Observations of sodium density variability in the upper mesosphere/lower thermosphere, obtained using a high-resolution lidar system, show rapid fluctuations in the sodium centroid altitude. The temporal power spectrum extends above 1 Hz and is well-fit by a power law having a slope that is -1.95±0.12. These fluctuations produce focus errors in adaptive optics systems employing continuous-wave sodium laser guide stars, which can be significant for large-aperture telescopes. For a 30 m aperture diameter, the associated rms wavefront error is approximately 4 nm per meter of altitude change and increases as the square of the aperture diameter. The vertical velocity of the sodium centroid altitude is found to be ~23 ms(-1) on a 1 s time scale. If these high-frequency fluctuations arise primarily from advection of horizontal structure by the mesospheric wind, our data imply that variations in the sodium centroid altitude on the order of tens of meters occur over the horizontal scales spanned by proposed laser guide star asterisms. This leads to substantial differential focus errors (~107 nm over a 1 arc min separation with a 30 m aperture diameter) that may impact the performance of wide-field adaptive optics systems. Short-lasting and narrow sodium density enhancements, more than 1 order of magnitude above the local sodium density, occur due to advection of meteor trails. These have the ability to change the sodium centroid altitude by as much as 1 km in less than 1 s, which could result in temporary disruption of adaptive optics systems.