprehensive overview of this literature. We broadly divide the available research in studies that aim to disentangle the dopaminergic underpinnings of EBR, investigate its utility in diagnosis of DA-related disorders and responsivity to drug treatment, and, lastly, investigate EBR as predictor of individual differences in DA-related cognitive performance. We conclude (i) EBR can reflect both DA receptor subtype D1 and D2 activity, although baseline EBR might be most strongly related to the latter, (ii) EBR can predict hypo- and hyperdopaminergic activity as well as normalization of this activity following treatment, and (iii) EBR can reliably predict individual differences in performance on many cognitive tasks, in particular those related to reward-driven behavior and cognitive flexibility. In sum, this review establishes EBR as a useful predictor of DA in a wide variety of contexts.

Neuromagnetic brain responses to other person's eye blinks seen on video

Eye blinks, typically occurring 15-20 times per minute, rarely capture attention during face-to-face interaction. To determine the extent to which eye blinks affect the viewer's brain activity, we recorded magnetoencephalographic brain responses to natural blinks, and to the same blinks slowed down to 38% of the original speed. The stimuli were presented on video once every 2.3-6.2 s. As a control, we presented two horizontal black bars moving with the same time courses and the same extent as the eyelids in the blink video. Both types of blinks and bars elicited clear responses peaking at about 200 ms in the occipital areas, with no systematic differences between hemispheres. For the bars, these main responses were (as expected) weaker (by 24%) and later (by 33 ms) to slow-motion than normal-speed stimuli. For blinks, however, the responses to both normal-speed and slow-motion stimuli were of the same amplitude and latency. Our results demonstrate that the brain not only responds to other persons' eye blinks, but that the responses are as fast and of equal size even when the blinks are considerably slowed down. We interpret this finding to reflect the increased social salience of the slowed-down blinks that counteracted the general tendency of the brain to react more weakly and more slowly to slowly- vs. quickly-changing stimuli. This finding may relate to the social importance of facial gestures, including eye blinks.

Effects of prolonged wakefulness: the role of PERIOD3 genotypes and personality traits

The roles of personality traits, as assessed by Eysenck Personality Inventory, and of the clock gene PERIODS (PER3) were analysed on the subjective effects of prolonged wakefulness. A sample of 70 healthy participants (7 men, 63 women; M age = 24.2 yr., SD = 3.2) was studied during forced wakefulness between 7:30 p.m. and 9:30 a.m. According to Eysenck's arousal model, it was hypothesized that prolonged wakefulness might affect in a different way those classified as Introverted and Extraverted. During the forced wakefulness period, the Introverted group showed greater decrease in subjective measures of vigilance than did the Extraverted group, but no differences were observed between groups with high and low scores on Psychoticism and Neuroticism. Prolonged wakefulness had a negative effect on subjective sleepiness and mood in all three PER3 polymorphisms analysed.

Algorithm for automatic analysis of electro-oculographic data

BACKGROUND

Large amounts of electro-oculographic (EOG) data, recorded during electroencephalographic (EEG) measurements, go underutilized. We present an automatic, auto-calibrating algorithm that allows efficient analysis of such data sets.

METHODS

The auto-calibration is based on automatic threshold value estimation. Amplitude threshold values for saccades and blinks are determined based on features in the recorded signal. The performance of the developed algorithm was tested by analyzing 4854 saccades and 213 blinks recorded in two different conditions: a task where the eye movements were controlled (saccade task) and a task with free viewing (multitask). The results were compared with results from a video-oculography (VOG) device and manually scored blinks.

RESULTS

The algorithm achieved 93% detection sensitivity for blinks with 4% false positive rate. The detection sensitivity for horizontal saccades was between 98% and 100%, and for oblique saccades between 95% and 100%. The classification sensitivity for horizontal and large oblique saccades (10 deg) was larger than 89%, and for vertical saccades larger than 82%. The duration and peak velocities of the detected horizontal saccades were similar to those in the literature. In the multitask measurement the detection sensitivity for saccades was 97% with a 6% false positive rate.

CONCLUSION

The developed algorithm enables reliable analysis of EOG data recorded both during EEG and as a separate metrics.

Cerebral perfusion differences between drowsy and nondrowsy individuals after acute sleep restriction

OBJECTIVES

To investigate changes in resting cerebral blood flow (CBF) after acute sleep restriction. To investigate the extent to which changes in CBF after sleep restriction are related to drowsiness as manifested in eye-video.

DESIGN

Participants were scanned for 5 min using arterial spin labeling (ASL) perfusion imaging after both sleep-restricted and rested nights. Participants were rated for visual signs of drowsiness in the eye-video recorded during the scan.

SETTING

Lying supine in a 3-Tesla magnetic resonance imaging scanner.

PARTICIPANTS

Twenty healthy adults (age 20-37 yr) with no history of neurologic, psychiatric, or sleep disorder, and with usual time in bed of 7.0-8.5 h.

INTERVENTIONS

In the night before the sleep-restricted session, participants were restricted to 4 h time in bed.

RESULTS

There was an overall reduction in CBF in the right-lateralized fronto-parietal attentional network after acute sleep restriction, although this was largely driven by participants who showed strong signs of drowsiness in the eye-video after sleep restriction. Change in CBF correlated with change in drowsiness in the basal forebrain-cingulate regions. In particular, there was a pronounced increase in CBF in the basal forebrain and anterior and posterior cingulate cortex of participants who remained alert after sleep restriction.

CONCLUSIONS

The pattern of cerebral activity after acute sleep restriction is highly dependent on level of drowsiness. Nondrowsy individuals are able to increase activity in the arousal-promoting brain regions and maintain activity in attentional regions. In contrast, drowsy individuals are unable to maintain arousal and show decreased activity in both arousal-promoting and attentional regions.

Spontaneous eyeblink activity

Spontaneous blinking is essential for maintaining a healthy ocular surface and clarity of vision. The spontaneous blink rate (SBR) is believed to reflect a complex interaction between peripheral influences mediated by the eye surface and the central dopaminergic activity. The SBR is thus extremely variable and dependent on a variety of psychological and medical conditions. Many different methods have been employed to measure the SBR and the upper eyelid kinematics during a blink movement. Each has its own merits and drawbacks, and the choice of a specific method should be tailored to the specific needs of the investigation. Although the sequence of muscle events that leads to a blink has been fully described, knowledge about the neural control of spontaneous blinking activity is not complete. The tear film is dynamically modified between blinks, and abnormalities of the blink rate have an obvious influence on the ocular surface.

Improving classification rates for use in fatigue countermeasure devices using brain activity

Fatigue can be defined as a state that involves psychological and physical tiredness with a range of symptoms such as tired eyes, yawning and increased blink rate. It has major implications for work place and road safety as well as a negative symptom of many acute and chronic illnesses. As such there has been considerable research dedicated to systems or algorithms that can be used to detect and monitor the onset of fatigue. This paper examines using electroencephalography (EEG) signals to classify fatigue and alert states as a function of subjective self-report, driving performance and physiological symptoms. The results show that EEG classification network for fatigue improved from 75% to 80% when these factors are applied, especially when the data is grouped by subjective self-report of fatigue with classification accuracy improving to 84.5%.

Sleep deprivation decreases binding of [11C]raclopride to dopamine D2/D3 receptors in the human brain

Sleep deprivation did not affect dopamine transporters (target for most wake-promoting medications) and thus dopamine increases are likely to reflect increases in dopamine cell firing and/or release rather than decreases in dopamine reuptake. Because dopamine-enhancing drugs increase wakefulness, we postulate that dopamine increases after sleep deprivation is a mechanism by which the brain maintains arousal as the drive to sleep increases but one that is insufficient to counteract behavioral and cognitive impairment. Sleep deprivation can markedly impair human performance contributing to accidents and poor productivity. The mechanisms underlying this impairment are not well understood, but brain dopamine systems have been implicated. Here, we test whether one night of sleep deprivation changes dopamine brain activity. We studied 15 healthy subjects using positron emission tomography and [11C]raclopride (dopamine D2/D3 receptor radioligand) and [11C]cocaine (dopamine transporter radioligand). Subjects were tested twice: after one night of rested sleep and after one night of sleep deprivation. The specific binding of [11C]raclopride in the striatum and thalamus were significantly reduced after sleep deprivation and the magnitude of this reduction correlated with increases in fatigue (tiredness and sleepiness) and with deterioration in cognitive performance (visual attention and working memory). In contrast, sleep deprivation did not affect the specific binding of [11C]cocaine in the striatum. Because [11C]raclopride competes with endogenous dopamine for binding to D2/D3 receptors, we interpret the decreases in binding to reflect dopamine increases with sleep deprivation. However, we cannot rule out the possibility that decreased [11C]raclopride binding reflects decreases in receptor levels or affinity. Sleep deprivation did not affect dopamine transporters (target for most wake-promoting medications) and thus dopamine increases are likely to reflect increases in dopamine cell firing and/or release rather than decreases in dopamine reuptake. Because dopamine-enhancing drugs increase wakefulness, we postulate that dopamine increases after sleep deprivation is a mechanism by which the brain maintains arousal as the drive to sleep increases but one that is insufficient to counteract behavioral and cognitive impairment.

Increased spontaneous eye blink rate following prolonged wakefulness

Sleep deprivation (SD) is a technique of sleep-wake manipulation which has been used to treat depression. Changes in neurotransmitter systems, that are also involved in the effects of the antidepressant drugs, have been suggested as the possible mechanisms of action of SD. However, the therapeutic effect of SD is acute and transient, while antidepressant effects of drug treatments are gradual and stable. SD might work throughout mechanisms that are different from those mediating drug's effects. In the present study we analyzed the role of dopamine activity in SD. Spontaneous eye blink rate provides a non invasive measure of central dopamine activity. We assessed eye blink rate across prolonged wakefulness (from 10:00 a.m. to 07:00 a.m.) in 25 young normal subjects. Eye blink rate increased at the end of the wakefulness period. Blink rates and sleepiness as assessed by Karolinska Sleepiness Scale correlated positively with time spent awake. We propose that increased blink rate might reflect a dopamine activation that counteracts sleep drive. Antidepressant effects of sleep deprivation might be related to activation of the physiological mechanisms which regulate wake maintenance.

The psychophysiological determinants of fatigue

Driver fatigue is a major risk for road accidents that can often result in injury and death. However, considerable debate still exists concerning factors associated with driver fatigue. Because of the complex nature of fatigue, this paper reports a study that investigated both physiological and psychological determinants of fatigue. Three fatigue outcome measures were used, including a physiological, psychological and a combined physiological and psychological measure. Fifty participants performed a driving simulator task till they showed symptoms of fatigue and were assessed before and after the task. Significant factors associated with physiological fatigue included higher levels of baseline delta activity and an extraverted personality. Factors related to the psychological fatigue outcome measure included sleepiness, low healthy lifestyle status, an extraverted personality and tension-prone personality, and negative mood states. The combined fatigue outcome measure was associated with factors such as a tension-prone and extraverted personality, low systolic blood pressure, and negative mood states. The findings emphasize the importance of assessing fatigue using a range of outcome measures in order to achieve a thorough understanding of what factors contribute to fatigue and highlight the need to develop fatigue countermeasures that employ a broad range of measures.

Resting EEG theta activity predicts cognitive performance in attention-deficit hyperactivity disorder

Quantitative electroencephalography has contributed significantly to elucidating the neurobiologic mechanisms of attention-deficit hyperactivity disorder. The most consistent and robust electroencephalographic disturbance in attention-deficit hyperactivity disorder has been abnormally increased theta band during resting conditions. Separate research using attention-demanding tests has elucidated cognitive disturbances that differentiate attention-deficit hyperactivity disorder. This study attempts to integrate electroencephalographic and neuropsychological indices to determine whether cognitive performance is specifically related to increased theta. Theta activity was recorded during a resting condition for 46 children/adolescents with attention-deficit hyperactivity disorder and their sex- and age-matched control subjects. Accuracy and reaction time during an auditory oddball and a visual continuous performance test were then recorded. Compared with control subjects, the attention-deficit hyperactivity disorder group manifested significantly increased (primarily left) frontal theta. Furthermore, the attention-deficit hyperactivity disorder group scored significantly delayed reaction time and decreased accuracy in both tasks. Correlation analysis revealed a significant relationship between frontal (primarily left) theta and oddball accuracy for the attention-deficit hyperactivity disorder group compared with a significant relationship between posterior (primarily right) theta and reaction time in the continuous performance test for the control group. These results indicate that spatial neurophysiologic deficits in attention-deficit hyperactivity disorder may be related to disturbances in signal detection. This observation has important implications for the role of trait-like biologic deficits in attention-deficit hyperactivity disorder predicting performance in information processing.

Effects of total sleep-deprivation on waking human EEG: functional cluster analysis

OBJECTIVE

The purpose of the present study was to investigate the effects of total sleep deprivation (TSD) on brain functions with an identification procedure for strongly interactive brain regions, relying on functional cluster (FC) analysis in multichannel electroencephalogram (EEG) data.

METHODS

EEGs from 16 electrodes in 18 healthy, right-handed, young male volunteers were recorded before TSD (after normal sleep) and after 24 h of experimentally induced sleep deprivation. We estimated cluster index to characterize joint interactions among many brain regions in order to determine if a particular FC is present or not, and if so, its anatomy.

RESULTS

As a result, we confirmed the presence of FC and found different FC patterns in both before and after TSD. The C3 and F7 locations were outside the cluster under the TSD condition, but belonged to the cluster with C4 and F8 before the TSD condition, and the F3/F4, and O1 locations were new entries to the functional cluster during sustained wakefulness.

CONCLUSIONS

These results indicate that the neuronal activities of the C3 and F7 location are functionally unrelated, whereas the F3/F4 locations are functionally involved with the C4, F8, and O1 locations after 24 h TSD. Our results suggest that FC changes with elapsed awake time and reflects the change of brain function due to TSD.

SIGNIFICANCE

This paper shows the existence of FC both before and after TSD, and the anatomy of each FC is different. So FC analysis would be a potential tool to investigate the simultaneous neuronal activity of human EEGs.

Effect of Sleep Deprivation on Saccades and Eyelid Blinking

In this study the effect of sleep deprivation on specific components of eye and eyelid movement was investigated in a group of young and healthy subjects. The duration of sleep deprivation was 20 h. Each subject had to execute different saccade tasks: reflexive saccades, voluntary prosaccades and antisaccades. Saccade latency, number of saccade errors and blink rate during the saccade tasks were evaluated as predictors of performance decrements resulting from sleep deprivation. The present study showed no significant deterioration of latency and number of errors in the different saccade tasks. However, the blink rate was significantly higher after a night without sleep than before. It is concluded that the blink rate appears to be a promising psychophysical measurement and a more sensitive parameter than saccade performance to evaluate the effects of 20 h of sleep deprivation. These results encourage further research on this topic.

Pattern analysis of sleep-deprived human EEG

Progress during the past decade in non-linear dynamics and instability theory has provided useful tools for understanding spatio-temporal pattern formation. Procedures which apply principle component analysis (using the Karhunen-Loeve decomposition technique) to the multichannel electroencephalograph (EEG) time series have been developed. This technique shows localized changes of cortical functioning; it identifies increases and decreases of the activity of localized cortical regions over time while the subject performs a simple task or test. It can be used to demonstrate the change in cortical dynamics in response to a continuous challenge. Using 16 EEG electrodes, the technique provides spatio-temporal information not obtained with power spectrum analysis, and includes the weighted information given with omega complexity. As an application, we performed a pattern analysis of sleep-deprived human EEG data in 20 healthy young men. Electroencephalograph recordings were performed on subjects for <2 min, with eyes closed after normal sleep and after 24 h of experimentally-induced sleep deprivation. The significant changes in the eigenvector components indicated the relative changes of local activity in the brain with progressive sleep deprivation. A sleep deprivation effect was observed, which was hemispherically correlated but with opposite directional dynamics. These changes were seen in the temporo-parietal regions bilaterally. The application of the technique showed that the simple test task was performed with a limited unilateral hemispheric involvement at baseline, but needed a much larger cortical participation with decreased frontal activity and increased coherence and bilateral hemispheric involvement. The calculations performed demonstrated that the same weighted changes as those obtained with omega complexity were shown, but the technique had the added advantage of showing the localized directional changes of the principle eigenvector at each studied electrode, pointing out the cortical localized region affected by the sleep deprivation and toward which direction the environmental challenge induced the spatial change. This methodology may allow the evaluation of changes in local dynamics in brain activity in normal and pathological conditions.

Effect of sleep deprivation on motor performance in patients with Parkinson's disease

Animal research provides evidence that sleep deprivation influences the dopamine system. Knowledge about the effect of sleep deprivation on motor performance in patients with Parkinsons disease is scarce. This study examines the influence of total and partial sleep deprivation compared to normal sleep on motor state and performance in Parkinson's disease. Fifteen nondepressed patients with Parkinson's disease underwent one night of total sleep deprivation (TSD), one night of partial sleep deprivation (PSD) after 3 a.m., and one control night of normal sleep (S), performed in a random, nonconsecutive order. Over a period of 3 hours the following morning, motor evaluations (United Parkinson's Disease Rating Scale, [UPDRS] and tapping rate) were performed before and every 30 minutes after intake of the usual morning dopaminergic drug dose. All patients underwent polysomnography apart from the sleep deprivation protocol. Mean UPDRS motor scores and tapping velocities did not differ significantly after each of the schedules, but a subgroup of four patients improved their motor score after partial sleep deprivation. These data do not confirm previous findings of an overall positive influence of sleep deprivation on motor function in Parkinson's disease. However, the results indicate that different response types to sleep deprivation may exist and that a subgroup of patients could benefit from partial sleep deprivation.

Diurnal variation in spontaneous eye-blink rate

The daily pattern of spontaneous eye-blink rate (BR), a non-invasive peripheral measure of central dopamine activity, was investigated in 24 healthy subjects. The spontaneous eye-blink rate showed a stable pattern in morning, midday and afternoon hours. A significant increase was found at the evening time point (20.30 h). The finding is suggestive of a late evening increase of central dopamine activity. An increased level of subjective sleepiness was also found at the same evening point, at a time corresponding to the 'evening wake maintenance zone' or the 'forbidden zone for sleep'. A possible hypothesis is that the 'forbidden zone for sleep' may reflect a dopamine-mediated activation that counteracts a rising sleep drive. The role of diurnal variation of dopamine function should be considered both in the choice of the drug treatment regimen, and in the evaluation of biological and neuropsychological parameters.