Sleep, attention, and executive function in health and disease

This chapter examines the intricate relationship between sleep and higher-order cognitive functions, particularly attention and executive control. Sleep is presented as a critical modulator of cognitive performance, influencing neural systems that underpin attentional regulation, working memory, and decision-making. The chapter highlights the vulnerability of attention to sleep deprivation, with impairments in sustained attention and processing efficiency linked to disruptions in dopaminergic and noradrenergic systems. The chapter also examines how sleep parameters and sleep architecture affect ADHD pathophysiology and symptomatology. Executive functions, including cognitive flexibility and inhibitory control, are shown to depend heavily on the integrity of prefrontal cortical networks, which are particularly sensitive to sleep disturbances. Neurobiological mechanisms underlying these relationships are explored, including thalamocortical circuitry, cholinergic modulation, and neuroendocrine influences such as cortisol dysregulation. Structural and functional neuroimaging studies reveal that insufficient sleep is associated with reduced prefrontal activity and altered connectivity, contributing to observable cognitive deficits. The chapter also discusses clinical implications, emphasizing the role of sleep interventions such as cognitive behavioral therapy in enhancing sleep quality, cognitive outcomes, and ADHD management. The bidirectional relationship between sleep and cognition is underscored, positioning sleep as a modifiable factor in optimizing cognitive resilience and mitigating neuropsychiatric risk.