Sleep-deprived residents and rapid picture naming performance using the Mobile Universal Lexicon Evaluation System (MULES) test

Jenna Conway, Luke Moretti, Rachel Nolan-Kenney, Omar Akhand, Liliana Serrano, Arielle Kurzweil, Janet C. Rucker, Steven L. Galetta, Laura J. Balcer

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective: The Mobile Universal Lexicon Evaluation System (MULES) is a rapid picture naming task that captures extensive brain networks involving neurocognitive, afferent/efferent visual, and language pathways. Many of the factors captured by MULES may be abnormal in sleep-deprived residents. This study investigates the effect of sleep deprivation in post-call residents on MULES performance. Methods: MULES, consisting of 54 color photographs, was administered to a cohort of neurology residents taking 24-hour in-hospital call (n = 18) and a group of similar-aged controls not taking call (n = 18). Differences in times between baseline and follow-up MULES scores were compared between the two groups. Results: MULES time change in call residents was significantly worse (slower) from baseline (mean 1.2 s slower) compared to non-call controls (mean 11.2 s faster) (P < 0.001, Wilcoxon rank sum test). The change in MULES time from baseline was significantly correlated to the change in subjective level of sleepiness for call residents and to the amount of sleep obtained in the 24 h prior to follow-up testing for the entire cohort. For call residents, the duration of sleep obtained during call did not significantly correlate with change in MULES scores. There was no significant correlation between MULES change and sleep quality questionnaire score for the entire cohort. Conclusion: The MULES is a novel test for effects of sleep deprivation on neurocognition and vision pathways. Sleep deprivation significantly worsens MULES performance. Subjective sleepiness may also affect MULES performance. MULES may serve as a useful performance assessment tool for sleep deprivation in residents.

Original languageEnglish
Article number100323
StatePublished - Mar 2021
Externally publishedYes


  • Fatigue
  • Mobile universal lexicon evaluation system (MULES)
  • Rapid picture naming
  • Resident education
  • Sleep deprivation


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