@article{ec1fb8b83b764c1b89bf7c9ffd880999,
title = "Chronic sleep curtailment, even without extended (>16-h) wakefulness, degrades human vigilance performance",
abstract = "Millions of individuals routinely remain awake for more than 18 h daily, which causes performance decrements. It is unknown if these functional impairments are the result of that extended wakefulness or from the associated shortened sleep durations. We therefore examined changes in objective reaction time performance and subjective alertness in a 32-d inpatient protocol in which participants were scheduled to wakefulness durations below 16 h while on a 20-h “day,” with randomization into standard sleep:wake ratio (1:2) or chronic sleep restriction (CSR) ratio (1:3.3) conditions. This protocol allowed determination of the contribution of sleep deficiency independent of extended wakefulness, since individual episodes of wakefulness in the CSR condition were only 15.33 h in duration (less than the usual 16 h of wakefulness in a 24-h day) and sleep episodes were 4.67 h in duration each cycle. We found that chronic short sleep duration, even without extended wakefulness, doubled neurobehavioral reaction time performance and increased lapses of attention fivefold, yet did not uniformly decrease self-reported alertness. Further, these impairments in neurobehavioral performance were worsened during the circadian night and were not recovered during the circadian day, indicating that the deleterious effect from the homeostatic buildup of CSR is expressed even during the circadian promotion of daytime arousal. These findings reveal a fundamental aspect of human biology: Chronic insufficient sleep duration equivalent to 5.6 h of sleep opportunity per 24 h impairs neurobehavioral performance and self-assessment of alertness, even without extended wakefulness.",
keywords = "Alertness, Circadian, Forced desynchrony, Insufficient sleep, Sleepiness",
author = "McHill, {Andrew W.} and Hull, {Joseph T.} and Wei Wang and Czeisler, {Charles A.} and Klerman, {Elizabeth B.}",
note = "Funding Information: Conflict of interest statement: C.A.C. has received consulting fees from or served as a paid member of scientific advisory boards for Bose Corporation; Boston Celtics; Boston Red Sox; Columbia River Bar Pilots; Institute of Digital Media and Child Development; Klarman Family Foundation; Koninklijke Philips Electronics, N.V.; Samsung Electronics; Sleep Multimedia, Inc.; and Vanda Pharmaceuticals. He has also received education/research support from Cephalon, Inc., Mary Ann & Stanley Snider via Combined Jewish Philanthropies, Optum, Philips Respironics, Inc., ResMed Foundation, San Francisco Bar Pilots, Schneider, Inc., and Sysco. He has received lecture fees from the Annual Congress of the German Sleep Society (DGSM), CurtCo Media Labs LLC, Global Council on Brain Health/AARP, Harvard School of Public Health, Integritas Communications Group, Maryland Sleep Society, National Sleep Foundation, University of Michigan, and Zurich Insurance Company, Ltd. The Sleep and Health Education Program of the Harvard Medical School Division of Sleep Medicine (which C.A.C. directs) has received educational grant funding from Cephalon, Inc., Jazz Pharmaceuticals, Takeda Pharmaceuticals, Teva Pharmaceuticals Industries, Ltd., Sanofi-Aventis, Inc., Sepracor, Inc., and Wake Up Narcolepsy. He is the incumbent of an endowed professorship provided to Harvard University by Cephalon, Inc., and holds a number of process patents in the field of sleep/circadian rhythms (e.g., photic resetting of the human circadian pacemaker). Since 1985, C.A.C. has also served as an expert on various legal and technical cases related to sleep and/or circadian rhythms, including those involving the following commercial entities: Bombardier, Inc.; Continental Airlines; FedEx; Greyhound; and United Parcel Service. He owns or owned an equity interest in Lifetrac, Inc., Somnus Therapeutics, Inc., and Vanda Pharmaceuticals. He received royalties from McGraw Hill, Houghton Mifflin Harcourt, and Philips Respironics, Inc. for the Actiwatch-2 and Actiwatch-Spectrum devices. His interests were reviewed and managed by Brigham and Women{\textquoteright}s Hospital and Partners HealthCare in accordance with their conflict of interest policies. E.B.K. has received travel reimbursement from the Sleep Technology Council, Wire In-Brain Conference, Free Health LLC, Employer Health Benefit Congress, The Society for Reproductive Investigation, and The Associated Professional Sleep Society, and has served as a consultant in cases involving transportation safety and sleep deprivation. This article is a PNAS Direct Submission. Funding Information: ACKNOWLEDGMENTS. We thank the participants and Center for Clinical Investigation staff for their support in conducting these studies. Funding: NIH (Grants KL2TR002370, F32DK107146, T32HL007901, K24HL105664, R01HL114088, R01GM105018, R01HL128538, P01AG009975, R21HD086392) and NSBRI (Grants HFP02802, HFP04201, HDP0006). Publisher Copyright: {\textcopyright} 2018 National Academy of Sciences. All Rights Reserved.",
year = "2018",
month = jun,
day = "5",
doi = "10.1073/pnas.1706694115",
language = "English (US)",
volume = "115",
pages = "6070--6075",
journal = "Proceedings of the National Academy of Sciences of the United States of America",
issn = "0027-8424",
publisher = "National Academy of Sciences",
number = "23",
}