The Effect of Sleep Deprivation on Executive Functions, Moral Decision Making and Social Cognition

The Effect of Sleep Deprivation on Executive Functions, Moral Decision Making and Social Cognition | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Effect of Sleep Deprivation on Executive Functions, Moral Decision Making and Social Cognition Ilkay Yilmaz, Erol Yildirim This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3953080/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective Sleep is a vital need for human life, and sleep deprivation is a common problem that can have serious consequences. Although the effects of acute sleep deprivation have been frequently reported in the literature, the effects of long-term sleep deprivation have not been well explained. This study investigated the effects of long-term sleep deprivation on executive functions, moral decision making, and social cognition. Method The study involved 85 participants who were between the ages of 20 and 40 and who has not any psychiatric or neurological disorders. The test performance averages of the groups with and without sleep problems were compared. Results The results showed that there was no significant difference in the performance of the two groups on any of the tests. Conclusions The results suggest that long-term sleep deprivation does not have a significant impact on executive functions, moral decision making and social cognition. These results are inconsistent with previous research that has shown that acute sleep deprivation can have a negative impact on these cognitive abilities. However, it is important to note that this study was relatively small, and participants are mostly university student. Further research is needed to confirm these findings. sleep deprivation prefrontal cortex executive functions moral decision making social cognition Introduction Sleep covers 1/3 of human life. During sleep, there are many changes in hormonal and chemical structures. With sleep, the body, and the brain find the opportunity to renew themselves. One of the most important requirements of living a healthy life is to sleep well, otherwise serious deficiencies are observed in our mental abilities [29]. Sleep deprivation is a serious problem that can disrupt the activity of the human brain, cause changes in brain structure and impairments in neurocognitive perforfman [25], [26], [12]. Today, sleep deprivation has become a common health problem in clinics [33]. It is reported that adults slept 9 hours a day in the early 1900s and 7 hours a day in later years, but today individuals sleep significantly less than in the past [33]. For the last 20 years, it has been known that especially the young population have poor sleep quality [3], [6], [35]. Considering the sleep quality in Turkey, the prevalence of poor sleep quality was reported as 55.1% [15]. There are important activities on the prefrontal cortex (PFC) in the brain during sleep. Compared to all other cortical regions, frontal cortical activity has the highest voltage during non-REM sleep. It is also known that dreaming occurs with forebrain structures. This region plays an important role in sleep physiology, dreaming and sleep deprivation [37]. PFC is responsible for the higher mental processes that distinguish humans from other living things; these higher mental functions are known as executive functions. These abilities are of vital importance such as determining and maintaining purposeful behavior, planning, strategy making, decision making, memory, and attention. PFC undertakes high-level human functions and is indispensable for success in a chaotic world and stands out as a connecting point for performing many of these highest and most complex cognitive processes [16], [25]. The dorsolateral part of the PFC, that is, the dorsolateral prefrontal cortex (DLPFC), appears to be responsible for these high-level abilities [43]. Data obtained from related studies also emphasize that PFC is particularly sensitive to sleep, and frontal executive functions are affected due to sleep deprivation [12], [18], [37]. Daily human life confronts us with tasks related to this region and PFC may be tired due to overuse; therefore, it may be particularly vulnerable to the effects of sleep deprivation as cited in [27]. PFC carries out many vital functions, it is one of the areas that needs a healthy sleep the most to rest and rejuvenate. Studies also suggest that sleep deprivation leads to a reduction in the glucose metabolism of the PFC, reducing the 'fuel' of the structures that sustain cognitive processes [48]. Thus, sleep deprivation impairs mental performance and impairs the most sensitive of these functions, attention and executive functions. Moreover, even just 1 night of sleep deprivation is reported to cause impairment in executive functions [30]. Due to the effects of sleep deprivation on the PFC, there are serious deficits in decision making, flexible thinking, and inhibiting impulsive behaviors, as well as executive functions that the DLPFC is responsible [41]. Sleep deprivation disrupts the proper functioning of the PFC and causes serious disruptions in personal and social life [47]. Therefore, the tasks for which the region is responsible are also expected to be disrupted: these are executive functions. Studies report another region most affected by sleep deprivation. This is the ventromedial part of the PFC: the ventromedial prefrontal cortex (VMPFC). Sleep problems have been associated with reduced gray matter in the VMPFC region and has been proven to impair the activity of this region as well. It has been demonstrated that people with sleep disorders such as narcolepsy, obstructive sleep apnea, and chronic insomnia have reduced gray matter volumes in VMPFC regions [26]. VMPFC activity changes significantly after sleep deprivation and increased daytime sleepiness and reduced gray matter in the left VMPFC were significantly associated [11], [26], [32], [52]. This component of the PFC appears to be responsible for critical abilities for social life. Consistent activations in the VMPFC related to social cognition and moral judgments [16], [28]. Social cognition and moral decision-making are interconnected [30]. Social cognition refers to the ability to understand the beliefs and intentions of other people in the social environment and to make predictions about intentions and behaviors. Through social cognition, certain norms are assigned for people, groups and roles with the information obtained about the environment [51]. Information obtained through social cognition contributes to moral cognition and moral decisions. Without these abilities, it would be impossible to maintain social relationships. Lack of these abilities are characterized by disorders such as autism spectrum disorder. Also, patients with VMPFC lesions are notorious for impaired decision-making, psychosocial dysfunction, and inappropriate behavior in the social environment [5]. It has been reported that the signals of decision values formed in the VMPFC change after sleep deprivation, and behaviors such as risk-taking increase after sleep deprivation [23], [25], [32], [36], [45]. Additionally, participants who experience sleep deprivation are more willing to act in violation of personal moral values [24]. These cognitive deficits can lead to riskier outcomes, especially in people working in critical professions [38]. However, there appears to be little interest in social and moral ability. Taking perspective is the main ability underlying social cognition. It has been stated in the limited studies that the participants ability to take the perspective of others regressed after sleep deprivation [13]. The results reveal that sleep deprivation causes poor performance in social cognition tasks [13]. [14]. As mentioned above, VMPFC appears to be responsible for social cognition and moral decision-making. Research has shown the significant effects of sleep deprivation on the VMPFC. It is predicted that the disruptive effect of sleep deprivation on the VMPFC will also lead to impairment of the tasks undertaken by the VMPFC; These tasks are social cognition and moral decision making. When the relevant literature is researched, it is found that research findings are quite limited. Previous studies on sleep deprivation mainly investigated the effects specified period sleep loss by depriving healthy subjects and the results are remarkably similar: Sleep deprivation causes a decrease in performance [13], [20], [24], [30], [38], [47], [48]. However, these declines are temporary and now predictable. In this study, the DLPFC and VMPFC regions of the prefrontal cortex, which are most affected by sleep deprivation, were featured. The reason for this is that it is the brain regions that show the most striking effects against sleep deprivation, and these two brain regions are responsible for the abilities that play a vital role in human life. Also, the side that provides convenience for research is the availability of measurement tools that measure the abilities of these regions and cause activation in these brain regions while being performed. It is known that DLPFC is responsible for executive functions and VMPFC is responsible for moral decision making and social cognition. We combined this two information and investigated how these abilities are affected due to the negative effects of sleep deprivation on the brain. To our knowledge, this is the first study to evaluate executive functions, social cognition, and moral decision-making abilities in brain regions affected by sleep deprivation. To our knowledge, there is no other study evaluating how chronic poor sleep quality affects the functions that guide human life. Method Research Design This study is a static-group comparison design where the independent variable is sleeping problem and the dependent variables are executive functions, moral decision making, and social cognition performances. Participants The sample group of the study consists of 85 university students-graduates, without any neuropsychiatric diagnosis, between the ages of 20–40 and participating in the study on a voluntary basis. The sample size was determined to have at least 30 participants in each group to obtain a statistically significant result. Procedure The study started after receiving Ethics Committee Approval. The Pittsburgh Sleep Quality Index to determine the sleep deprivation level of the participants, the Moral Judgment Test to evaluate the moral decision-making ability; Faux-Pas Test, Iowa Gambling Test (IGT), Stroop Test and Verbal Fluency Tests were used to evaluate executive functions and social cognition. After the data of the study were collected, the participants with a total score of 5 and above from the Pittsburgh Sleep Quality Index were included in the research group with sleep problems/deprivation, and the participants with a total score of less than 5 were included in the control group without sleep problems/deprivation. Then, the performance averages of the groups with and without sleep problems in the Moral Judgment Test, Faux-Pas Test, Iowa Gambling Test, Stroop Test, Tracking Test and Verbal Fluency Test were compared. All tests and scales were applied face to face by the researcher. During the study, an average of 40 minutes of interview was provided with each participant. The data collection phase was completed by the researcher in the same room and physical conditions every day. Measurement Tools and Methods Data collection tools are as follows, in order of application: Pittsburgh Sleep Quality Index (PSQI) Pittsburgh Sleep Quality Index, developed in 1989 [ 9 ]. Turkish validity and reliability study has been completed [ 2 ]. The cronbach alpha value of this index is 0.80. [ 2 ], [ 9 ]. It is a scale that provides quantitative analysis of sleep quality to define well and poor sleep. This scale helps to evaluate the amount of sleep, sleep quality, the presence and severity of sleep problems, if any, in the last month. The items to be scored in the scale are grouped according to 7 components: subjective sleep quality, sleep duration, sleep disturbance, daytime dysfunction, sleep latency (delay), habitual sleep efficiency, and sleep medication use. The total score ranges from 0 to 21, and a total score of 5 or above suggesting significantly sleep disorder [ 17 ]. The total score obtained clearly distinguishes welll sleep quality (PSQI total score ≤ 5) from poor sleep quality (PUKI > 5) [ 2 ]. Moral Judgment Test The moral judgment test was developed by Lind in 1977 to measure the moral judgment levels of individuals, and with this scale, it is aimed to measure all six steps of Kohlberg's Moral Judgment Development theory [ 34 ]. Its validity and reliability study was conducted in Turkey and it was adapted to Turkish [ 10 ]. The test is theoretically based on Kohlberg's theory of cognitive moral development. The Moral Judgment Test consists of arguments involving various moral duties. There are moral dilemmas in the scale where the person who takes this test cannot make a decision without violating serious moral rules and principles. The extent to which 12 arguments are accepted or rejected in each dilemma is returned as -4 “strongly disagree” and + 4 “strongly agree” on the nine- point Likert type scale. Stroop Test This test was developed by Stroop in 1935. Tests related to Stroop tasks are accepted as the 'gold standard' in attention measures [ 21 ]. Reliability and validity for the Turkish population have been demonstrated [ 21 ]. In this study, the Stroop Test TBAG Form was used [ 21 ]. The reliability coefficient of the test is reported as approximately 0.90 [ 21 ]. Participants complete four tasks as part of this test. Resistance to interference is measured by calculating the time difference between the task of just saying the color without reading the colored words and the task of reading the words written in different colours. A stopwatch was used to measure reaction time. Faux-Pas Test Faux-Pas test was developed in 1999 [ 4 ] and an adaptation study was conducted for Turkey [ 40 ]. This test assesses the ability of participants to comprehend that when someone else says something inappropriately wrong, that person said it unintentionally. In order for this inappropriateness to be perceived, it should be perceived that there is something that should not be said in the speech and that it may cause feelings such as sadness and anger in the person exposed to this situation [ 40 ]. This test requires social cognition and empathy skills. There are 20 stories in the original of this test, but not all of the 20 stories were used as in the studies in the literature [ 1 ], [59]. In this study, the 9 most appropriate stories translated into Turkish from the original 20 stories obtained from [ 40 ] were used. After the participant read each story, related questions were asked by the researcher and the answers were noted. Analyzes were made on the answers given by the participants. Verbal Fluency Test Verbal Fluency Test was developed to assess vocabulary and categorical fluency [ 31 ]. The study of norm values for individuals aged 18–49 in the Turkish population was conducted by [ 42 ]. Verbal Fluency Test is used to measure DLPFC functions [ 50 ]. The test mainly assesses executive functions and ability to maintain attention [ 22 ]. For a successful performance, in addition to maintaining attention, the skills of scanning and using the cognitive dictionary flexibly are required. In the vocabulary and category fluency sections, the maximum number of words that can be produced in 1 minute is evaluated [ 22 ].The researcher noted the spoken words and then the total number of words was calculated by subtracting perseveration and out-of-category words. Iowa Gambling Test IGT is a neuropsychological test developed to evaluate patients with VMPFC lesions with impaired decision-making functions [ 7 ]. Norm determination study completed for Turkish sample [ 19 ]. It has been reported that this disorder is safely evaluated by the IGT in studies [ 8 ]. In this research, the computerized version of the IKT program written by Dr. Gulay Buyukaksoy Kaplan and obtained from [ 19 ] was used. When the test starts, there are 4 decks named A, B, C and D on the screen. A and B decks are advantageous, C and D decks are disadvantageous [ 39 ]. For IGT scoring, the number of disadvantageous decks selected during the test was subtracted from the number of advantageous decks. This was done both for all the choices and for 5 separate blocks of 20 choices, and the total scores were calculated. Statistical analysis After the data collection phase, the data were analyzed in terms of missing values and extreme values [ 46 ]. Data were analyzed using Jamovi, version 2.3. The data of 15 out of 100 participants were excluded from the study because they completed the scales incorrectly. The data of the study, collected from 85 participants, were included in the analysis. Initially, Shapiro-Wilk test was used to test whether the data conformed to the normality assumption, and normality was observed only in the animal names category of the Verbal Fluency Test and the third, fourth, fifth and total scores of the Iowa Gambling Test. It was determined that the data other than these did not provide the normality assumption. Then, to separate the study and control groups, the participants with a total score of 5 and above on the PSQI index were included in the research group, and the participants with a total score of less than 5 were included in the control group and divided into two groups. After the data were divided into two groups according to the PSQI index, the executive functions, moral decision making and social cognition performance averages of the study and control groups were compared using the Independent Sample T-test for data that provided normality assumption, and the Mann-Whitney U Test for data that did not provide normality assumption. Moral Judgment Test, Faux-Pas Test, Iowa Gambling Test, Stroop Test, and Verbal Fluency Test performance averages were compared. All data have been made publicly available and can be accessed at [osf.io/wvkpa]. Results Data collected from 85 participants in the study were included in the analysis. Gender distribution of the participants; 67 females (78.82%) and 18 males (21.17%). Out of 85 participants, 80 people (94.12%) have undergraduate education and 5 people (5.88%) graduate education (Table 1 ). The mean age is 22.12 ± 2.77 years. Again, with the help of the same program, the participants with a PSQI score of 5 and above were included in the group with poor sleep, and the participants with a total score of less than 5 were included in the group with good sleep and divided into two groups. 41 (48.23%) out of 85 participants did not experience sleep deprivation; It was determined that 44 (51.76%) experienced sleep deprivation. There were 34 women (82.92%) and 7 men (17.8%) with good sleep quality, 33 women (74.99%) and 11 men (24.99%) with poor sleep quality (Table 2 ). The ages of these two groups were similar (p > .05) (Table 3 and Table 4). Table 1 Participant Demographics Postgraduate Undergraduate Total Male 1 17 18 Female 4 63 67 Total 5 80 85 Table 2 Descriptive Statistics of Sleep Quality Groups PSQI Gender Counts % of Total Cumulative % Well Sleep Male 7 8.2% 8.2% Female 34 40.0% 48.2% Poor Sleep Male 11 12.9% 61.2% Female 33 38.8% 100. 0% Table 3-4 Evaluation of Grups In Terms of Age Variable Statistics df p AGE Student’s t 0.994 83.0 0.323 a Levene’s test is significant (p < .05), suggesting a violation of the assumption of equal variances. Group N Mean Median SD SE AGE Well Sleep 41 22.4 21.0 3.34 0.522 Poor Sleep 44 21.08 21.8 2.11 0.318 Shapiro-Wilk test was used to test the normality assumption of the data and normality was observed only in the animal names category of Verbal Fluency Test and in the third, fourth, fifth and total scores of the Iowa Gambling Test. The Independent Sample T-Test was used for these variables, and the Mann-Whitney U-Test was used for all variables that did not comply with the normality assumption (Table 5 ). Thus, the performance averages of the group with and without sleep problems on the Moral Judgment Test, Pot Breaking Test, Iowa Gambling Test, Stroop Test and Verbal Fluency Test were compared. Table 5 Statistical Analysis Statistic df p AGE Mann-Whitney U 897 0.964 PSQI Mann-Whitney U 0 < .001* Cwert Mann-Whitney U 835 0.561* CwertA Mann-Whitney U 872 0.792* CwertD Mann-Whitney U 841 0.592* Stroop Mann-Whitney U 847 0.628* Faus-Pas Detection Mann-Whitney U 773 0.250* Understanding Inappropriateness Mann-Whitney U 782 0.279* Intentions Mann-Whitney U 830 0.520* Belief Mann-Whitney U 786 0.296* Empathy Mann-Whitney U 819 0.455* Animal Student’s t 0.2314 83.0 0.818** KAS Mann-Whitney U 754 0.194* First20 Mann-Whitney U 872 0.793* Second20 Mann-Whitney U 902 1.000* Third20 Student’s t 0.3261 83.0 0.745** Fourth20 Student’s t 0.1903 83.0 0.850** Fifth20 Student’s t -0.6210 83.0 0.536** IowaTotal Student’s t -0.1995 83.0 0.842** a Levene’s test is significant (p < .05), suggesting a violation of the assumption of equal variances. * Mann-Whitney U; ** Student’s t In the evaluation of the effect of sleep deprivation on executive functions, the Stroop Test TBAG Form and Verbal Fluency Test were applied to the participants. As a result of the analysis, no significant difference was found between the poor sleep and good sleep groups in terms of performance in these tests (p > .05) (Table 5 ). When the effect of sleep deprivation on moral decision-making ability is examined; In the measurement, which includes the evaluation of moral judgment through scenarios, no significant. difference was found between the good sleep quality and poor sleep quality groups in terms of this ability (p > .05) (Table 5 ). The effect of sleep deprivation on social cognition was evaluated with the results of the Faux Pas Test and the Iowa Gambling Test. According to the results of the scale, no significant difference was found between the poor sleep quality and good sleep quality groups in terms of social cognition (p > .05) (Table 5 ). With the results, the null hypothesis (H0) was accepted in this study: Sleep deprivation has no significant effect on executive functions, moral decision making and social cognition. Discussion In the present study, we aimed to evaluate the effect of sleep deprivation on executive functions, moral decision making and social cognition performances. PFC is the brain region most affected by sleep deprivation, significant impairments in the activity of this region are expected due to poor sleep quality. The data of related studies also emphasize that the PFC is particularly sensitive to sleep and that frontal executive functions are affected due to sleep deprivation [ 37 ]. Similarly, [ 20 ] and other studies reported that sleep deprivation causes significant disruptions on high-level mental function tasks such as executive functions; [ 44 ] and [ 49 ] did not report such effects in their study (as cited in [ 25 ]). It can be concluded that some executive functions are affected by sleep deprivation, and some executive functions are not affected by sleep deprivation [ 25 ]. Studies evaluating the effect of sleep deprivation on executive functions, sleep deprivation was generally created in a laboratory and for a relatively short period of time. In this study, it was investigated whether a general sleep deprivation would affect these functions. As concluded in this study, it was found that long term sleep deprivation did not have a significant impairing effect on executive functions. As mentioned above, there is data suggesting that another component of the PFC that is most affected by sleep deprivation is the VMPFC. Consistent activations related to social cognition have been reported in this area [ 28 ]. Also, inappropriate behaviors are observed in the social environment in patients with VMPFC lesions [ 5 ]. Studies on social cognition and sleep deprivation are very limited [ 13 ], [ 14 ]. In this study, ıt was found that there is no significant effect of sleep deprivation on social cognition performances. Neuroimaging studies have revealed consistent activity of the VMPFC for moral judgments. Generally, the effect of sleep deprivation on moral decision-making abilities has been evaluated by inducing sleep deprivation for a certain period of time. It has been reported that participants who experience sleep deprivation are more willing to engage in behaviors that violate personal moral values than other participants [ 24 ]. Another study reported that, moral logic has been decreased in military personnel [ 38 ]. It is highly probable that the acute sleep deprivation will affect mental functions such as moral decisions, it was investigated whether a general sleep deprivation/poor sleep quality would affect these functions. Our results show that poor sleep quality does not have a significant effect on moral decision making. Although studies have shown that acute sleep deprivation has effects on mental functions, this study did not find any effect of general sleep deprivation and poor sleep quality on executive functions, moral decision making, and social cognition. This suggests that the effects of long-term poor sleep quality may be somewhat offset. However, it should be noted that one of the important limitations of the study is the number of participants. Although all healthy adults without any neuropsychiatric disease were invited to be included in this study, the sample group of this study consists of university students/graduates who are easy-to-access due to the current location and conditions. Because of these limitations, it would probably not be appropriate to generalize the results of the study to the general population This study shows that sleep deprivation does not have a significant effect on executive functions, moral decision-making, and social cognition, but the results of a study with a larger and diverse sample group may differ. The effects of long term sleep deprivation on individuals is a very important issue that needs further research. Conclusion This study evaluated the effect of sleep deprivation on high-level abilities. Our results show that executive functions, moral decision making and social cognition abilities performances of people with poor sleep quality do not differ significantly from those with good sleep quality. As stated above, the study has important limitations regarding the number and diversity of participants. In future studies, the effects of sleep deprivation on our daily lives can be re-evaluated with a more diverse group of participants. To the best of our knowledge, this study is the only one investigating the effect of sleep deprivation on these functions. The effects of sleep deprivation have mostly been evaluated by depriving people of sleep for a certain period. These studies have certainly increased our knowledge of sleep. However, this study aimed to draw attention to the impact of long-term sleep deprivation on the most critical cognitive skills of people experiencing sleep deprivation. Studies on acute sleep deprivation show that many functions will deteriorate in a short time. In this case, impaired sleep quality will also cause significant deficits. In the future, there is a need to investigate the effects of poor sleep quality on human functions. Declarations Funding This study was funded by The Scientific and Technological Research Council of Turkey (TUBITAK) 2209-A University Students Research Projects Support Program (2020/2 Term, Application Number: 1919B012005237). Competing Interests The authors have no competing interests to declare that are relevant to the content of this article. Ethics Approval The questionnaire and methodology for this study was approved by the Non-Interventional Clinical Research Ethics committee of the University of Medipol (Ethics approval number: E-10840098-772.02-2346). APA ethical standards were followed in the conduct of the study. Consent to Participate Informed consent was obtained from all individual participants included in the study. Before the scales were applied, the purpose, requirements, and each step to be applied were clearly explained to the participants verbally and they were expected to read and sign the informed consent form. Participants were informed that they could leave the study without giving any reason. In addition, due to the confidentiality principle, it was ensured that the participants did not write their names on any scale. Participants signed informed consent regarding publishing their data. Data Availability Data, headlines, and additional online materials are openly available at the project’s Open Science Framework page (osf.io/wvkpa). Author’s contribution statements All authors contributed to the study conception and design. Study conception and design were performed by [Erol Yildirim] and [Ilkay Yilmaz]. Material preparation and data collection were performed by [Ilkay Yilmaz]. Analysis and interpretation of results were performed by [Erol Yildirim] and [Ilkay Yilmaz]. The first draft of the manuscript was written by [Ilkay Yilmaz] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Acknowledgments This study was supported financially by the Scientific and Technological Research Council of Turkey (TUBITAK) 2209-A University Students Research Projects Support Program (2020/2 Term, Application Number: 1919B012005237). The data collection phase of this study was completed at Ege University School of Medicine, Department of Physiology. We would like to thank especially Ersin Oguz Koylu and our valuable professors from Ege University School of Medicine, Department of Physiology for helping us with the data collection phase by providing the appropriate laboratory. References Abdullayev, A. (2016). Cortical activity assessment by near infrared spectroscopy during facial emotion recognition in schizophrenic patients (Publication No. 443685). [Doctoral dissertation, Ankara University]. YOKTEZ Open. https://tez.yok.gov.tr/UlusalTezMerkezi/tezDetay.jsp?id=s5u26sWPm 7h9VInwBnYyFQ&no=A KKLdK6Hnm8LKEtzCQVOmQ Agargun, M. Y., Kara, H. ve Anlar, O. (1996). 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Venkatraman, V., Chuah, Y. M., Huettel, S. A., & Chee, M. W. (2007). Sleep deprivation elevates expectation of gains and attenuates response to losses following risky decisions. Sleep, 30(5), 603–609. https://doi.org/10.1093/sleep/30.5.603 Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics (5th ed.). Allyn& Bacon/Pearson Education. Tempesta, D., Couyoumdjian, A., Moroni, F., Marzano, C., de Gennaro, L., & Ferrara, M. (2012). The impact of one night of sleep deprivation on moral judgments. Social Neuroscience, 7(3), 292–300. https://doi.org/10.1080/17470919.2011.614002 Thomas, M., Sing, H., Belenky, G., Holcomb, H., Mayberg, H., Dannals, R., Wagner, H., Thorne, D., Popp, K., Rowland, L., Welsh, A., Balwinski, S., & Redmond, D. (2000). Neural basis of alertness and cognitive performance impairments during sleepiness. I. Effects of 24 h of sleep deprivation on waking human regional brain activity. 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Changes in ventromedial prefrontal cortex functional connectivity are correlated with increased risk-taking aier total sleep deprivation. Behavioural Brain Research, 418. https://doi.org/10.1016/j.bbr.2021.113674 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3953080","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":280667654,"identity":"7f4a79ad-dd60-4486-bba6-6ac4f36dc57b","order_by":0,"name":"Ilkay Yilmaz","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIiWNgGAWjYBACNnY2ECUhA+Z9MGAAMQzwa2GGaOEBkYwzDBh4CGphgGgBq2Rg5mEgQgsfM1viZ942Cx7d9uOPP9sU2PHwSyRvYPhRsQ2fww5L87ZJ8JidSUiTzjFI5pGckVbA2HPmNh4t7A0QLQcSjjHnGBzgMbiRY8DM2IZXS/NvsJbzD5s/WxCnhe0YxJYbyQzSDERqSbOccw6k5RmbZA/ILz3PCg7i84t8e5vxjTdldXJm59Mff/jxx06Onz1544MfFbi1gAATLxuayAG86oGA8ccfQkpGwSgYBaNgRAMANCNJ1kEWDDMAAAAASUVORK5CYII=","orcid":"","institution":"Ege University","correspondingAuthor":true,"prefix":"","firstName":"Ilkay","middleName":"","lastName":"Yilmaz","suffix":""},{"id":280667655,"identity":"39f2f87e-6d11-47d0-abd7-5d958cfb47dd","order_by":1,"name":"Erol Yildirim","email":"","orcid":"","institution":"Istanbul Medipol University","correspondingAuthor":false,"prefix":"","firstName":"Erol","middleName":"","lastName":"Yildirim","suffix":""}],"badges":[],"createdAt":"2024-02-13 08:31:31","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3953080/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3953080/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":58623065,"identity":"38bc4728-c936-4cdc-9f2e-9dfefd4ded93","added_by":"auto","created_at":"2024-06-19 03:51:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":509344,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3953080/v1/a766041f-d5a5-48a7-86b1-cb6c21a6fafa.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Effect of Sleep Deprivation on Executive Functions, Moral Decision Making and Social Cognition","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSleep covers 1/3 of human life. During sleep, there are many changes in hormonal and chemical structures. With sleep, the body, and the brain find the opportunity to renew themselves. One of the most important requirements of living a healthy life is to sleep well, otherwise serious deficiencies are observed in our mental abilities [29]. Sleep deprivation is a serious problem that can disrupt the activity of the human brain, cause changes in brain structure and impairments in neurocognitive perforfman [25], [26], [12]. Today, sleep deprivation has become a common health problem in clinics [33]. It is reported that adults slept 9 hours a day in the early 1900s and 7 hours a day in later years, but today individuals sleep significantly less than in the past [33]. For the last 20 years, it has been known that especially the young population have poor sleep quality [3], [6], [35]. Considering the sleep quality in Turkey, the prevalence of poor sleep quality was reported as 55.1% [15].\u003c/p\u003e\n\u003cp\u003eThere\u0026nbsp;are\u0026nbsp;important\u0026nbsp;activities on the prefrontal\u0026nbsp;cortex\u0026nbsp;(PFC) in the brain during sleep. Compared to all other cortical regions, frontal cortical activity has the highest voltage during non-REM sleep. It is also known that dreaming occurs with forebrain\u0026nbsp;structures. This region plays an important role in sleep physiology,\u0026nbsp;dreaming and sleep deprivation [37].\u003c/p\u003e\n\u003cp\u003ePFC is responsible for the higher mental processes that distinguish humans from other living things; these higher mental functions are known as executive functions. These abilities are of vital importance such as determining and maintaining purposeful behavior, planning, strategy making, decision making, memory, and attention. PFC undertakes high-level human functions and is indispensable for success in a chaotic world and stands out as a connecting point for performing many of these highest and most complex cognitive processes [16], [25]. The dorsolateral part of the PFC, that is, the dorsolateral prefrontal cortex (DLPFC), appears to be responsible for these high-level abilities [43].\u003c/p\u003e\n\u003cp\u003eData obtained from related studies also emphasize that PFC is particularly sensitive to sleep, and frontal executive functions are affected due to sleep deprivation [12], [18], [37]. Daily human life confronts us with tasks related to this region and PFC may be tired due to overuse; therefore, it may be particularly vulnerable to the effects of sleep deprivation as cited in [27]. PFC carries out many vital functions, it is one of the areas that needs a healthy sleep the most to rest and rejuvenate. Studies also suggest that sleep deprivation leads to a reduction in the glucose metabolism of the PFC, reducing the \u0026apos;fuel\u0026apos; of the structures that sustain cognitive processes [48]. Thus, sleep deprivation impairs mental performance and impairs the most sensitive of these functions, attention and executive functions. Moreover, even just 1 night of sleep deprivation is reported to cause impairment in executive functions [30]. Due to the effects of sleep deprivation on the PFC, there are serious deficits in decision making, flexible thinking, and inhibiting impulsive behaviors, as well as executive functions that the DLPFC is responsible [41].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSleep deprivation disrupts the proper functioning of\u0026nbsp;the PFC and\u0026nbsp;causes serious\u0026nbsp;disruptions in\u0026nbsp;personal\u0026nbsp;and social life [47].\u0026nbsp;Therefore, the tasks for which the region is responsible are also expected to be disrupted: these are executive functions.\u003c/p\u003e\n\u003cp\u003eStudies report another region most affected by sleep deprivation. This is the ventromedial part of the PFC: the ventromedial prefrontal cortex (VMPFC). Sleep problems have been associated with reduced gray matter in the VMPFC region and has been proven to impair the activity of this region as well. It has been demonstrated that people with sleep disorders such as narcolepsy, obstructive sleep apnea, and chronic insomnia have reduced gray matter volumes in VMPFC regions [26]. VMPFC activity changes significantly after sleep deprivation and increased daytime sleepiness and reduced gray matter in the left VMPFC were significantly associated \u0026nbsp;[11], [26], [32], [52].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis component of the PFC appears to be responsible for critical abilities for social life. Consistent activations in the VMPFC related to social cognition and moral judgments [16], [28]. Social cognition and moral decision-making are interconnected [30]. Social cognition refers to the ability to understand the beliefs and intentions of other people in the social environment and to make predictions about intentions and behaviors. Through social cognition, certain norms are assigned for people, groups and roles with the information obtained about the environment [51]. Information obtained through social cognition contributes to moral cognition and moral decisions. Without these abilities, it would be impossible to maintain social relationships. Lack of these abilities are characterized by disorders such as autism spectrum disorder. Also, patients with VMPFC lesions are notorious for impaired decision-making, psychosocial dysfunction, and inappropriate behavior in the social environment [5].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIt has been reported that the signals of decision values formed in the VMPFC change after sleep deprivation, and behaviors such as risk-taking increase after sleep deprivation [23], [25], [32], [36], [45]. Additionally, participants who experience sleep deprivation are more willing to act in violation of personal moral values [24]. These cognitive deficits can lead to riskier outcomes, especially in people working in critical professions [38]. However, there appears to be little interest in social and moral ability. Taking perspective is the main ability underlying social cognition. It has been stated in the limited studies that the participants ability to take the perspective of others regressed after sleep deprivation [13]. The results reveal that sleep deprivation causes poor performance in social cognition tasks [13]. [14].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs mentioned above, VMPFC appears to be responsible for social cognition and moral decision-making. Research has shown the significant effects of sleep deprivation on the VMPFC. It is predicted that the disruptive effect of sleep deprivation on the VMPFC will also lead to impairment of the tasks undertaken by the VMPFC; These tasks are social cognition and moral decision making.\u003c/p\u003e\n\u003cp\u003eWhen the relevant literature is researched, it is found that research findings are quite limited. Previous studies on sleep deprivation mainly investigated the effects specified period sleep loss by depriving healthy subjects and the results are remarkably similar: Sleep deprivation causes a decrease in performance [13], [20], [24], [30], [38], [47], [48]. However, these declines are temporary and now predictable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this study, the DLPFC and VMPFC regions of the prefrontal cortex, which are most affected by sleep deprivation, were featured. The reason for this is that it is the brain regions that show the most striking effects against sleep deprivation, and these two brain regions are responsible for the abilities that play a vital role in human life. Also, the side that provides convenience for research is the availability of measurement tools that measure the abilities of these regions and cause activation in these brain regions while being performed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIt is known that DLPFC is responsible for executive functions and VMPFC is responsible for moral decision making and social cognition. We combined this two information and investigated how these abilities are affected due to the negative effects of sleep deprivation on the brain. To our knowledge, this is the first study to evaluate executive functions, social cognition, and moral decision-making abilities in brain regions affected by sleep deprivation. To our knowledge, there is no other study evaluating how chronic poor sleep quality affects the functions that guide human life.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eResearch Design\u003c/h2\u003e \u003cp\u003eThis study is a static-group comparison design where the independent variable is sleeping problem and the dependent variables are executive functions, moral decision making, and social cognition performances.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThe sample group of the study consists of 85 university students-graduates, without any neuropsychiatric diagnosis, between the ages of 20\u0026ndash;40 and participating in the study on a voluntary basis. The sample size was determined to have at least 30 participants in each group to obtain a statistically significant result.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eProcedure\u003c/h2\u003e \u003cp\u003e The study started after receiving Ethics Committee Approval. The Pittsburgh Sleep Quality Index to determine the sleep deprivation level of the participants, the Moral Judgment Test to evaluate the moral decision-making ability; Faux-Pas Test, Iowa Gambling Test (IGT), Stroop Test and Verbal Fluency Tests were used to evaluate executive functions and social cognition. After the data of the study were collected, the participants with a total score of 5 and above from the Pittsburgh Sleep Quality Index were included in the research group with sleep problems/deprivation, and the participants with a total score of less than 5 were included in the control group without sleep problems/deprivation. Then, the performance averages of the groups with and without sleep problems in the Moral Judgment Test, Faux-Pas Test, Iowa Gambling Test, Stroop Test, Tracking Test and Verbal Fluency Test were compared. All tests and scales were applied face to face by the researcher. During the study, an average of 40 minutes of interview was provided with each participant. The data collection phase was completed by the researcher in the same room and physical conditions every day.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eMeasurement Tools and Methods\u003c/h2\u003e \u003cp\u003eData collection tools are as follows, in order of application:\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003ePittsburgh Sleep Quality Index (PSQI)\u003c/h2\u003e \u003cp\u003ePittsburgh Sleep Quality Index, developed in 1989 [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Turkish validity and reliability study has been completed [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The cronbach alpha value of this index is 0.80. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. It is a scale that provides quantitative analysis of sleep quality to define well and poor sleep. This scale helps to evaluate the amount of sleep, sleep quality, the presence and severity of sleep problems, if any, in the last month. The items to be scored in the scale are grouped according to 7 components: subjective sleep quality, sleep duration, sleep disturbance, daytime dysfunction, sleep latency (delay), habitual sleep efficiency, and sleep medication use. The total score ranges from 0 to 21, and a total score of 5 or above suggesting significantly sleep disorder [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The total score obtained clearly distinguishes welll sleep quality (PSQI total score\u0026thinsp;\u0026le;\u0026thinsp;5) from poor sleep quality (PUKI\u0026thinsp;\u0026gt;\u0026thinsp;5) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eMoral Judgment Test\u003c/h2\u003e \u003cp\u003eThe moral judgment test was developed by Lind in 1977 to measure the moral judgment levels of individuals, and with this scale, it is aimed to measure all six steps of Kohlberg's Moral Judgment Development theory [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Its validity and reliability study was conducted in Turkey and it was adapted to Turkish [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The test is theoretically based on Kohlberg's theory of cognitive moral development.\u003c/p\u003e \u003cp\u003eThe Moral Judgment Test consists of arguments involving various moral duties. There are moral dilemmas in the scale where the person who takes this test cannot make a decision without violating serious moral rules and principles. The extent to which 12 arguments are accepted or rejected in each dilemma is returned as -4 \u0026ldquo;strongly disagree\u0026rdquo; and +\u0026thinsp;4 \u0026ldquo;strongly agree\u0026rdquo; on the nine- point Likert type scale.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eStroop Test\u003c/h2\u003e \u003cp\u003eThis test was developed by Stroop in 1935. Tests related to Stroop tasks are accepted as the 'gold standard' in attention measures [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Reliability and validity for the Turkish population have been demonstrated [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In this study, the Stroop Test TBAG Form was used [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The reliability coefficient of the test is reported as approximately 0.90 [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Participants complete four tasks as part of this test.\u003c/p\u003e \u003cp\u003eResistance to interference is measured by calculating the time difference between the task of just saying the color without reading the colored words and the task of reading the words written in different colours. A stopwatch was used to measure reaction time.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eFaux-Pas Test\u003c/h2\u003e \u003cp\u003eFaux-Pas test was developed in 1999 [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] and an adaptation study was conducted for Turkey [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. This test assesses the ability of participants to comprehend that when someone else says something inappropriately wrong, that person said it unintentionally. In order for this inappropriateness to be perceived, it should be perceived that there is something that should not be said in the speech and that it may cause feelings such as sadness and anger in the person exposed to this situation [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. This test requires social cognition and empathy skills.\u003c/p\u003e \u003cp\u003eThere are 20 stories in the original of this test, but not all of the 20 stories were used as in the studies in the literature [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], [59]. In this study, the 9 most appropriate stories translated into Turkish from the original 20 stories obtained from [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] were used. After the participant read each story, related questions were asked by the researcher and the answers were noted. Analyzes were made on the answers given by the participants.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eVerbal Fluency Test\u003c/h2\u003e \u003cp\u003eVerbal Fluency Test was developed to assess vocabulary and categorical fluency [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The study of norm values for individuals aged 18\u0026ndash;49 in the Turkish population was conducted by [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Verbal Fluency Test is used to measure DLPFC functions [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. The test mainly assesses executive functions and ability to maintain attention [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor a successful performance, in addition to maintaining attention, the skills of scanning and using the cognitive dictionary flexibly are required. In the vocabulary and category fluency sections, the maximum number of words that can be produced in 1 minute is evaluated [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].The researcher noted the spoken words and then the total number of words was calculated by subtracting perseveration and out-of-category words.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eIowa Gambling Test\u003c/h2\u003e \u003cp\u003eIGT is a neuropsychological test developed to evaluate patients with VMPFC lesions with impaired decision-making functions [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Norm determination study completed for Turkish sample [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. It has been reported that this disorder is safely evaluated by the IGT in studies [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In this research, the computerized version of the IKT program written by Dr. Gulay Buyukaksoy Kaplan and obtained from [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] was used.\u003c/p\u003e \u003cp\u003eWhen the test starts, there are 4 decks named A, B, C and D on the screen. A and B decks are advantageous, C and D decks are disadvantageous [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. For IGT scoring, the number of disadvantageous decks selected during the test was subtracted from the number of advantageous decks. This was done both for all the choices and for 5 separate blocks of 20 choices, and the total scores were calculated.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eAfter the data collection phase, the data were analyzed in terms of missing values and extreme values [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Data were analyzed using Jamovi, version 2.3. The data of 15 out of 100 participants were excluded from the study because they completed the scales incorrectly. The data of the study, collected from 85 participants, were included in the analysis. Initially, Shapiro-Wilk test was used to test whether the data conformed to the normality assumption, and normality was observed only in the animal names category of the Verbal Fluency Test and the third, fourth, fifth and total scores of the Iowa Gambling Test. It was determined that the data other than these did not provide the normality assumption.\u003c/p\u003e \u003cp\u003eThen, to separate the study and control groups, the participants with a total score of 5 and above on the PSQI index were included in the research group, and the participants with a total score of less than 5 were included in the control group and divided into two groups. After the data were divided into two groups according to the PSQI index, the executive functions, moral decision making and social cognition performance averages of the study and control groups were compared using the Independent Sample T-test for data that provided normality assumption, and the Mann-Whitney U Test for data that did not provide normality assumption. Moral Judgment Test, Faux-Pas Test, Iowa Gambling Test, Stroop Test, and Verbal Fluency Test performance averages were compared. All data have been made publicly available and can be accessed at [osf.io/wvkpa].\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eData collected from 85 participants in the study were included in the analysis. Gender distribution of the participants; 67 females (78.82%) and 18 males (21.17%). Out of 85 participants, 80 people (94.12%) have undergraduate education and 5 people (5.88%) graduate education (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). The mean age is 22.12\u0026thinsp;\u0026plusmn;\u0026thinsp;2.77 years. Again, with the help of the same program, the participants with a PSQI score of 5 and above were included in the group with poor sleep, and the participants with a total score of less than 5 were included in the group with good sleep and divided into two groups. 41 (48.23%) out of 85 participants did not experience sleep deprivation; It was determined that 44 (51.76%) experienced sleep deprivation. There were 34 women (82.92%) and 7 men (17.8%) with good sleep quality, 33 women (74.99%) and 11 men (24.99%) with poor sleep quality (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). The ages of these two groups were similar (p\u0026thinsp;\u0026gt;\u0026thinsp;.05) (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e and Table 4).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003e\u003cem\u003eParticipant Demographics\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePostgraduate\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003e\u003cem\u003eDescriptive Statistics of Sleep Quality Groups\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePSQI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCounts\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e% of Total\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCumulative %\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eWell Sleep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e48.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ePoor Sleep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e100. 0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3-4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003e\u003cem\u003eEvaluation of Grups In Terms of Age Variable\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStatistics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003edf\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAGE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudent\u0026rsquo;s t\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.994\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.323\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e\u003csup\u003ea\u003c/sup\u003eLevene\u0026rsquo;s test is significant (p\u0026thinsp;\u0026lt;\u0026thinsp;.05), suggesting a violation of the assumption of equal variances.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAGE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWell Sleep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.522\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoor Sleep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.318\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eShapiro-Wilk test was used to test the normality assumption of the data and normality was observed only in the animal names category of Verbal Fluency Test and in the third, fourth, fifth and total scores of the Iowa Gambling Test. The Independent Sample T-Test was used for these variables, and the Mann-Whitney U-Test was used for all variables that did not comply with the normality assumption (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e). Thus, the performance averages of the group with and without sleep problems on the Moral Judgment Test, Pot Breaking Test, Iowa Gambling Test, Stroop Test and Verbal Fluency Test were compared.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Taba\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003e\u003cem\u003eStatistical Analysis\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStatistic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003edf\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAGE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMann-Whitney U\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e897\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.964\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePSQI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMann-Whitney U\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCwert\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMann-Whitney U\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e835\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.561*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCwertA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMann-Whitney U\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e872\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.792*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCwertD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMann-Whitney U\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e841\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.592*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStroop\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMann-Whitney U\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e847\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.628*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFaus-Pas Detection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMann-Whitney U\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e773\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.250*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnderstanding Inappropriateness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMann-Whitney U\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e782\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.279*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIntentions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMann-Whitney U\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e830\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.520*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBelief\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMann-Whitney U\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e786\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.296*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmpathy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMann-Whitney U\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e819\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.455*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnimal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudent\u0026rsquo;s t\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.2314\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e83.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.818**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMann-Whitney U\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e754\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.194*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFirst20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMann-Whitney U\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e872\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.793*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecond20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMann-Whitney U\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e902\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThird20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudent\u0026rsquo;s t\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.3261\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e83.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.745**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFourth20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudent\u0026rsquo;s t\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.1903\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e83.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.850**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFifth20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudent\u0026rsquo;s t\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.6210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e83.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.536**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIowaTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudent\u0026rsquo;s t\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.1995\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e83.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.842**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e\u003csup\u003ea\u003c/sup\u003eLevene\u0026rsquo;s test is significant (p\u0026thinsp;\u0026lt;\u0026thinsp;.05), suggesting a violation of the assumption of equal variances.\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e* Mann-Whitney U; ** Student\u0026rsquo;s t\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eIn the evaluation of the effect of sleep deprivation on executive functions, the Stroop Test TBAG Form and Verbal Fluency Test were applied to the participants. As a result of the analysis, no significant difference was found between the poor sleep and good sleep groups in terms of performance in these tests (p\u0026thinsp;\u0026gt;\u0026thinsp;.05) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eWhen the effect of sleep deprivation on moral decision-making ability is examined; In the measurement, which includes the evaluation of moral judgment through scenarios, no significant.\u003c/p\u003e\n \u003cp\u003edifference was found between the good sleep quality and poor sleep quality groups in terms of this ability (p\u0026thinsp;\u0026gt;\u0026thinsp;.05) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eThe effect of sleep deprivation on social cognition was evaluated with the results of the Faux Pas Test and the Iowa Gambling Test. According to the results of the scale, no significant difference was found between the poor sleep quality and good sleep quality groups in terms of social cognition (p\u0026thinsp;\u0026gt;\u0026thinsp;.05) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eWith the results, the null hypothesis (H0) was accepted in this study: Sleep deprivation has no significant effect on executive functions, moral decision making and social cognition.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the present study, we aimed to evaluate the effect of sleep deprivation on executive functions, moral decision making and social cognition performances. PFC is the brain region most affected by sleep deprivation, significant impairments in the activity of this region are expected due to poor sleep quality. The data of related studies also emphasize that the PFC is particularly sensitive to sleep and that frontal executive functions are affected due to sleep deprivation [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Similarly, [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] and other studies reported that sleep deprivation causes significant disruptions on high-level mental function tasks such as executive functions; [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e] and [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e] did not report such effects in their study (as cited in [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]). It can be concluded that some executive functions are affected by sleep deprivation, and some executive functions are not affected by sleep deprivation [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Studies evaluating the effect of sleep deprivation on executive functions, sleep deprivation was generally created in a laboratory and for a relatively short period of time. In this study, it was investigated whether a general sleep deprivation would affect these functions. As concluded in this study, it was found that long term sleep deprivation did not have a significant impairing effect on executive functions.\u003c/p\u003e \u003cp\u003eAs mentioned above, there is data suggesting that another component of the PFC that is most affected by sleep deprivation is the VMPFC. Consistent activations related to social cognition have been reported in this area [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Also, inappropriate behaviors are observed in the social environment in patients with VMPFC lesions [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Studies on social cognition and sleep deprivation are very limited [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In this study, ıt was found that there is no significant effect of sleep deprivation on social cognition performances.\u003c/p\u003e \u003cp\u003eNeuroimaging studies have revealed consistent activity of the VMPFC for moral judgments. Generally, the effect of sleep deprivation on moral decision-making abilities has been evaluated by inducing sleep deprivation for a certain period of time. It has been reported that participants who experience sleep deprivation are more willing to engage in behaviors that violate personal moral values than other participants [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Another study reported that, moral logic has been decreased in military personnel [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. It is highly probable that the acute sleep deprivation will affect mental functions such as moral decisions, it was investigated whether a general sleep deprivation/poor sleep quality would affect these functions. Our results show that poor sleep quality does not have a significant effect on moral decision making.\u003c/p\u003e \u003cp\u003eAlthough studies have shown that acute sleep deprivation has effects on mental functions, this study did not find any effect of general sleep deprivation and poor sleep quality on executive functions, moral decision making, and social cognition. This suggests that the effects of long-term poor sleep quality may be somewhat offset. However, it should be noted that one of the important limitations of the study is the number of participants. Although all healthy adults without any neuropsychiatric disease were invited to be included in this study, the sample group of this study consists of university students/graduates who are easy-to-access due to the current location and conditions. Because of these limitations, it would probably not be appropriate to generalize the results of the study to the general population This study shows that sleep deprivation does not have a significant effect on executive functions, moral decision-making, and social cognition, but the results of a study with a larger and diverse sample group may differ. The effects of long term sleep deprivation on individuals is a very important issue that needs further research.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study evaluated the effect of sleep deprivation on high-level abilities. Our results show that executive functions, moral decision making and social cognition abilities performances of people with poor sleep quality do not differ significantly from those with good sleep quality. As stated above, the study has important limitations regarding the number and diversity of participants. In future studies, the effects of sleep deprivation on our daily lives can be re-evaluated with a more diverse group of participants. To the best of our knowledge, this study is the only one investigating the effect of sleep deprivation on these functions. The effects of sleep deprivation have mostly been evaluated by depriving people of sleep for a certain period. These studies have certainly increased our knowledge of sleep. However, this study aimed to draw attention to the impact of long-term sleep deprivation on the most critical cognitive skills of people experiencing sleep deprivation. Studies on acute sleep deprivation show that many functions will deteriorate in a short time. In this case, impaired sleep quality will also cause significant deficits. In the future, there is a need to investigate the effects of poor sleep quality on human functions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by\u0026nbsp;The Scientific and Technological Research Council of Turkey (TUBITAK) 2209-A University Students Research Projects Support Program (2020/2 Term, Application Number: 1919B012005237).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interests to declare that are relevant to the content of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe questionnaire and methodology for this study was approved by the\u0026nbsp;Non-Interventional Clinical Research\u0026nbsp;Ethics committee of the University of Medipol (Ethics approval number:\u0026nbsp;E-10840098-772.02-2346).\u0026nbsp;APA ethical standards were followed in the conduct of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u0026nbsp;Before the scales were applied, the purpose, requirements, and each step to be applied were clearly explained to the participants verbally and they were expected to read and sign the informed consent form. Participants were informed that they could leave the study without giving any reason. In addition, due to the confidentiality principle, it was ensured that the participants did not write their names on any scale.\u0026nbsp;Participants signed informed consent regarding publishing their data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData, headlines, and additional online materials are openly available at the project\u0026rsquo;s Open Science Framework page (osf.io/wvkpa).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contribution statements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Study conception and design were performed by [Erol Yildirim] and [Ilkay Yilmaz]. Material preparation and data collection were performed by [Ilkay Yilmaz]. Analysis and interpretation of results were performed by [Erol Yildirim] and [Ilkay Yilmaz]. \u0026nbsp;The first draft of the manuscript was written by [Ilkay Yilmaz] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported financially by the Scientific and Technological Research Council of Turkey (TUBITAK) 2209-A University Students Research Projects Support Program (2020/2 Term, Application Number: 1919B012005237). The data collection phase of this study was completed at Ege University School of Medicine, Department of Physiology. We would like to thank especially Ersin Oguz Koylu and our valuable professors from Ege University School of Medicine, Department of Physiology for helping us with the data collection phase by providing the appropriate laboratory. \u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbdullayev, A. (2016). Cortical activity assessment by near infrared spectroscopy during facial emotion recognition in schizophrenic patients (Publication No. 443685). [Doctoral dissertation, Ankara University]. 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Changes in ventromedial prefrontal cortex functional connectivity are correlated with increased risk-taking aier total sleep deprivation. Behavioural Brain Research, 418. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.bbr.2021.113674\u003c/span\u003e\u003cspan address=\"10.1016/j.bbr.2021.113674\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"sleep deprivation, prefrontal cortex, executive functions, moral decision making, social cognition","lastPublishedDoi":"10.21203/rs.3.rs-3953080/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3953080/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eSleep is a vital need for human life, and sleep deprivation is a common problem that can have serious consequences. Although the effects of acute sleep deprivation have been frequently reported in the literature, the effects of long-term sleep deprivation have not been well explained. This study investigated the effects of long-term sleep deprivation on executive functions, moral decision making, and social cognition.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eThe study involved 85 participants who were between the ages of 20 and 40 and who has not any psychiatric or neurological disorders. The test performance averages of the groups with and without sleep problems were compared.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe results showed that there was no significant difference in the performance of the two groups on any of the tests.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe results suggest that long-term sleep deprivation does not have a significant impact on executive functions, moral decision making and social cognition. These results are inconsistent with previous research that has shown that acute sleep deprivation can have a negative impact on these cognitive abilities. However, it is important to note that this study was relatively small, and participants are mostly university student. Further research is needed to confirm these findings.\u003c/p\u003e","manuscriptTitle":"The Effect of Sleep Deprivation on Executive Functions, Moral Decision Making and Social Cognition","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-20 08:49:57","doi":"10.21203/rs.3.rs-3953080/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bb1e525f-cd88-40d7-b9fc-a12813d609b7","owner":[],"postedDate":"March 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-19T03:51:14+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-20 08:49:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3953080","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3953080","identity":"rs-3953080","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}