P.2.034 - Genotype-dependent deterioration of sustained attention by the COMT inhibitor tolcapone after sleep deprivation

Abstract

Introduction Elevated sleepiness and impaired vigilance due to medical disorders, is often treated by drugs that enhance dopaminergic neurotransmission, including modafinil, caffeine or cocaine [1]. Tolcapone is a brain penetrant selective inhibitor of catechol-O-methyltransferase (COMT) devoid of psychostimulant properties that leads to relatively specific increases in prefrontal cortex (PFC) dopamine signaling [2,3]. Because it hardly affects striatal domapinergic transmission, tolcapone may mitigate subjective and behavioral consequences of sleep deprivation without unwanted psychostimulant adverse effects [2]. Tolcapone also improves cognition and cortical information processing in rested volunteers, depending on the genotype of the functional Val158Met polymorphism of COMT [3]. The impact of this common genetic variant for efficient treatment of hypersomnolence and behavioral markers of increased sleep need after sleep loss is controversial. Here we investigated the potential usefulness of tolcapone to mitigate consequences of sleep deprivation on lapses of sustained attention, and tested the hypothesis that dopamine signaling in the prefrontal cortex (PFC) causally contributes to neurobehavioral and neurophysiological markers of human sleep homeostasis. Methods We first quantified the impact of COMT genotype (SNP-Id: rs4680) on the evolution of attentional lapses during two days of extended wakefulness in a non-tolcapone treated group of 73 volunteers. Subsequently, in an independent group of 30 healthy male study participants, we tested whether selective inhibition of COMT activity by tolcapone counteracts attentional and neurophysiological markers of elevated sleep need in a COMT genotype-dependent manner. 2 x 100 mg tolcapone were administered after 11 and 23 hours, in a randomized, double-blind, placebo-controlled, cross-over design. The psychomotor Vigilance Test (PVT) and objective electroencephalogram (EEG) recordings were carried out in three-hour intervals among all 103 volunteers across the 40 hours of prolonged wakefulness. Repeated measure linear mixed-models were applied, followed by multiple comparison corrected post-hoc testing when appropriate. Results Both COMT genotype and tolcapone modulated the sleep-loss induced impairment of vigilant attention. More specifically, data from the non-tolcapone treated group revealed that Val/Met heterozygotes produced twice as many lapses after a night without sleep compared to Met/Met homozygotes (p Conclusions The current results demonstrate that PFC dopaminergic neurotransmission regulates attentional lapses during sleep deprivation without changing neurophysiological markers of sleep homeostasis. Intriguingly, selective inhibition of COMT can even reverse the expected beneficial effects of pharmacologically enhanced dopaminergic tone after prolonged wakefulness. These findings may have important implications, given the increased use of stimulants in healthy people aimed at improving vigilance and cognitive functions [1,4].