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Review
. 2025 Jul 22:19:1626309.
doi: 10.3389/fnins.2025.1626309. eCollection 2025.

The effects of sleep deprivation on cognitive flexibility: a scoping review of outcomes and biological mechanisms

Xuefeng Sun  1 , Zihan Qu  1 , Xiaotu Zhang  1 , Ye Zhang  1 , Xinye Zhang  1 , Haifeng Zhao  2 , Hongshi Zhang  1
Affiliations
Review

The effects of sleep deprivation on cognitive flexibility: a scoping review of outcomes and biological mechanisms

Xuefeng Sun et al. Front Neurosci. .

Abstract

Background: Sleep is vital for physical and mental health, yet sleep deprivation is a widespread issue that may impair cognitive flexibility, leading to rigid thinking and slower decision-making. This scoping review synthesizes evidence on the impact of sleep deprivation or sleep loss on cognitive flexibility.

Objective: To provide a comprehensive understanding of the complex and multifaceted effects of sleep deprivation on cognitive flexibility.

Methods: We searched PubMed, Web of Science, ClinicalKey, Cochrane, Scopus, SinoMed, and CNKI for studies evaluating the effects of sleep deprivation on cognitive flexibility. Two researchers independently screened and extracted data, assessing study quality using the Mixed Method Appraisal Tool (MMAT).

Results: Among the 410 retrieved articles, 6 randomized controlled trials and 11 non-randomized studies were included, focusing on the impact of sleep deprivation on cognitive flexibility across children, adolescents, college students, clinicians, athletes, and other adults. Eight studies found that sleep deprivation reduces cognitive flexibility, six reported no significant impact, and two noted temporary improvements due to physical stress. One study highlighted that being overweight exacerbates the negative effects of sleep deprivation on cognitive flexibility.

Conclusions: Sleep deprivation may predominantly impair accuracy rather than reaction time. Total sleep deprivation consistently reduces task-switching accuracy and cognitive flexibility, whereas partial sleep deprivation's effects remain unclear. The primary biological mechanisms involve decreased cerebral oxygen supply, impaired cerebrovascular reactivity, and alterations in gene expression and hormone levels. Rigorous randomized trials with objective measures are needed to assess long-term impacts across populations and age groups.

Keywords: biological mechanisms; cognitive flexibility; cognitive performance; executive function; sleep deprivation.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Flowchart illustrating the identification of studies via databases. Initial records identified: 410 from databases such as Web of Science, PubMed, and others. Duplicates removed: 139. Remaining records: 271. Excluded: 230 due to reviews, abstracts, irrelevant content. Remaining records: 41. Full-text exclusions: 24 due to implementation and result issues. Final studies included in the review: 17.
Figure 1
PRISMA 2020 flow diagram.
Flowchart illustrating the effects of sleep deprivation. Central image of a head with a clock symbolizes sleep deprivation. It leads to impaired neurocognitive function, cerebrovascular-metabolic dysfunction, and stress and neuroendocrine dysregulation. Consequences include decreased PFC, reduced cerebral reactivity, and disturbed neurohormonal secretion. Related factors such as weight and gene are highlighted. Overall, it results in impaired cognitive flexibility.
Figure 2
Mechanism diagram of the effects of sleep deprivation on cognitive flexibility.
See this image and copyright information in PMC

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