Psychomotor Vigilance Task Demonstrates Impaired Vigilance in Disorders with Excessive Daytime Sleepiness

Abstract

Study Objective: The Psychomotor Vigilance Task (PVT) is one of the leading assays of sustained vigilant attention in sleep research and highly sensitive to the effects of sleep loss. Even though PVT is widely used in sleep deprivation studies, little is known about PVT performance in patients suffering from sleep-wake disorders. We aimed to quantify the impact of sleep-wake disorders on PVT outcome measures and examine whether PVT can distinguish between healthy controls and patients with sleep-wake disorders and whether PVT can distinguish between three different disorders that express excessive daytime sleepiness. Methods: We compared PVT data of 143 patients and 67 ageand gender-matched healthy controls. Patients were diagnosed with one of the following sleep-wake disorders: narcolepsy with cataplexy (n = 20), insuffi cient sleep syndrome (ISS, n = 67) and hypersomnia (HS, n = 56). Several PVT outcomes were analyzed: reciprocal mean reaction time, response variability, number of lapses, number of false reaction time, slowest and fastest 10% of reaction time, and duration of lapses. Results: PVT performance was generally better in healthy controls than in patients with any of the sleep-wake disorders analyzed. Patients with narcolepsy and HS performed worse on PVT than subjects with ISS. In controls, but not in patients, older subjects had slower reactions times and higher response variability in PVT. Conclusions: PVT performance shows different patterns in patients with different sleep-wake disorders and control subjects and may add useful information to the diagnostic work-up of sleep-wake disorders. S C I E N T I F I C I N V E S T I G A T I O N SI n current practice and in most clinical studies, diagnostic tests to assess daytime alertness and wakefulness focus almost exclusively on the quantifi cation of excessive daytime sleepiness. Hence, an equally important complaint of patients suffering from sleep-wake disorders has been much less explored, i.e., impaired sustained vigilant performance.In sleep research, Psychomotor Vigilance Task (PVT) has emerged as one of the most widely used tools to assess vigilant attention.1 Vigilance can be defi ned as sustained attention and tonic alertness.2 In sleep deprived individuals, vigilance is the component of cognition that is most consistently and dramatically affected.3 The PVT is a reaction-time test that allows the collection of a large amount of data in a relatively short period of time. These characteristics increase the sensitivity of the test to detect even small changes in vigilant attention, which can wax and wane within seconds. 4Increased sleep drive raises performance variability because of competing sleep-initiating and wake-promoting factors. 5-7Thus, the PVT is highly sensitive to sleep deprivation. 3,8,9 Its reliability and validity have been amply demonstrated, 3 and the test shows virtually no learning curve and is independent of aptitude. 10Research describing PVT performance in sleep-wake disorders is sparse. Some data are available on PVT pe...

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