Postural control after a night without sleep
Introduction
Postural control is determined by an interplay of visual, proprioceptive and vestibular inputs which are dynamically weighted to determine body position and maintain equilibrium. Such control requires attentional resources. To test this point, studies using the dual-task paradigm have proved particularly useful. Pellecchia (2003) asked subjects to maintain equilibrium while performing three different kinds of tasks requiring a steadily increasing level of attention. Postural sways were measured by stabilometric platform and it was found that the biggest postural change occurred when the most difficult task was administered. In line with this study, Maki and McIlroy (1996) found postural sway increased as the attention load of the cognitive tasks given to the subjects increased. Teasdale and Simoneau (2001) studied the efficiency of postural control during a dual-task in both young and elderly adults. Subjects were asked to perform a cognitive task while standing up straight. As in previous studies, as the difficulty of the cognitive task increased, postural sway heightened because of a lack of attentional resources. However, while lower postural control efficiency during dual-task was found in both groups, the elderly subjects proved more sensitive to drops in attention levels than the younger subjects (and hence experienced more postural sways) (Teasdale & Simoneau, 2001). It has been suggested that as age increases, postural control requires greater attentional resources (Fife & Baloh, 1993). This has been ascribed to the malfunctioning of visual (Nashner, Black, & Wall, 1982), vestibular (Norre, Forrez, & Beckers, 1987) and proprioceptive (Lord, Clark, & Webster, 1991) systems.
Some authors have not excluded the role of arousal as potential puzzled factor affecting the efficiency of postural control. Arousal varies regularly over 24 h (circadian rhythm), but might be affected by other variables like sleep deprivation. In our society, many people have to work during the night so a night without sleep is not an exceptional situation. Sleep deprivation induces decreased subjective alertness and cognitive performance. Decreased alertness levels have been found with short- and long-term periods of sleep deprivation, using both objective and subjective measures of sleepiness (Harma et al., 1998). The drop in cognitive performance in simple (Gillberg & Akerstedt, 1998) and complex (Harrison and Horne, 1997, Harrison and Horne, 1998, Harrison and Horne, 1999) tasks was present in the first night of sleep deprivation and increased in the following nights.
Neuropsychological data show that after a night of sleep deprivation, neuronal activity decreases mainly in the cortico-thalamic network, which mediates attention and higher order cognitive performance (Thomas et al., 2000). In a night of sleep deprivation, the bilateral posterior-parietal prefrontal areas (PFC) are less activated (Drummond et al., 1999, Thomas et al., 2000) prompting lower levels of activity in the central executive system. This can affect executive functions such as mental flexibility, behavioural inhibition, thinking and problem solving.
Changes in standing postures over 19, 24 and 48 h of continuous wakefulness have been explained by a drop in attention levels (Gribble & Hertel, 2004; Liu, Higuchi, & Motohashi, 2001; Manganotti, Palermo, Patuzzo, Zanette, & Fiaschi, 2001; Nakano et al., 2001). The effect of sleep deprivation on postural sways is correlated to drops in alertness levels (Liu et al., 2001), peaking when the body temperature reaches its negative peak (Nakano et al., 2001). It is however still unclear how sleep deprivation affects the efficiency of postural control.
Some studies have investigated the effects of sleep deprivation on postural control using centre of pressure (COP), centre of pressure area (COPA) and centre of pressure velocity (COPV) as stabilometric indexes (Caldwell, Prazinko, & Caldwell, 2003; Gribble & Hertel, 2004; Liu et al., 2001, Manganotti et al., 2001, Nakano et al., 2001, Schlesinger et al., 1998; Uimonen, Laitakari, Bloigu, & Sorri, 1994). The COP is the ratio between lateral and antero-posterior mean deviations of postural sways. The present study investigated the effect of 12 h of forced nocturnal wakefulness on postural control efficiency using Romberg's test (Lanska, 2002, Lanska and Goetz, 2000; Thyssen, Brynskov, Jansen, & Munster-Swendsen, 1982), a test never used before for this purpose. This test is named after Moritz von Romberg, who described a patient with tabes dorsalis presenting with complaints of increased unsteadiness in the dark (Romberg, 1853). Romberg's test has subsequently become a commonly performed test in neurological studies to evaluate the spinal cord. In particular, Romberg's test assesses the functional integrity of the entire proprioceptive pathway (Khasnis & Gokula, 2003). At the beginning and end of the period of forced wakefulness in our study, we recorded mean lateral deviation, antero-posterior mean deviation, support surface, statokinesigram length, length in function of surface and Romberg's index. These parameters allowed us to quantify the impact of visual input on postural control comparing the performance of eyes-open and eyes-closed conditions on the efficiency of postural control. Subjective mood and alertness score and body temperature level were also recorded throughout the night.
We expected a decrease in postural control after a whole night without sleep. Manipulating the visual input enabled us to verify if the worsening performance is unspecific (in both eyes-closed and eyes-open conditions) or selective (in only one of the conditions).
Section snippets
Subjects
The experimental sample comprised 55 volunteer students (mean age 23.45 ± 3.29), 39 females (mean age 23.28 ± 3.59) and 16 males (23.87 ± 2.50). After a brief description of the study, subjects read and signed a written consent form.
Materials
Postural sways were measured by stabilometric platform, using the normalised balance platform (NBP) system (Beac Biomedical, 1999). The instrument, constructed in accordance with the specifications of the French Society of Posturology (1986), comprised a smooth surface
Results
Results for body temperature are shown in Fig. 2. The analysis of variance carried out revealed a significant effect of time of day (F5,270 = 29.84−p < .00001). The post-hoc test indicated that body temperature was significantly greater at 22:00 (36.69 ± 0.43) and at 24:00 h (36.56 ± 0.49) than at 02:00 (36.35 ± 0.60), 04:00 (36.17 ± 0.61), 06:00 (36.19 ± 0.48) and 08:00 h (36.24 ± 0.48) (p < .00001). As expected, body temperature reached its lowest level at 04:00 h before increasing slightly. The body temperature
Discussion
The aim of the present work was to study the effect of a night without sleep on postural control. In our study, postural sways were measured for the first time by MD-x, MD-y, SS, SL, LFS and Romberg's index, allowing us to compare eyes-open versus eyes-closed performances. The two recording conditions were kept in constant order, according to standard procedure of Romberg's test. The results illustrated, in general, how the performance worsened when the subjects did the first recording with
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2022, Gait and PostureCitation Excerpt :In regard to COP variables, eight studies [11,24,31,34,37,44,45,49] reported COP velocity in which four studies demonstrated meaningful and higher value of mean sway velocity [11,37] and COP speed in the AP [45] and ML [24,45] directions in response to SD. Fourteen investigations [15–17,20,24,31,32,34,42–45,48,49] also extracted COP displacement, which included COP range (AP and ML) [44,45], variance of torque of AP and lateral movements [43], RMS sway of AP [31,44,48] and ML [44] directions, standard deviation of mean displacement in the AP and ML [15,20,42], mean displacement (AP and ML) [15,16,20,42,49], whole path length [15,42], unit area path length [42], and total displacement length of COP [17]. Many of the studies found a significant difference for COP displacement variables; in particular, COP rangeAP [44,45], SDAP and ML [15,20,42], swayAP [24,32,34], swayML [24], RMSLAP [31], and total displacement length of COP [15,17] increased, after SD.
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