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If this assertion is correct, it implies that the amount of impairment on tests that putatively assess the same cognitive domain may still differ considerably following SD.
In other words, the validity of these tests in assessing the cognitive process may not be as high after SD. For example, total SD is known to exacerbate the time-on-task effect Doran et al.
To obtain an objective standard of impairment, therefore, it may be necessary to establish norms on several of the most commonly used tests in each domain.
Although it would have been interesting to test the moderating effect of self-paced and work-paced paradigms in this analysis, these variables were highly confounded with cognitive domain i.
From the data obtained in the main effects, however, we can infer that the differential effects of self-paced versus work paced on accuracy and reaction time measures are unlikely to be significant as suggested in previous meta-analyses.
Instead, it is possible that these effects are present only under certain conditions e. As stated in the introduction, the chief objective of this meta-analysis was not to rule out any particular theoretical model but to direct attention to which of these models may have the greatest importance in explaining the real-world consequences of total SD.
Although total SD does produce statistically significant differences in most cognitive domains, the largest effects are seen in tests of simple, sustained attention.
Moreover, relatively brief failures of vigilance may potentially lead to disastrous consequences.
We argue, therefore, that this cognitive module is of the greatest practical concern in combating SD-related problems in real-world situations.
A striking feature of this deficit in sustained attention is how rapidly large changes emerge. Although our analysis was restricted to subjects who had gone a single night without sleep, effect sizes were still large for both speed and accuracy measures on simple attention tasks.
These findings support the data showing that deficits in sustained attention often presage the other observable cognitive effects of SD and may have considerable utility as an early warning system for imminent cognitive failure.
This cognitive component should therefore be one of the primary targets of assessment for work fitness and a basis for decisions on whether subsequent countermeasures should be applied.
On the next rung of the hierarchy, we note that tests of working memory and other tests of executive attention are also robustly affected by one night of SD.
Considerable research has been conducted over the past several decades to assess the effects of SD on decision making and its component subprocesses e.
Finally, although tests of processing speed and cognitive throughput such as the Digit Symbol Substitution Test are commonly used in SD paradigms, the results of this analysis demonstrate that their effects are relatively small compared with those of other tests.
The implication of this finding is that changes in processing speed may be theoretically interesting but not of great practical significance in explaining and predicting real-world cognitive failures Monk, This analysis contains a small number of limitations that may have affected the validity of the conclusions drawn.
As we were able to obtain only a small amount of unpublished data, it is possible that there was a bias in the analysis toward effect sizes that reached statistical significance.
We are, therefore, relatively confident that the study was not greatly affected by publication bias. Although every effort was made in this analysis to classify studies into appropriate and meaningful categories, it is clear that with the possible exception of simple attention, pure assays of most of the cognitive domains we have identified do not exist.
Moreover, there remained numerous dissimilarities among the forms and characteristics of the tests within each category e. As discussed, this is the most likely reason why heterogeneity was in the moderate range for almost all categories studied.
Despite these drawbacks, we propose that our taxonomy is a useful heuristic for several reasons. First, significant between-categories differences were found in the meta-analysis, suggesting that we have captured meaningful constructs with the classification we employed.
Second, we have stayed faithful to categories that are well defined in the neuropsychological literature. In many cases, focal deficits on these tests have been observed in patients with specific pathologies or injuries e.
Finally, several of the domains studied here have relatively high external validity. For instance, the challenge in simple attention tasks is similar to the real-world demands on air traffic controllers, and tasks such as the Psychomotor Vigilance Test have been shown to correlate highly with other indicators of dangerous, drowsy driving Dinges et al.
We were not able to study a number of moderator effects that may be important predictors of the residual intradomain heterogeneity.
Task duration is likely to be one of these factors, with longer tasks associated with greater effect sizes due to the presence of the time-on-task effect.
We were unable to code this moderator chiefly because many articles did not report task length and because of the variability in time to completion for all tasks that were self-paced.
As we have already mentioned, the difference between self-paced and work-paced tests was highly confounded with cognitive domain, making it unfeasible to test this as a moderator.
Finally, a substantial number of studies entered into this meta-analysis reported only accuracy or reaction time as a dependent variable in their final published work.
As a result, we could not conduct paired comparisons of these measures to assess their reliability.
We encourage authors publishing in this field in the future to consider reporting both accuracy and reaction time measures where appropriate so that their relationship after SD can be better explored.
We also suggest that, wherever possible, data from individual test bouts and not just omnibus F values for a series of bouts be reported, so as to enable the inclusion of more studies in future quantitative syntheses.
The results of this analysis have revealed the pattern of effects across cognitive domains and outcomes after a period of short-term total SD.
Overall, there was a significant difference among cognitive domains, but not between speed and accuracy, suggesting that SD has differential effects on different cognitive processes but does not bias subjects toward either faster or more accurate responding in any of these domains.
As some of the known key moderators of this effect did not explain the remaining between-studies variance, we infer that that the remaining heterogeneity is due to intertest differences and that test characteristics can influence the level of performance in the sleep-deprived state even when they are ostensibly assessing the same cognitive domain.
Finally, our results indicate that simple attention is the cognitive domain most strongly affected by short-term SD.
Although decrements in other cognitive modules such as decision-making and memory processes no doubt contribute to real-world errors and accidents, the results of this analysis argue that deficits in sustained attention may represent the most parsimonious explanation for these occurrences.
Thus, in light of these and other data, we believe that countermeasures targeting this cognitive module may be the most efficient means of accident prevention in industries where SD poses a significant safety risk.
David F. We wish to thank Oo Htaik for his assistance in coding study quality and moderator variables.
In cases where reliability information for a particular test was not available, we first searched the literature for tests that were highly similar to the one used, then as a last resort used the average reliability from tests within the respective cognitive domain.
In all cases, separate reliability coefficients were located and used for accuracy and reaction time measures.
For the purposes of comparison, the supplemental materials table reports pooled effect sizes for each cognitive domain with and without these study-quality weights.
References marked with an asterisk indicate studies included in the meta-analysis that are discussed in the text. National Center for Biotechnology Information , U.
Psychol Bull. Author manuscript; available in PMC Feb Julian Lim and David F. Author information Copyright and License information Disclaimer.
Copyright notice. The publisher's final edited version of this article is available at Psychol Bull. See other articles in PMC that cite the published article.
Keywords: sleep deprivation, meta-analysis, attention, working memory, processing speed. The Neuropsychological Hypothesis Several reviewers have suggested that SD has domain-specific effects on cognition, with particular focus on tasks mediated by prefrontal cortex PFC function.
The Vigilance Hypothesis Finally, other reviewers have singled out arousal and vigilance as general factors that explain much of the variance in cognitive deficits following sleep loss.
Prior Meta-Analyses To our knowledge, three meta-analyses have been conducted to date on the effects of SD on performance.
Method Study Selection Our primary collection of literature was gathered by searching online electronic databases for articles relevant to our topic of interest through December These criteria were as follows: Participants in the study must all have been healthy adults aged 18 years and older.
Table 1 List of Studies and Effect Sizes. Open in a separate window. Effect sizes were calculated on the basis of change from baseline performance to performance at the melatonin midpoint, which was around hr for each subject.
Tasks were performed while subjects underwent positron emission tomography scanning. Cognitive Domains Each cognitive test was assigned a domain according to the classification scheme below.
Complex attention Tests in complex attention assessed all attentional processes more demanding than those in the first category e. Processing speed Tests in processing speed primarily assessed cognitive throughput or processing speed, requiring multiple repetitions of a rehearsed process within a fixed period.
Short-term memory Tests in short-term memory involved the encoding, maintenance, and retrieval of information. Reasoning and crystallized intelligence Tests in reasoning and crystallized intelligence assessed mental processes such as problem solving, vocabulary exercises, and other forms of crystallized cognitive ability.
Verbal fluency We had originally intended to analyze tests of verbal fluency e. Coding for Study Quality It has been recommended that studies entered into a meta-analysis be coded for study quality Chalmers et al.
Adequacy of control group Were the treatment and control groups equal in number? Subject recruitment Were subjects randomly recruited from the population?
Quality of statistical analysis Were appropriate statistical tests used to analyze the data? Adequacy of measures used Did the cognitive tests used appropriately capture the construct of interest?
Adequacy of control over SD Was the study conducted in a sleep laboratory? Adequacy of control over sleep history Were participants screened for good sleep history or absence of sleep disorders?
Coding Reliability Studies were assessed and coded by two independent raters Julian Lim and one other rater who was trained on the criteria above.
Other Study Variables In addition to coding for study quality, we recorded the following variables for use as potential moderators in the secondary analysis: length of SD and the times of test administration which were used to calculate circadian offset.
Effect Size Calculation The primary metric of the meta-analysis is the effect size, which is a standardized estimate of the magnitude of the treatment effect.
Calculation of Sampling Variance We computed the within-studies variance due to sampling error Var e for each of the data sets using Equation 6 for within-subjects studies and Equation 7 for between-subjects studies.
Meta-Analysis Procedure Separate analyses were conducted for accuracy or lapses and speed for the cognitive domains of simple attention, complex attention, working memory, and processing speed.
Results A complete list of studies and individual effect sizes is presented in Table 1. Aggregate Effect Sizes Average effect sizes for each cognitive domain and outcome are presented in Table 2.
Cognitive domain z Simple attention 0. Figure 1. Figure 2. Moderator Analyses We coded three study variables to test their impact as moderators of the effect of SD.
Discussion The results from our meta-analysis support the conclusions of previous reviews that short-term total SD has a significant deleterious effect across most cognitive domains.
Figure 3. Moderator Analysis Of the three moderator variables studied, only hours awake homeostatic sleep drive or sleep pressure was a significant moderator of the effect of SD, and only for accuracy, not reaction time variables.
Theoretical Implications As stated in the introduction, the chief objective of this meta-analysis was not to rule out any particular theoretical model but to direct attention to which of these models may have the greatest importance in explaining the real-world consequences of total SD.
Limitations This analysis contains a small number of limitations that may have affected the validity of the conclusions drawn.
Conclusions The results of this analysis have revealed the pattern of effects across cognitive domains and outcomes after a period of short-term total SD.
References References marked with an asterisk indicate studies included in the meta-analysis that are discussed in the text.
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