Postural control after a night without sleep

doi:10.1016/j.neuropsychologia.2006.03.033

Neuropsychologia

Volume 44, Issue 12, 2006, Pages 2520-2525

https://doi.org/10.1016/j.neuropsychologia.2006.03.033 Get rights and content

Abstract

The present study analysed the efficiency of postural control after 12 h of nocturnal forced wakefulness using Romberg's test comprising 1 min of recording with eyes-open and 1 min of recording with eyes-closed, with a 1 min break between the two sessions. Our aim was to see if the decreased postural control efficiency after a sleepless night was unspecific (in both eyes-closed and eyes-open conditions) or selective (in only one of the conditions). A total of 55 students spent a whole night awake at our laboratory and were tested at 22:00 and 08:00 h. In general, the results showed that postural sway increased, performing the recording from eyes-open to eyes-closed condition. The statokinesigram length (SL or efficiency of the postural system) increased after the sleepless night, while in eyes-open condition, the length in function of surface (LFS or accuracy of postural control) and Romberg's index (or contribution of vision to maintain posture) significantly decreased. This could indicate that after a night without sleep, there is a slower elaboration of visual inputs in the postural control process. On the basis of these results, the effects of sleep deprivation on cognitive performance were considered from a neuropsychological point of view.

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 (F_5,270 = 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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Postural control after a night without sleep

Abstract

Introduction

Section snippets

Subjects

Materials

Results

Discussion

Neuroscience Letters

Clinical Neurophysiology

Physiology and Behaviour

Organic Behaviour and Human Decision Processes

Neuroscience Letters

Psychiatry Research

Gait and Posture

Gait and Posture

Validation of axillary temperature measurement as a biorhythm marker. Study of the sex variable

Archivio Neurobiologia

Static and dynamic posturography in patients with vestibular and cerebellar lesions

Archives of Neurology

Normalised balance platform (NBP) stabilometric system

Sleep deprivation-induced reduction in cortical functional response to serial subtraction

Neuroreport

Disequilibrium of unknown cause in older people

Annuals Neurology

Statistical studies of measurements made on normal man using the standardised platform of clinical stabilometry. (I) Spatial parameters

Agressologie

Changes in postural control during a 48-hr. sleep deprivation period

Perceptual and Motor Skills

A dose-response study of total sleep time and the ability to maintain wakefulness

Journal of Sleep Research

Sleep deprivation affects speech

Sleep

Sleep loss impairs short and novel language tasks having a prefrontal focus

Journal of Sleep Research