Hormonal contraceptives impair psychomotor vigilance task performance under sleep deprivation with stress induction

Hormonal contraceptives (HC) have been shown to influence cognitive performance, yet their effects under conditions of sleep deprivation remain poorly understood. Consistent with prior research demonstrating greater fatigue among individuals using HC, we hypothesized that vigilant attention would be impaired among females using HC compared with males and females not using HC.

Forty-eight participants (18-30 years; 23 females) underwent 28 hours of total sleep deprivation (TSD) while completing serial stress tasks, psychomotor vigilance tasks (PVT), and providing salivary cortisol samples. Mixed-effects models were constructed with either PVT outcomes or cortisol reactivity as dependent variables, group (males, females not using HC, females using HC) time, and mood induction group as fixed effects, as well as a group-by-time interaction, and participant as a random effect.

Females using HC demonstrated significantly more PVT lapses (F(1,45) = 3.75; p = .031) and a trend toward lower PVT speed (F(2,44) = 3.05; p = .057) than males and females not using HC during the second half of the sleep deprivation period. No significant group differences were observed for PVT reaction time or false starts. Neither self-reported sleepiness, cortisol reactivity, or amplitude differed by group.

Use of HC was associated with greater attentional instability following TSD, reflected by increased lapses and reduced vigilance efficiency. These effects occurred independently of cortisol responses. Larger studies are needed to further characterize the cognitive effects of HC use under sleep loss and to elucidate underlying mechanisms.