Brandy Solheim1, Knut Langsrud2, Håvard Kallestad3, Alexander Olsen4, Bjørn Bjorvatn5, Trond Sand6. 1. Department of Clinical Neurosciences, Norwegian University of Science and Technology, Trondheim, Norway. Electronic address: brandy.solheim@ntnu.no. 2. Department of Clinical Neurosciences, Norwegian University of Science and Technology, Trondheim, Norway; Department of Psychiatry, St Olavs Hospital, Trondheim, Norway. 3. Department of Psychiatry, St Olavs Hospital, Trondheim, Norway. 4. MI Laboratory and Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Department of Physical Medicine and Rehabilitation, St Olavs Hospital, Trondheim, Norway. 5. Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway. 6. Department of Clinical Neurosciences, Norwegian University of Science and Technology, Trondheim, Norway; Department of Neurology and Clinical Neurophysiology, St Olavs Hospital, Trondheim, Norway.
Abstract
OBJECTIVES: Difficult awakening is a key symptom of delayed sleep phase disorder (DSPD), but no studies have quantified awakening thresholds in a sleep laboratory. This study assessed whether cognitive function was impaired after awakening and whether difficult awakening was associated with specific polysomnographic features such as slow wave sleep stage N3. METHODS: Nine patients with DSPD and nine sex- and age-matched healthy controls were included. Polysomnography was performed at our university hospital from midnight. An alarm clock was activated at 07:00 with sound intensity increasing from 72 to 104 dB. Participants performed a continuous performance test (CPT) the previous afternoon and immediately upon awakening. RESULTS: Three DSPD patients and zero controls did not wake up to the maximum 104 dB alarm sound; all three patients were in rapid eye movement (REM) sleep when the alarm clock went off (difference in proportions, P = 0.047). In patients, CPT reaction time was prolonged in the morning compared to the afternoon [analysis of variance (ANOVA) interaction, P = 0.01]. DSPD patients made more omission errors than controls regardless of time of the day (ANOVA main effect, P = 0.046). CONCLUSION: Difficult awakening from slow wave sleep was not observed. A subgroup of DSPD patients may have a severe problem waking up from REM sleep. DSPD patients may also have a state-like impairment in cognitive function in the morning and a trait-like impairment not depending on time of day, compared to normal sleepers.
OBJECTIVES: Difficult awakening is a key symptom of delayed sleep phase disorder (DSPD), but no studies have quantified awakening thresholds in a sleep laboratory. This study assessed whether cognitive function was impaired after awakening and whether difficult awakening was associated with specific polysomnographic features such as slow wave sleep stage N3. METHODS: Nine patients with DSPD and nine sex- and age-matched healthy controls were included. Polysomnography was performed at our university hospital from midnight. An alarm clock was activated at 07:00 with sound intensity increasing from 72 to 104 dB. Participants performed a continuous performance test (CPT) the previous afternoon and immediately upon awakening. RESULTS: Three DSPDpatients and zero controls did not wake up to the maximum 104 dB alarm sound; all three patients were in rapid eye movement (REM) sleep when the alarm clock went off (difference in proportions, P = 0.047). In patients, CPT reaction time was prolonged in the morning compared to the afternoon [analysis of variance (ANOVA) interaction, P = 0.01]. DSPDpatients made more omission errors than controls regardless of time of the day (ANOVA main effect, P = 0.046). CONCLUSION: Difficult awakening from slow wave sleep was not observed. A subgroup of DSPDpatients may have a severe problem waking up from REM sleep. DSPDpatients may also have a state-like impairment in cognitive function in the morning and a trait-like impairment not depending on time of day, compared to normal sleepers.