brain

sciences
Editorial
The Mechanisms of Sleep Function and Regulation for Health
and Cognitive Performance
Marco Fabbri

Department of Psychology, University of Campania Luigi Vanvitelli, 81100 Casert, Italy;

[email protected]; Tel.: +39-0823-275333

Although we spend about one third of our life sleeping, the function and regulation
of sleep remain scientific enigmas. It has been widely proposed that sleep function and
sleep regulation are inseparable, although there is a lack of consensus concerning their
mechanisms. This Special Issue includes ten papers that highlight this topic from different
points of view. For example, Barbato [1] presents a comprehensive review of the rapid eye
movement (REM) density mechanisms as an index of sleep satiety and a sensitive measure
of sleep homeostasis, in addition to the analysis of slow wave activity. The review clearly
presents the relevance of REM density as a possible index of the intensity of REM sleep,
which is generally altered in depressed patients. Given that the discovery of REM sleep has
consistently influenced the scientific community in studying the sleep architecture and its
association with cognitive function and psychophysical well-being, Barbato [1] presents an
interesting analysis of how REM density can be considered a physiological marker of the
“time to wake” during sleep.
Another perspective of the focus of the Special Issue is that of assessing patients with
sleep disorders in their cognitive functioning. Fabbri et al. [2] categorized individuals from
the general population into normal, subclinical, and moderate/severe sleep groups accord-
ing to their Insomnia Severity Index (ISI) scores and requested participants to perform a
visual dot-probe task. The results seemed to support the evidence for several cognitive
models of insomnia, with a potential utility for the clinical assessment of insomnia. In a
similar way, Castelnovo et al. [3] present the neuropsychological and neurophysiological
assessment of a group of chronic insomniacs and long-term, high-dosage benzodiazepine
(BDZ) treatment. This cross-sectional study revealed a specific frontal dysfunction in their
unique sample and should reinforce the vulnerability of the prefrontal cortex due to sleep
Citation: Fabbri, M. The Mechanisms
loss or disturbed sleep. This last assumption was further investigated by You et al. [4]
of Sleep Function and Regulation for
analyzing the oxygen changes in the prefrontal cortex in short-sleep young adults with
Health and Cognitive Performance.
different physical activity levels during the execution of a Stroop task. The results showed
Brain Sci. 2023, 13, 1680. https://
doi.org/10.3390/brainsci13121680
not only the involvement of different brain regions in the cognitive performance but also
the importance of a balance between physical activities and sleep for cognitive functioning
Received: 10 October 2023 in short-sleep population. Notably, D’Este et al. [5] evaluated the influence of cognitive
Accepted: 4 December 2023 reserve on cognitive performance in isolated rapid-eye-movement sleep behavior disorder
Published: 6 December 2023
(iRBD) patients. The results showed that, in this specific sleep disorder group, patients with
high levels of cognitive reserve achieved the best performance in visuo-constructive and
verbal memory functions and reported a lower percentage of mild cognitive impairment.
Copyright: © 2023 by the author.
Considering that the iRBD is recognized as the prodromal stage of neurodegenerative
Licensee MDPI, Basel, Switzerland. disorders, the protective role of the cognitive reserve for cognitive decline could explain
This article is an open access article the intersubject variability in the time of progression of this disease.
distributed under the terms and The importance of a good sleep quality for cognition was demonstrated in two studies
conditions of the Creative Commons in children with specific sleep disorders. In the first study, DelRosso et al. [6] assessed
Attribution (CC BY) license (https:// several cognitive abilities in a small sample of children with restless sleep disorder (RSD),
creativecommons.org/licenses/by/ abilities such as executive functions, attention, memory, cognitive processing, and lan-
4.0/). guage. This exploratory study revealed that children with RSD were mainly affected in

Brain Sci. 2023, 13, 1680. https://doi.org/10.3390/brainsci13121680 https://www.mdpi.com/journal/brainsci

Brain Sci. 2023, 13, 1680 2 of 3

selective attention, cognitive flexibility, and inhibitory control, in addition to daytime

impairment, providing useful information for the clinicians. In the second study [7],
children with different types (i.e., primary snoring, mild obstructive sleep apnea, and mod-
erate/severe obstructive sleep apnea) of sleep-disordered breathing (SDB) were requested
to perform an emotional expression recognition task. The authors found that children with
moderate/severe obstructive sleep apnea tended to exhibit problems in facial expression
categorization, with a possible impact in their social communication ability. The last ap-
proach presented in this Special Issue, as a tentative response to the scientific enigma of the
function and regulation of sleep, assesses the changes in sleep quality in specific situations
and context. On the one hand, the link between sleep and wake was studied through
the relationship between habitual videogame playing and subjective sleep and daytime
quality [8] and by the investigation of a specific phenomenon observed after morning
awakening, that is, the sleep inertia [9]. In the first case, De Rosa et al. [8], through results of
their online survey, revealed that participants who were habitual gamers showed delayed
bed- and risetimes and were evening types, but they did not differ in daytime sleepiness
and sleep quality with respect to nonhabitual gamers and non-gamer participants, sug-
gesting a reconsideration of the impact of videogames on well-being. Using an ecological
approach (i.e., motor activity measured using an actigraph) to evaluate the time course of
sleep inertia dissipation in different age groups (from 9 to 70 years old), Tonetti et al. [9]
report that sleep inertia was dissipated in 70 min after spontaneous morning awakening
in line with the cortisol awakening response. In addition, the authors reported that the
sleep inertia was more evident in younger people, suggesting again the importance of
morning cortisol secretion for the decline in subjective sleepiness after the awakening. On
the other hand, it is possible to investigate the sleep function and regulation in specific
settings, such as prison [10]. Specifically, this particular environment plays an influence
on sleep habits and sleep quality. This study [10] confirmed that prisoners showed more
anxiety and depression than controls and that they reported a lower sleep quality with
more signals of insomnia than the controls. Moreover, the objective measure of the sleep
quantity indicated that prisoners reported longer sleep onset and less total sleep time.
This Special Issue provides a unique perspective on how sleep influences several
cognitive functions and psychophysical well-being [11]. In addition, the importance of
sleep can be seen throughout one’s life span, given that sleep is important for healthy
growth and development [12]. Thus, the subjective and objective assessment of changes in
sleep quality, as well as in daytime functioning, in several sleep disorders could not only
shed light on the mechanisms of sleep function and regulation, but also provide useful
information for clinicians in both diagnosis and treatment. This Special Issue could be
considered a “starting point” along the way to elucidating the enigma of sleep.

Acknowledgments: I would like to thank all the authors who contributed to this Special Issue and
the Editorial staff of Brain Science for their support in this Special Issue.
Conflicts of Interest: The author declares no conflict of interest.

References
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2. Fabbri, M.; Simione, L.; Catalano, L.; Mirolli, M.; Martoni, M. Attentional bias for sleep-related words as a function of severity of
insomnia symptoms. Brain Sci. 2023, 13, 50. [CrossRef] [PubMed]
3. Castelnovo, A.; Miano, S.; Ferri, R.; Raggi, A.; Maestri, M.; Bottasini, V.; Anelli, M.; Zucconi, M.; Castronovo, V.; Ferini-Strambi, L.;
et al. Electrophysiological and neuropsychological indices of cognitive dysfunction in patients with chronic insomnia and severe
benzodiazepine use disorder. Brain Sci. 2023, 13, 375. [CrossRef] [PubMed]
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levels: A cross-sectional fNIRS study. Brain Sci. 2023, 13, 171. [CrossRef] [PubMed]
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7. Zhao, F.-J.; Chen, Q.-W.; Wu, Y.; Xie, X.; Xu, Z.; Ni, X. Facial emotion recognition déficit in children with moderate/severe
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does not compromise subjective sleep quality and is associated with improved daytime functioning. Brain Sci. 2023, 13, 279.
[CrossRef] [PubMed]
9. Tonetti, L.; Fabbri, M.; Giovagnoli, S.; Martoni, M.; Occhionero, M.; Natale, V. Time course of motor sleep inertia dissipation
according to age. Brain Sci. 2022, 12, 424. [CrossRef] [PubMed]
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and increased sleep latency in prisoners: A pilot study in an Italian jail. Brain Sci. 2023, 13, 132. [CrossRef] [PubMed]
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Recommended amount of sleep for pediatric populations: A consensus statement of the American Academy of Sleep Medicine. J.
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