10-min Psychomotor Vigilance Test Research Articles

P106 Evaluating the correlation between objective daytime sleepiness, daytime functioning and subjective sleepiness

Abstract Introduction Daytime sleepiness is typically assessed in clinical settings with the Multiple Sleep Latency Test (MSLT) and Maintenance of Wakefulness Test (MWT). However, these tests do not necessarily assess daytime functioning. This study aimed to assess the correlation between a 10-min Psychomotor Vigilance Test (PVT), as a measure of daytime functioning, and excessive daytime sleepiness as measured with the MSLT or MWT. Methods Patients attending the sleep clinic for assessments of daytime sleepiness underwent overnight polysomnography (PSG) and completed the Epworth Sleepiness Scale (ESS). The following day, patients completed four test sessions every 2h starting 1.5h after waking. Testing sessions included the Stanford Sleepiness Scale (SSS), PVT, MWT or MSLT. PVT lapses (reaction time >500ms), SSS score and sleep latencies (MSLT and MWT) were averaged within participants across sessions and regression analyses performed to assess the relationship between PVT lapses and sleepiness measures. Results A total of 41 patients (BMI: 33.7±8.7kg/m²; aged 44.8±17.8 years) completed the study. Of these, 22 (19 F) underwent the MSLT and 19 (2 F) underwent the MWT. PVT lapses correlated with MWT mean sleep latency (r²=0.62; p<0.001), ESS (r²= 0.19; p<0.01) and SSS (r²= 0.12; p<0.05) but not MSLT mean sleep latency (r²= 0.02; p = 0.50). Discussion In clinical practice, MWT and ESS are often used in conjunction to assess daytime functioning. Results suggest that the PVT could be used alongside MWT to aid clinical judgments around an individuals’ daytime functioning.

“20,000 leagues under the sea”: Sleep, cognitive performance, and self-reported recovery status during a 67-day military submarine mission

Employing a field-based monitoring paradigm, the current study examined day-to-day fluctuations in actigraphy-based sleep recordings, cognitive performance (10-min psychomotor vigilance test; PVT), and self-reported recovery status among 14 submariners throughout a 67-day military mission. Mission averages reflected suboptimal sleep that was of short overall duration (5:46 ± 1:29 h per 24-h day) and relatively low efficiency (82.5 ± 9.9%); suboptimal levels of cognitive performance (PVT mRT = 283 ± 35 ms; PVT response errors = 5.3 ± 4.8); and moderate levels of self-reported recovery. Whilst self-reported recovery status remained stable across mission days, small but consistent day-to-day increases in sleep onset latency and PVT mRT accumulated to reflect meaningful deterioration in sleep and cognitive performance across the entire 67-day mission (i.e., 47% and 16% of the overall mission average, respectively). Future work is required to corroborate the current findings, firmly establish underlying causes, and make evidence-based suggestions for interventions to improve and uphold submariners’ health and performance.

Sleep, self-management, neurocognitive function, and glycemia in emerging adults with Type 1 diabetes mellitus: A research protocol.

Type 1 Diabetes (T1D) affects 1.6 million Americans, and only 14% of emerging adults ages 18-25 years achieve targets for glycemic control (A1C < 7.0%). Sleep deficiency, including habitual short sleep duration (<6.5 hr total sleep time and high within-person variability in total sleep time), is associated with poorer glycemic control. Emerging adults with T1D have a more pronounced sleep extension on weekends compared with matched controls, consistent with sleep deficiency; however, associations among sleep variability and glycemic control have not been explored in this population. Sleep deficiency may affect the complex higher-order neurocognitive functioning needed for successful diabetes self-management (DSM). We report the protocol for an ongoing study designed to characterize sleep and the associations among sleep deficiency, neurocognitive function, DSM, diabetes quality of life, and glycemia among a sample of 40 emerging adults with T1D. We monitor sleep via wrist-worn actigraphy and glucose via continuous glucose monitoring concurrently over 14 days. We are collecting data on self-report and objective sleep, a 10-min psychomotor vigilance test on a PVT-192 device, a 3-min Trail Making Test on paper, and questionnaires, including twice-daily Pittsburgh sleep diaries using Research Electronic Data Capture (REDCap)TM . Results from this study will be used to support the development and testing of the efficacy of a tailored sleep self-management intervention that may improve total sleep time, sleep variability, neurocognitive function, DSM, glycemic control, and glucose variability among emerging adults with T1D.

0144 Relationship Between Sleep EEG K-Complex Slow Wave Coupling and Next-Day Thalamic Activity During Psychomotor Vigilance Test in Obstructive Sleep Apnea

Abstract Introduction There is large inter-individual variability in the relationship between obstructive sleep apnea (OSA) severity and lapses in vigilance as measured using psychomotor vigilance test (PVT). We have previously shown that overnight sleep EEG K-complex slow wave coupling (∆SWAK) exhibits a dose-responsive relationship with next-day lapses in vigilance in OSA on and off treatment. We hypothesized that a variable thalamic dysfunction in OSA explains difference in lapses in vigilance and alterations in ∆SWAK across individuals. Methods Five newly diagnosed severe OSA subjects (mean apnea-hypopnea index [AHI4%=57.1±22.8/hr.]) with excessive daytime sleepiness (Epworth Sleepiness Scale=11±3.4) underwent nocturnal polysomnography followed by PVT testing within a 3T SKYRA MRI scanner. The PVT task inside the scanner (PVT-fMRI) was adapted to match the gold standard PVT-192 device. Each fMRI scanning session consisted of 2 10-min PVT runs interleaved with 2 control conditions wherein the subject pressed the response button at random intervals absent of a visual stimulus. fMRI data was analyzed in 2-step procedure (individual time-series followed by group analysis) using Analysis of Functional Neuroimages (AFNI) software package. To estimate thalamic activity during PVT-fMRI, parameter estimates of the %change in blood-oxygen-level-dependent (BOLD) signal using the contrast PVT-Control were used as the primary metric. The region of interest was limited to the bilateral thalamus using the Eickhoff-Zilles macro labels from the MNI N27 template. Results In a preliminary test, PVT performance for the subjects inside the scanner was not significantly different from that outside the scanner (PVTLapsesfMRI=7.3±2.1 vs. PVTLapsesPVT192=6.4±3.6 mean±std; PVTLapses=reaction time &amp;gt; 500 ms.). Within subjects, a trend toward lower thalamic recruitment was observed during PVT-fMRI (-0.17±0.2%; p=0.1). Further, lower thalamic activity during PVT-fMRI also showed a trend to lower overnight ∆SWAK (mean -1.2±1.4) values (r = 0.61, p = 0.17). Conclusion In severe OSA subjects with excessive daytime sleepiness, we observed a trend to reduced thalamic activity during daytime PVT. Overnight EEG K-complex slow wave coupling showed a similar trend with next-day thalamic activity during PVT, however the small sample size may have limited our ability to detect this association with statistical significance. Support AASM Foundation 199-FP-18; NIH K24HL109156

Classifying attentional vulnerability to total sleep deprivation using baseline features of Psychomotor Vigilance Test performance

There are strong individual differences in performance during sleep deprivation. We assessed whether baseline features of Psychomotor Vigilance Test (PVT) performance can be used for classifying participants’ relative attentional vulnerability to total sleep deprivation. In a laboratory, healthy adults (n = 160, aged 18–30 years) completed a 10-min PVT every 2 h while being kept awake for ≥24 hours. Participants were categorized as vulnerable (n = 40), intermediate (n = 80), or resilient (n = 40) based on their number of PVT lapses during one night of sleep deprivation. For each baseline PVT (taken 4–14 h after wake-up time), a linear discriminant model with wrapper-based feature selection was used to classify participants’ vulnerability to subsequent sleep deprivation. Across models, classification accuracy was about 70% (range 65–76%) using stratified 5-fold cross validation. The models provided about 78% sensitivity and 86% specificity for classifying resilient participants, and about 70% sensitivity and 89% specificity for classifying vulnerable participants. These results suggest features derived from a single 10-min PVT at baseline can provide substantial, but incomplete information about a person’s relative attentional vulnerability to total sleep deprivation. In the long term, modeling approaches that incorporate baseline performance characteristics can potentially improve personalized predictions of attentional performance when sleep deprivation cannot be avoided.

Effect of Acute, Subacute, and Repeated Exposure to High Altitude (5050 m) on Psychomotor Vigilance.

Aim: High altitude (HA) hypoxia may affect cognitive performance and sleep quality. Further, vigilance is reduced following sleep deprivation. We investigated the effect on vigilance, actigraphic sleep indices, and their relationships with acute mountain sickness (AMS) during very HA exposure, acclimatization, and re-exposure.Methods: A total of 21 healthy altitude-naive individuals (25 ± 4 years; 13 females) completed 2 cycles of altitude exposure separated by 7 days at low altitude (LA, 520 m). Participants slept at 2900 m and spent the day at HA, (5050 m). We report acute altitude exposure on Day 1 (LA vs. HA1) and after 6 days of acclimatization (HA1 vs. HA6). Vigilance was quantified by reaction speed in the 10-min psychomotor vigilance test reaction speed (PVT-RS). AMS was evaluated using the Environmental Symptoms Questionnaire Cerebral Score (AMS-C score). Nocturnal rest/activity was recorded to estimate sleep duration using actigraphy.Results: In Cycle 1, PVT-RS was slower at HA1 compared to LA (4.1 ± 0.8 vs. 4.5 ± 0.6 s-1, respectively, p = 0.029), but not at HA6 (4.6 ± 0.7; p > 0.05). In Cycle 2, PVT-RS at HA1 (4.6 ± 0.7) and HA6 (4.8 ± 0.6) were not different from LA (4.8 ± 0.6, p > 0.05) and significantly greater than corresponding values in Cycle 1. In both cycles, AMS scores were higher at HA1 than at LA and HA6 (p < 0.05). Estimated sleep durations (TST) at LA, 1st and 5th nights were 431.3 ± 28.7, 418.1 ± 48.6, and 379.7 ± 51.4 min, respectively, in Cycle 1 and they were significantly reduced during acclimatization exposures (LA vs. 1st night, p > 0.05; LA vs. 5th night, p = 0.012; and 1st vs. 5th night, p = 0.054). LA, 1st and 5th nights TST in Cycle 2 were 477.5 ± 96.9, 430.9 ± 34, and 341.4 ± 32.2, respectively, and we observed similar deteriorations in TST as in Cycle 1 (LA vs. 1st night, p > 0.05; LA vs. 5th night, p = 0.001; and 1st vs. 5th night, p < 0.0001). At HA1, subjects who reported higher AMS-C scores exhibited slower PVT-RS (r = -0.56; p < 0.01). Subjects with higher AMS-C scores took longer time to react to the stimuli during acute exposure (r = 0.62, p < 0.01) during HA1 of Cycle 1.Conclusion: Acute exposure to HA reduces the PVT-RS. Altitude acclimatization over 6 days recovers the reaction speed and prevents impairments during subsequent altitude re-exposure after 1 week spent near sea level. However, acclimatization does not lead to improvement in total sleep time during acute and subacute exposures.

The psychomotor vigilance test: a comparison of different test durations in elite athletes

ABSTRACTThe 10-min Psychomotor Vigilance Test (PVT-10) is regarded as the gold-standard for assessing vigilant attention following sleep loss; however, other studies have investigated whether shorter versions of the test elicit similar results to the PVT-10. The present study compared the PVT-10 with 3-min (PVT-3) and 5-min (PVT-5) versions of the test in elite female basketball players. Athletes performed all three tests in the morning and evening for seven consecutive days. Response speed (mean reciprocal reaction time; mean 1/RT), number of errors and number of lapses were determined for each test and time point. The PVT-3 elicited significantly faster response speeds than the other two tests (p < 0.01), while the PVT-5 and PVT-10 were not different. The PVT-10 resulted in more lapses than the PVT-5, followed by the PVT-3, with all tests being significantly different to each other (p < 0.01). In conclusion, while the PVT-5 and PVT-10 were generally similar for response speed, the PVT-3 did not produce results comparable with the PVT-10 for response speed, lapses or errors, and should therefore not be used interchangeably. Further research is required to determine whether the shorter tests are a suitable replacement for the PVT-10 in professional basketball players.

Time-on-Task Effect During Sleep Deprivation in Healthy Young Adults Is Modulated by Dopamine Transporter Genotype.

The time-on-task (TOT) effect and total sleep deprivation (TSD) have similar effects on neurobehavioral functioning, including increased performance instability during tasks requiring sustained attention. The TOT effect is exacerbated by TSD, suggesting potentially overlapping mechanisms. We probed these mechanisms by investigating genotype-phenotype relationships on psychomotor vigilance test (PVT) performance for 3 a-priori selected genes previously linked to the TOT effect and/or TSD: dopamine active transporter 1 (DAT1), catechol-O-methyltransferase (COMT), and tumor necrosis factor alpha (TNFα). N = 82 healthy adults participated in 1 of 3 laboratory studies. A 10-min PVT was administered repeatedly during 38 h of TSD. We assessed changes in response time (RT) across each minute of the PVT as a function of time awake and genotype. Additionally, cumulative relative RT frequency distributions were constructed to examine changes in performance from the first to the second 5 min of the PVT as a function of genotype. DAT1, COMT, and TNFα were associated with differences in the build-up of the TOT effect across the 10-min PVT. DAT1 additionally modulated the interaction between TSD and the TOT effect. Subjects homozygous for the DAT1 10-repeat allele were relatively protected against TOT deficits on the PVT during TSD compared to carriers of the 9-repeat allele. DAT1 is known to regulate dopamine reuptake and is highly expressed in the striatum. Our results implicate striatal dopamine in mechanisms involved in performance instability that appear to be common to TSD and the TOT effect. Furthermore, DAT1 may be a candidate biomarker of resilience to the build-up of performance impairment across TOT due to TSD.

Preliminary validation study of the 3-min wrist-worn psychomotor vigilance test.

The 10-min psychomotor vigilance test (PVT) is a widely used tool to assess behavioral alertness. In operational environments, however, the 3-min version of the PVT is more practicable. Under controlled laboratory conditions, we compared performance on the 3-min PVT on a wrist-worn device with the 3-min PVT on a laptop computer. We conducted two repeated measures experiments (72 participants) to assess the effects of PVT device type (laptop or wrist-worn), backlight on the wrist-worn device (on or off), ambient light (low or normal levels), and interstimulus interval (ISI). First, we compared the wrist-worn PVT (ISI of 2-10s) with the laptop-based PVT (ISI of 1-4s). Participants performed six PVT trials counterbalanced for order of ambient light and device type. In both ambient-lighting conditions, the median differences in PVT metrics (reaction time, response speed, and percentage of 355-ms or 500-ms lapses combined with false starts) between the laptop and the wrist-worn PVT with the backlight on were less than 4.5%. Specifically, the median difference in reaction times was less than 10ms. However, the standard deviation in most metrics using the wrist-worn PVT was twice that of the laptop. In a second experiment, we compared the wrist-worn and laptop PVTs with the same ISIs (1-4s) in normal light conditions. The results suggest that PVT data can be collected reliably in the field using the wrist-worn device with the backlight on and an ISI of 2-10s.

Sleepiness, parkinsonian features and sustained attention in mild Alzheimer's disease

we previously demonstrated that patients with mild Alzheimer's disease and parkinsonian features (AD+PF) are at a higher risk of having daytime sleepiness than mild AD patients without PF (AD-PF). to determine whether AD+PF patients demonstrate a known a consequence of daytime sleepiness, reduced performance-based sustained attention, compared with AD-PF patients. a nocturnal polysomnogram and a next-day multiple sleep latency test (MSLT) were performed. Between MSLT nap opportunities, a 10-min psychomotor vigilance test (PVT) was administered and analysed for reciprocal mean response times (IMEAN), number of lapses (LAPSE) and reciprocal mean slowest 10% (ISLOW). a total of 35 patients met criteria (AD+PF, n=16; AD-PF, n=19). Comparatively, the AD+PF group had slower IMEAN results [F((1,28))=6.64, P<0.05] and higher LAPSE rates [F((1,27))=7.57, P<0.05]. ISLOW measures were not different between groups. When accounting for MSLT results, IMEAN and LAPSE results were no longer significantly different between groups during morning tests, but remained significantly different on afternoon tests. PFs in mild AD are associated with decreased sustained attention as measured by the PVT. Sleepiness did not fully account for the impairment in sustained attention, suggesting that the presence of PFs has an independent negative association with sustained attention in mild AD.

Validity and sensitivity of a brief psychomotor vigilance test (PVT-B) to total and partial sleep deprivation

The Psychomotor Vigilance Test (PVT) objectively assesses fatigue-related changes in alertness associated with sleep loss, extended wakefulness, circadian misalignment, and time on task. The standard 10-min PVT is often considered impractical in applied contexts. To address this limitation, we developed a modified brief 3-min version of the PVT (PVT-B). The PVT-B was validated in controlled laboratory studies with 74 healthy subjects (34 female, aged 22–45 years) that participated either in a total sleep deprivation (TSD) study involving 33 h awake ( N=31 subjects) or in a partial sleep deprivation (PSD) protocol involving 5 consecutive nights of 4 h time in bed ( N=43 subjects). PVT and PVT-B were performed regularly during wakefulness. Effect sizes of 5 key PVT outcomes were larger for TSD than PSD and larger for PVT than for PVT-B for all outcomes. Effect size was largest for response speed (reciprocal response time) for both the PVT-B and the PVT in both TSD and PSD. According to Cohen's criteria, effect sizes for the PVT-B were still large (TSD) or medium to large (PSD, except for fastest 10% RT). Compared to the 70% decrease in test duration the 22.7% (range 6.9–67.8%) average decrease in effect size was deemed an acceptable trade-off between duration and sensitivity. Overall, PVT-B performance had faster response times, more false starts and fewer lapses than PVT performance (all p<0.01). After reducing the lapse threshold from 500 to 355 ms for PVT-B, mixed model ANOVAs indicated no differential sensitivity to sleep loss between PVT-B and PVT for all outcome variables (all P>0.15) but the fastest 10% response times during PSD ( P<0.001), and effect sizes increased from 1.38 to 1.49 (TSD) and 0.65 to 0.76 (PSD), respectively. In conclusion, PVT-B tracked standard 10-min PVT performance throughout both TSD and PSD, and yielded medium to large effect sizes. PVT-B may be a useful tool for assessing behavioral alertness in settings where the duration of the 10-min PVT is considered impractical, although further validation in applied settings is needed.

Sleep and psychomotor vigilance in female shiftworkers.

The purpose of this study was to evaluate the relationships between sleep and psychomotor vigilance in female nurses and the changes in these variables over time. Participants comprised 16 staff registered nurses (10 day, 6 night; aged 30-65 years [M = 47.6; SD = 8.1]) who wore wrist actigraphs continuously and completed a 10-min psychomotor vigilance test (PVT-192, Ambulatory Monitoring, Inc., Ardsley, New York) and the Stanford Sleepiness Scale (SSS) in their homes before and after work for three consecutive 24-hr periods. Repeated measures ANOVA revealed that night nurses slept significantly less than day nurses, F(1, 15) = 26.06, p ≤ .001; M = 227.88 ± 37.03 min versus M = 365.75 ± 59.01 min, respectively, daily for three consecutive days. Night nurses napped more frequently and had more changes in the length of their main sleep periods than day nurses. Day nurses reported more wake episodes during main sleep periods. Night nurses were sleepier after work than day nurses; both groups had increased sleepiness after work for the first 2 days and similar psychomotor vigilance test results. These findings suggest that sleep deprivation, irregular sleep patterns, and sleepiness are significant issues for shiftworking nurses. Future study of the characteristics of sleep and sleepiness in a larger sample would be useful to evaluate the focus for interventions to improve sleep and alertness in shiftworking nurses.

Maximizing Sensitivity of the Psychomotor Vigilance Test (PVT) to Sleep Loss

The psychomotor vigilance test (PVT) is among the most widely used measures of behavioral alertness, but there is large variation among published studies in PVT performance outcomes and test durations. To promote standardization of the PVT and increase its sensitivity and specificity to sleep loss, we determined PVT metrics and task durations that optimally discriminated sleep deprived subjects from alert subjects. Repeated-measures experiments involving 10-min PVT assessments every 2 h across both acute total sleep deprivation (TSD) and 5 days of chronic partial sleep deprivation (PSD). Controlled laboratory environment. 74 healthy subjects (34 female), aged 22-45 years. TSD experiment involving 33 h awake (N = 31 subjects) and a PSD experiment involving 5 nights of 4 h time in bed (N = 43 subjects). In a paired t-test paradigm and for both TSD and PSD, effect sizes of 10 different PVT performance outcomes were calculated. Effect sizes were high for both TSD (1.59-1.94) and PSD (0.88-1.21) for PVT metrics related to lapses and to measures of psychomotor speed, i.e., mean 1/RT (response time) and mean slowest 10% 1/RT. In contrast, PVT mean and median RT outcomes scored low to moderate effect sizes influenced by extreme values. Analyses facilitating only portions of the full 10-min PVT indicated that for some outcomes, high effect sizes could be achieved with PVT durations considerably shorter than 10 min, although metrics involving lapses seemed to profit from longer test durations in TSD. Due to their superior conceptual and statistical properties and high sensitivity to sleep deprivation, metrics involving response speed and lapses should be considered primary outcomes for the 10-min PVT. In contrast, PVT mean and median metrics, which are among the most widely used outcomes, should be avoided as primary measures of alertness. Our analyses also suggest that some shorter-duration PVT versions may be sensitive to sleep loss, depending on the outcome variable selected, although this will need to be confirmed in comparative analyses of separate duration versions of the PVT. Using both sensitive PVT metrics and optimal test durations maximizes the sensitivity of the PVT to sleep loss and therefore potentially decreases the sample size needed to detect the same neurobehavioral deficit. We propose criteria to better standardize the 10-min PVT and facilitate between-study comparisons and meta-analyses.