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Feder MA, Baroni A. Just Let Me Sleep in: Identifying and Treating Delayed Sleep Phase Disorder in Adolescents. Psychiatr Clin North Am 2024; 47:163-178. [PMID: 38302205 DOI: 10.1016/j.psc.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Individuals with delayed sleep phase disorder (DSPD) are unable to naturally fall asleep and awake at conventional times; for this reason, DSPD is often mistaken for insomnia. However, unlike many patients with insomnia, those with DSPD struggle to get up at appropriate times. DSPD is associated with school refusal, academic difficulties, and lower employment rate. DSPD in youth has prevalence as high as 16%, and is often comorbid with other psychiatric disorders. Treatments include appropriate light exposure during the day, melatonin use, developing an evening routine that minimizes arousal-increasing activities, and gradually shifting sleep-wake times toward more functional ones.
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Affiliation(s)
- Michael A Feder
- Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at NYU Langone, NYC H+H/Bellevue, New York, NY, USA; Child Study Center, One Park Avenue, 7th Floor, New York, NY 10016, USA
| | - Argelinda Baroni
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 7th Floor, New York, NY 10016, USA.
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2
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Trosman I, Ivanenko A. Classification and Epidemiology of Sleep Disorders in Children and Adolescents. Psychiatr Clin North Am 2024; 47:47-64. [PMID: 38302213 DOI: 10.1016/j.psc.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Sleep disturbances are common in children and adolescents but still remain unrecognized and undertreated. Several classification systems of sleep disorders are available, which include recent attempts to develop more specific nosologic categories that reflect developmental aspects of sleep. The prevalence of sleep disorders has been studied across various samples of healthy, typically developing children and those with special medical, psychiatric, and neurodevelopmental needs. Sleep disorders are highly prevalent in children and adolescents with psychiatric disorders, making it important for mental health professionals to be aware of sleep problems and to address them in the context of psychiatric comorbidities.
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Affiliation(s)
- Irina Trosman
- Division of Pulmonary and Sleep Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue Box 43, Chicago, IL 60611-2991, USA
| | - Anna Ivanenko
- Division of Child and Adolescent Psychiatry, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
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Nelson MJ, Soliman PS, Rhew R, Cassidy RN, Haass-Koffler CL. Disruption of circadian rhythms promotes alcohol use: a systematic review. Alcohol Alcohol 2024; 59:agad083. [PMID: 38123479 PMCID: PMC10794164 DOI: 10.1093/alcalc/agad083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 11/15/2023] [Accepted: 11/19/2023] [Indexed: 12/23/2023] Open
Abstract
This systematic review investigates the bidirectional relationship between alcohol consumption and disrupted circadian rhythms. The goal of this study was to identify (i) the types of circadian rhythm disruptors (i.e. social jet lag, extreme chronotypes, and night shift work) associated with altered alcohol use and (ii) whether sex differences in the consequences of circadian disruption exist. We conducted a search of PubMed, Embase, and PsycINFO exclusively on human research. We identified 177 articles that met the inclusion criteria. Our analyses revealed that social jet lag and the extreme chronotype referred to as eveningness were consistently associated with increased alcohol consumption. Relationships between night shift work and alcohol consumption were variable; half of articles reported no effect of night shift work on alcohol consumption. Both sexes were included as participants in the majority of the chronotype and social jet lag papers, with no sex difference apparent in alcohol consumption. The night shift research, however, contained fewer studies that included both sexes. Not all forms of circadian disruption are associated with comparable patterns of alcohol use. The most at-risk individuals for increased alcohol consumption are those with social jet lag or those of an eveningness chronotype. Direct testing of the associations in this review should be conducted to evaluate the relationships among circadian disruption, alcohol intake, and sex differences to provide insight into temporal risk factors associated with development of alcohol use disorder.
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Affiliation(s)
- Morgan J Nelson
- Biotechnology Graduate Program, Warren Alpert Medical School, Brown University, Providence, RI 02912, United States
- Center for Alcohol and Addiction Studies, Warren Alpert Medical School, Brown University, Providence, RI 02912, United States
| | - Paul S Soliman
- Center for Alcohol and Addiction Studies, Warren Alpert Medical School, Brown University, Providence, RI 02912, United States
- Department of Neuroscience, Warren Alpert Medical School, Brown University, Providence, RI 02912, United States
| | - Ryan Rhew
- Center for Alcohol and Addiction Studies, Warren Alpert Medical School, Brown University, Providence, RI 02912, United States
- Department of Neuroscience, Warren Alpert Medical School, Brown University, Providence, RI 02912, United States
| | - Rachel N Cassidy
- Center for Alcohol and Addiction Studies, Warren Alpert Medical School, Brown University, Providence, RI 02912, United States
- Department of Behavioral and Social Sciences, School of Public Health, Warren Alpert Medical School, Brown University, Providence, RI 02912, United States
| | - Carolina L Haass-Koffler
- Center for Alcohol and Addiction Studies, Warren Alpert Medical School, Brown University, Providence, RI 02912, United States
- Department of Behavioral and Social Sciences, School of Public Health, Warren Alpert Medical School, Brown University, Providence, RI 02912, United States
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI 02912, United States
- Carney Institute for Brain Science, Brown University, Providence, RI 02912, United States
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4
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Cheung FTW, Li X, Hui TK, Chan NY, Chan JW, Wing YK, Li SX. Circadian preference and mental health outcomes in youth: A systematic review and meta-analysis. Sleep Med Rev 2023; 72:101851. [PMID: 37793219 DOI: 10.1016/j.smrv.2023.101851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 07/10/2023] [Accepted: 09/12/2023] [Indexed: 10/06/2023]
Abstract
Youth is a vulnerable developmental period associated with an increased preference for eveningness and risk for developing psychopathology. Growing evidence suggests a link between eveningness and poorer mental health outcomes, but the findings in the current literature are inconsistent, and a comprehensive synthesis of evidence in this area remains lacking. This meta-analysis aimed to 1) synthesise the existing evidence on the association between circadian preference and mental health outcomes in youths and 2) explore potential sleep-related factors that may moderate the relationship between circadian preference and mental health outcomes. A systematic search of five electronic databases resulted in 81 observational studies included in the review. Eveningness was found to be significantly associated with general mental health (r = 0.20), mood-related disturbances (r = 0.17), and anxiety problems (r = 0.13). The qualitative review also identified that eveningness was associated with greater risks for psychotic symptoms and maladaptive eating behaviours. These findings highlighted the need to consider circadian preference in the clinical management of youth mental health problems. Further research is needed to examine the efficacy of a circadian-focused intervention in the context of youth mental health.
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Affiliation(s)
- Forrest Tin Wai Cheung
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong.
| | - Xiao Li
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong
| | - Tsz Kwan Hui
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong
| | - Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Joey Wy Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Shirley Xin Li
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong.
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5
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Liebig L, Bergmann A, Voigt K, Balogh E, Birkas B, Faubl N, Kraft T, Schöniger K, Riemenschneider H. Screen time and sleep among medical students in Germany. Sci Rep 2023; 13:15462. [PMID: 37726327 PMCID: PMC10509232 DOI: 10.1038/s41598-023-42039-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023] Open
Abstract
Medical students are a vulnerable group for harmful health behaviours due to academic stress. Increased screen time is associated with adverse health behaviour, particularly delayed bedtime, shorter sleep duration and poorer sleep quality. This possible relationship has not yet been examined among medical students in Europe. Medical students at the Technical University of Dresden were invited to participate in an online questionnaire based cross-sectional study. To analyse correlations between screen time and sleep parameters, correlation coefficients, linear regression and mixed-model analysis were calculated. 415 students (average age 24 years, 70% female) were included in the analysis. The students reported an average of 7 h screen time per day and 7.25 h sleep duration per night. Approximately 23% (n = 97) reported sleeping less than 7 h per night and 25% (n = 105) reported fairly to very poor sleep quality. Students who reported more screen time for leisure went to bed significantly later (r = 0.213, p < 0.001). Students who spent more screen time for study/work tended to sleep shorter (r = - 0.108, p < 0.015). There was no significant association between screen time and sleep quality (p = 0.103). The results show a need for educational interventions to promote healthy sleep behaviour and to limit screen time.
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Affiliation(s)
- Lukas Liebig
- Department of General Practice, Medical Clinic 3, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - Antje Bergmann
- Department of General Practice, Medical Clinic 3, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Karen Voigt
- Department of General Practice, Medical Clinic 3, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Erika Balogh
- Department of Public Health Medicine, University of Pécs Medical School, Pecs, Hungary
| | - Béla Birkas
- Department of Behavioral Sciences, University of Pécs Medical School, Pecs, Hungary
| | - Nora Faubl
- Department of Behavioral Sciences, University of Pécs Medical School, Pecs, Hungary
| | - Theresa Kraft
- Institute for Medical Informatics and Biometry (IMB), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Konrad Schöniger
- Department of Biological and Clinical Psychology, Institute of Psychology, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Henna Riemenschneider
- Department of General Practice, Medical Clinic 3, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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6
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Wu A. Updates and confounding factors in delayed sleep-wake phase disorder. Sleep Biol Rhythms 2023; 21:279-287. [PMID: 37363638 PMCID: PMC9979143 DOI: 10.1007/s41105-023-00454-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 02/09/2023] [Indexed: 03/06/2023]
Abstract
Delayed sleep-wake phase disorder (DSWPD) is a circadian rhythm sleep disorder characterised by a delay in the main sleep period, with patients experiencing difficulty getting to sleep and waking up at socially appropriate times. This often causes insomnia and compromised sleep, results in impairment to daytime function and is associated with a range of comorbidities. Besides interventions aimed at ameliorating symptoms, there is good evidence supporting successful phase advancement with bright light therapy or melatonin administration. However, no treatment to date addresses the tendency to phase delay, which is a common factor amongst the various contributing causes of DSWPD. Circadian phase markers such as core body temperature and circulating melatonin typically correlate well with sleep timing in healthy patients, but numerous variations exist in DSWPD patients that can make these unpredictable for use in diagnostics. There is also increasing evidence that, on top of problems with the circadian cycle, sleep homeostatic processes actually differ in DSWPD patients compared to controls. This naturally has ramifications for management but also for the current approach to the pathogenesis itself in which DSWPD is considered a purely circadian disorder. This review collates what is known on the causes and treatments of DSWPD, addresses the pitfalls in diagnosis and discusses the implications of current data on modified sleep homeostasis, making clinical recommendations and directing future research.
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Affiliation(s)
- Alexandra Wu
- Division of Biosciences, University College London, Gower Street, London, WC1E 6BT UK
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Abstract
BACKGROUND Individuals with poor sleep (e.g., insomnia) and mental health (e.g., depression) experience negative stigma but no studies have examined the relationship between stigma and evening chronotype. The present mixed methods study aimed to assess and describe explicit and implicit attitudes about evening and morning chronotypes in a sample of emerging adults. PARTICIPANTS 49 undergraduates (Mage = 19.9 [SD = 1.5], 83.7% female). METHODS Participants completed self-reports of demographics and chronotype. Attitudes about "night owls" and "early birds" were measured with self-report questionnaires (explicit attitudes) and an Implicit Association Task (implicit attitudes). Participants described associations with evening and morning chronotypes in free-text responses, which were qualitatively coded. RESULTS We found evidence of implicit bias against night owls and for early birds. The positive mean implicit d score was 0.57 (SD = 0.47), indicating a moderate implicit bias for pairing "bad" with "night owl" and "good" with "early bird." No baseline characteristics, including chronotype, were significantly associated with implicit bias. Analyses of explicit bias revealed participants perceived night owls as significantly more lazy, unhealthy, undisciplined, immature, creative, and young. Analysis of free-text responses provided further evidence of these associations. CONCLUSIONS Consistent with hypothesis, undergraduates demonstrated predominantly negative implicit and explicit stigma toward evening chronotypes compared to morning types. As stigma can lead to adverse consequences, future studies should assess the impact of negative societal and self-stigma on evening types. Consideration of societal stigma within clinical intervention contexts could have the potential to reduce shame or other emotions that interfere with sleep.
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Affiliation(s)
- Jessica R Dietch
- Department of Psychology, University of North Texas, Denton, Texas, USA.,School of Psychological Science, Oregon State University, Corvallis, Oregon, USA
| | - Megan Douglas
- Department of Psychology, University of North Texas, Denton, Texas, USA.,Trauma Research Consortium, Baylor Scott & White Research Institute, Dallas, Texas, USA
| | - Kelly Kim
- Department of Psychology, The University of Arizona, Tucson, Arizona, USA
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Cox RC, Olatunji BO. Delayed circadian rhythms and insomnia symptoms in obsessive-compulsive disorder. J Affect Disord 2022; 318:94-102. [PMID: 36057288 PMCID: PMC10201922 DOI: 10.1016/j.jad.2022.08.118] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 05/09/2022] [Accepted: 08/26/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Accumulating evidence implicates sleep and circadian rhythm disturbance in obsessive-compulsive disorder (OCD). However, a multimethod characterization of sleep and circadian rhythms in OCD, their association with symptom severity, and the functional relationship between these variables is lacking. METHODS The present study measured multiple indicators of sleep and circadian rhythms in a sample of adults with OCD, adults without OCD, and healthy controls (n = 74). Participants completed measures of morningness-eveningness, delayed sleep-wake phase disorder (DSWPD), insomnia symptoms, and OCD symptoms, as well as one week of sleep monitoring via a sleep diary and actigraphy. RESULTS Delayed circadian rhythms (higher eveningness, later mid-sleep timing, and higher rates of DSWPD) and higher insomnia symptoms were observed in those with OCD compared to healthy controls, as well as associations between delayed circadian rhythms and insomnia symptoms and OCD symptom severity across the full sample. Further, insomnia symptoms mediated the relationship between delayed circadian rhythms and OCD symptoms. In contrast, there were no links between total sleep time or sleep quality and OCD. LIMITATIONS Data collection during COVID-19 pandemic, correlational data, no physiological measure of circadian rhythms. CONCLUSIONS These findings highlight a robust association between delayed circadian rhythms and OCD and suggest insomnia symptoms may be one mechanism in this relationship. Sleep and circadian rhythm disturbance may be novel targets for OCD treatment.
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Affiliation(s)
- Rebecca C Cox
- Vanderbilt University, United States of America; University of Colorado Boulder, United States of America.
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9
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Vadnie CA, Petersen KA, Eberhardt LA, Hildebrand MA, Cerwensky AJ, Zhang H, Burns JN, Becker-Krail DD, DePoy LM, Logan RW, McClung CA. The Suprachiasmatic Nucleus Regulates Anxiety-Like Behavior in Mice. Front Neurosci 2022; 15:765850. [PMID: 35126036 PMCID: PMC8811036 DOI: 10.3389/fnins.2021.765850] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/23/2021] [Indexed: 01/21/2023] Open
Abstract
Individuals suffering from mood and anxiety disorders often show significant disturbances in sleep and circadian rhythms. Animal studies indicate that circadian rhythm disruption can cause increased depressive- and anxiety-like behavior, but the underlying mechanisms are unclear. One potential mechanism to explain how circadian rhythms are contributing to mood and anxiety disorders is through dysregulation of the suprachiasmatic nucleus (SCN) of the hypothalamus, known as the "central pacemaker." To investigate the role of the SCN in regulating depressive- and anxiety-like behavior in mice, we chronically manipulated the neural activity of the SCN using two optogenetic stimulation paradigms. As expected, chronic stimulation of the SCN late in the active phase (circadian time 21, CT21) resulted in a shortened period and dampened amplitude of homecage activity rhythms. We also repeatedly stimulated the SCN at unpredictable times during the active phase of mice when SCN firing rates are normally low. This resulted in dampened, fragmented, and unstable homecage activity rhythms. In both chronic SCN optogenetic stimulation paradigms, dampened homecage activity rhythms (decreased amplitude) were directly correlated with increased measures of anxiety-like behavior. In contrast, we only observed a correlation between behavioral despair and homecage activity amplitude in mice stimulated at CT21. Surprisingly, the change in period of homecage activity rhythms was not directly associated with anxiety- or depressive-like behavior. Finally, to determine if anxiety-like behavior is affected during a single SCN stimulation session, we acutely stimulated the SCN in the active phase (zeitgeber time 14-16, ZT14-16) during behavioral testing. Unexpectedly this also resulted in increased anxiety-like behavior. Taken together, these results indicate that SCN-mediated dampening of rhythms is directly correlated with increased anxiety-like behavior. This work is an important step in understanding how specific SCN neural activity disruptions affect depressive- and anxiety-related behavior.
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Affiliation(s)
- Chelsea A. Vadnie
- Department of Psychology, Ohio Wesleyan University, Delaware, OH, United States
| | - Kaitlyn A. Petersen
- Translational Neuroscience Program, Department of Psychiatry, Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States
| | - Lauren A. Eberhardt
- Translational Neuroscience Program, Department of Psychiatry, Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States
| | - Mariah A. Hildebrand
- Translational Neuroscience Program, Department of Psychiatry, Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States
| | - Allison J. Cerwensky
- Translational Neuroscience Program, Department of Psychiatry, Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States
| | - Hui Zhang
- Translational Neuroscience Program, Department of Psychiatry, Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jennifer N. Burns
- Translational Neuroscience Program, Department of Psychiatry, Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States
| | - Darius D. Becker-Krail
- Translational Neuroscience Program, Department of Psychiatry, Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States
| | - Lauren M. DePoy
- Translational Neuroscience Program, Department of Psychiatry, Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ryan W. Logan
- Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, MA, United States
| | - Colleen A. McClung
- Translational Neuroscience Program, Department of Psychiatry, Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States
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Hirose M, Nakamura T, Watanabe A, Esaki Y, Koike S, Yamamoto Y, Iwata N, Kitajima T. Altered distribution of resting periods of daily locomotor activity in patients with delayed sleep phase disorder. Front Psychiatry 2022; 13:933690. [PMID: 36311503 PMCID: PMC9606617 DOI: 10.3389/fpsyt.2022.933690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022] Open
Abstract
Delayed sleep phase disorder (DSPD) and mood disorders have a close relationship. However, the shared mechanisms by DSPD and mood disorders have not been well-elucidated. We previously found that micro-fluctuations in human behaviors are organized by robust statistical laws (behavioral organization), where the cumulative distributions of resting and active period durations take a power-law distribution form and a stretched exponential functional form, respectively. Further, we found that the scaling exponents of resting period distributions significantly decreased in major depressive disorder (MDD). In this study, we hypothesized that DSPD had similar characteristics of the altered behavioral organization to that of MDD. Locomotor activity data were acquired for more than 1 week from 17 patients with DSPD and 17 age- and gender-matched healthy participants using actigraphy. We analyzed the cumulative distributions of resting and active period durations in locomotor activity data and subsequently derived fitting parameters of those distributions. Similar to patients with MDD, we found that resting period distributions took a power-law form over the range of 2-100 min, with significantly lower values of scaling exponents γ in patients with DSPD compared with healthy participants. The shared alteration in γ suggests the existence of similar pathophysiology between DSPD and MDD.
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Affiliation(s)
- Marina Hirose
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
| | - Toru Nakamura
- Graduate School of Engineering Science, Osaka University, Osaka, Japan
| | - Akiko Watanabe
- Department of Sleep Medicine, Toyohashi Mates Sleep Disorders Center, Toyohashi, Japan
| | - Yuichi Esaki
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
| | - Shigefumi Koike
- Department of Sleep Medicine, Toyohashi Mates Sleep Disorders Center, Toyohashi, Japan
| | - Yoshiharu Yamamoto
- Educational Physiology Laboratory, Graduate School of Education, University of Tokyo, Tokyo, Japan
| | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tsuyoshi Kitajima
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
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Lang C, Richardson C, Micic G, Gradisar M. Understanding Sleep-Wake Behavior in Late Chronotype Adolescents: The Role of Circadian Phase, Sleep Timing, and Sleep Propensity. Front Psychiatry 2022; 13:785079. [PMID: 35360141 PMCID: PMC8963423 DOI: 10.3389/fpsyt.2022.785079] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Adolescents with a late chronotype are at greater risk for mood disorders, risk-taking behaviors, school absenteeism, and lower academic achievement. As there are multiple causes for late chronotype, the field lacks studies on the relationship between mood, circadian phase, and phase angle of entrainment in late chronotype adolescents. Three objectives guide this explorative study: (1) to describe sleep, circadian phase, and phase angle of entrainment in late chronotype adolescents, (2) to explore how different levels of lateness are associated with sleep quality, sleep propensity, and mood, and (3) to investigate the influence of circadian phase on bedtime choice and sleep duration. METHODS Baseline data from 19 male adolescents (M = 16.4 ± 1.0 yrs), who were part of a larger intervention trial, were analyzed. Chronotype was measured with the Munich Chronotype Questionnaire, circadian timing via dim light melatonin onset (DLMO), and sleep habits with a 7-day sleep log. Further questionnaires assessed daytime sleepiness, sleep quality, and mood. Evening sleepiness and sustained attention were used as a proxy for evening sleep propensity. RESULTS On school nights, sleep duration averaged 7.78 h (±1.65), and 9.00 h (±1.42) on weekend nights. Mean DLMO was observed at 23.13 h (± 1.65), with a weekend phase angle of entrainment of 2.48 h. Regression fittings revealed a tendency for shorter phase angles with delayed DLMOs. Further analysis with chronotype subgroups revealed that this was only true for light and moderate late types, whereas extreme late types showed wide phase angles. Even though daytime sleepiness and sleep duration did not differ between subgroups, mood and sleep quality declined as lateness increased. Extreme late chronotypes experienced higher evening sleepiness, while slight late chronotypes showed higher evening attention. Chronotype but not DLMO predicted bedtime on school- and particularly weekend-nights. CONCLUSIONS Our findings suggest that with increasing lateness, the likelihood of experiencing poor sleep quality and mood disorders increases. As DLMO did not predict bedtime, our data indicate that the factors contributing to a late chronotype are versatile and complex, particularly for extreme late types. Further studies involving a larger and gender-balanced sample are needed to confirm findings.
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Affiliation(s)
- Christin Lang
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.,College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Cele Richardson
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia.,Centre for Sleep Science, School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Gorica Micic
- Adelaide Institute for Sleep Health, Flinders Health & Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Michael Gradisar
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
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12
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Characterizing the Genetic Overlap Between Psychiatric Disorders and Sleep-Related Phenotypes. Biol Psychiatry 2021; 90:621-631. [PMID: 34482950 DOI: 10.1016/j.biopsych.2021.07.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND A range of sleep disturbances are commonly experienced by patients with psychiatric disorders, and genome-wide genetic analyses have shown some significant genetic correlations between these traits. Here, we applied novel statistical genetic methodologies to better characterize the potential shared genetic architecture between sleep-related phenotypes and psychiatric disorders. METHODS Using the MiXeR method, which can estimate polygenic overlap beyond genetic correlation, the shared genetic architecture between major psychiatric disorders (bipolar disorder [N = 51,710], depression [N = 480,359], and schizophrenia [N = 77,096]) and sleep-related phenotypes (chronotype [N = 449,734], insomnia [N = 386,533] and sleep duration [N = 446,118]) were quantified on the basis of genetic summary statistics. Furthermore, the conditional/conjunctional false discovery rate framework was used to identify specific shared loci between these phenotypes, for which positional and functional annotation were conducted with FUMA. RESULTS Extensive genetic overlap between the sleep-related phenotypes and bipolar disorder (63%-77%), depression (76%-79%), and schizophrenia (64%-79%) was identified, with moderate levels of congruence between most investigated traits (47%-58%). Specific shared loci were identified for all bivariate analyses, and a subset of 70 credible genes were mapped to these shared loci. CONCLUSIONS The current results provide evidence for substantial polygenic overlap between psychiatric disorders and sleep-related phenotypes, beyond genetic correlation (|rg| = 0.02 to 0.42). Moderate congruency within the shared genetic components suggests a complex genetic relationship and potential subgroups with higher or lower genetic concordance. This work provides new insights and understanding of the shared genetic etiology of sleep-related phenotypes and psychiatric disorders and highlights new opportunities and avenues for future investigation.
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13
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Richardson C, Gradisar M. Depressed mood and repetitive negative thinking in Delayed Sleep-Wake Phase Disorder: Treatment effects and a comparison with good sleepers. J Sleep Res 2021; 31:e13452. [PMID: 34350657 DOI: 10.1111/jsr.13452] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 05/14/2021] [Accepted: 07/15/2021] [Indexed: 11/29/2022]
Abstract
Circadian dysregulation and depressed mood commonly co-occur in young people, yet mechanisms linking Delayed Sleep-Wake Phase disorder (DSWPD) with depression are poorly understood. The present study aimed to examine the role of repetitive negative thinking (RNT), by comparing sleep, RNT and depressive symptomology between 40 'good' sleeping young people and 63 with DSWPD, with (n = 30) and without (n = 33) self-reported doctor-diagnosed depression. Secondary analysis from a randomised controlled trial was also undertaken to observe changes in depressive symptoms and RNT as a result of treatment for DSWPD. The 60 young people with DSWPD (mean [SD] age of 15.9 [2.2] years, 63% female) received either short (green) or long (red) wavelength bright light therapy (BLT) over 3 weeks. Cross-sectional baseline comparisons revealed an escalating pattern of worse sleep, more RNT and higher depressed mood scores in the DSWPD young people compared to good sleepers. Across all participants, RNT accounted for the associations between sleep-onset difficulties and depressed mood at baseline. Symptoms of depression, RNT and sleep onset difficulties in DSWPD individuals significantly improved after treatment (d = 0.47-0.65) and at the 1- (d = 0.43-1.00) and 3-month follow-up (d = 0.39-1.38), yet there were no differences between short- and long-wavelength BLT. Results provide preliminary evidence that RNT may link delayed sleep phase with depression. BLT conferred sleep benefits, but also improvements in depressed mood and RNT, and thus represents a potentially cost-effective strategy for young people experiencing delayed sleep phase and low mood.
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Affiliation(s)
- Cele Richardson
- School of Psychological Science, Centre for Sleep Science, University of Western Australia, Perth, WA, Australia.,Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | - Michael Gradisar
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
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Abstract
PURPOSE OF REVIEW This article provides an overview of circadian physiology and discusses common presentations and treatment strategies for the circadian rhythm sleep-wake disorders. RECENT FINDINGS Circadian rhythms are present throughout the body, and appreciation for the role that circadian dysregulation plays in overall health is increasing, with mounting associations between circadian disruption and cardiometabolic disease risk. SUMMARY It is important to recognize the ubiquitous role that circadian rhythms play throughout the brain and body. An understanding of circadian neurophysiology will provide insight into the means by which patients with a variety of neuropathologies at the level of the retina, optic nerve, or hypothalamus may also be at risk for circadian dysfunction.
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15
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Partington HS, Nutter JM, Eells JB. Nurr1 deficiency shortens free running period, enhances photoentrainment to phase advance, and disrupts circadian cycling of the dopamine neuron phenotype. Behav Brain Res 2021; 411:113347. [PMID: 33991560 DOI: 10.1016/j.bbr.2021.113347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 02/06/2023]
Abstract
Neurological and neuropsychiatric disorders, including addiction, schizophrenia, and Parkinson's disease (PD), involve dysfunction in midbrain dopamine (DA) neurotransmission with severity of disease symptoms and progression associated with disrupted circadian rhythms. The nuclear transcription factor Nurr1, essential for DA neuron (DAN) development, survival, and maintenance, is also known to interact with circadian rhythm regulating clock proteins. In the Nurr1-null heterozygous (+/-) mice, a Nurr1 deficient model which reproduces some of the alterations in DA function found in schizophrenia and PD, we measured, using wheel-running activity, the free running period (tau) and photoperiod entrainment. Because Nurr1 has a role in regulating the DA phenotype, we also measured the circadian fluctuations in the number of DANs using tyrosine hydroxylase (TH) immunofluorescence. In Nurr1 +/- mice, tau was significantly shorter and entrainment to a 6 h earlier shift in the dark cycle was accelerated. The Nurr1 wild-type (+/+) mice cycled DAN numbers across time, with a significantly greater number (∼2-fold increase) of DANs at zeitgeber time (ZT) 0 than ZT12. The +/- mice, however, did not cycle the DA phenotype, as no differences in DAN numbers were observed between ZT0 and ZT12. Additionally, the +/- mice had significantly fewer DANs at ZT0 but not at ZT12 as compared to +/+ mice. Based these data, circadian rhythms and fluctuations in the DA phenotype requires normal Nurr1 function. A better understanding is needed of the mechanisms regulating the DA phenotype and subsequent neurotransmission across the circadian cycle and how this is altered in circadian rhythm and DA neurotransmission-associated disorders.
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Affiliation(s)
- Heath S Partington
- East Carolina University, Department of Anatomy and Cell Biology, Brody School of Medicine, Greenville, NC, USA
| | - Jennifer Makenzie Nutter
- East Carolina University, Department of Anatomy and Cell Biology, Brody School of Medicine, Greenville, NC, USA
| | - Jeffrey B Eells
- East Carolina University, Department of Anatomy and Cell Biology, Brody School of Medicine, Greenville, NC, USA.
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16
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Cornwell JFM, Mandelbaum O, Bajger AT, Crookes RD, Krantz DH, Higgins ET. Locomoting Larks and Assessing Owls: Morality from Mode and Time of Day. SOCIAL COGNITION 2021. [DOI: 10.1521/soco.2021.39.1.59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Moral psychology is used to explore the interaction between regulatory mode (locomotion; assessment) and diurnal preference (“early birds”; “night owls”). Moral and immoral behavior was partly explained by an interaction between regulatory mode and the time of day the task took place. In Studies 1a and 1b, we established a relation between self-reported diurnal preference and regulatory mode using both a chronic measure and an induction: stronger locomotion preferring an earlier time of day; stronger assessment preferring a later time of day. In Study 2, we show that those with a locomotion predominance were less likely to invest in a public good later in the day compared to those with an assessment predominance. Lastly, in Study 3, those induced into an assessment mode were more likely to cheat when randomly assigned to complete a task in the morning compared to those induced into a locomotion mode.
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17
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Disorders of Arousal: A Chronobiological Perspective. Clocks Sleep 2021; 3:53-65. [PMID: 33494408 PMCID: PMC7838780 DOI: 10.3390/clockssleep3010004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 12/12/2022] Open
Abstract
Non-rapid eye movement (NREM) sleep parasomnias are characterized by motor and emotional behaviors emerging from incomplete arousals from NREM sleep and they are currently referred to as disorders of arousal (DoA). Three main clinical entities are recognized, namely confusional arousal, sleep terror and sleepwalking. DoA are largely present in pediatric populations, an age in which they are considered as transitory, unhabitual physiological events. The literature background in the last twenty years has extensively shown that DoA can persist in adulthood in predisposed individuals or even appear de novo in some cases. Even though some episodes may arise from stage 2 of sleep, most DoA occur during slow wave sleep (SWS), and particularly during the first two sleep cycles. The reasons for this timing are linked to the intrinsic structure of SWS and with the possible influence on this sleep phase of predisposing, priming and precipitating factors for DoA episodes. The objective of this paper is to review the intrinsic sleep-related features and chronobiological aspects affecting SWS, responsible for the occurrence of the majority of DoA episodes during the first part of the night.
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Xerfan EMS, Facina AS, Galduróz JCF, Tufik S, Tomimori J, Andersen ML. Hand eczema, obsessive compulsive disorder and the role of sleep: a triad of associated factors and the influence of the current pandemic. Sleep Med 2021; 79:164-165. [PMID: 33550094 DOI: 10.1016/j.sleep.2020.12.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/30/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Ellen M S Xerfan
- Programa de Pós-Graduação em Medicina Translacional, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Anamaria S Facina
- Departamento de Dermatologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
| | - José Carlos F Galduróz
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Jane Tomimori
- Departamento de Dermatologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Monica L Andersen
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Feder MA, Baroni A. Just Let Me Sleep in: Identifying and Treating Delayed Sleep Phase Disorder in Adolescents. Child Adolesc Psychiatr Clin N Am 2021; 30:159-174. [PMID: 33223060 DOI: 10.1016/j.chc.2020.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Individuals with delayed sleep phase disorder (DSPD) are unable to naturally fall asleep and awake at conventional times; for this reason, DSPD is often mistaken for insomnia. However, unlike many patients with insomnia, those with DSPD struggle to get up at appropriate times. DSPD is associated with school refusal, academic difficulties, and lower employment rate. DSPD in youth has prevalence as high as 16%, and is often comorbid with other psychiatric disorders. Treatments include appropriate light exposure during the day, melatonin use, developing an evening routine that minimizes arousal-increasing activities, and gradually shifting sleep-wake times toward more functional ones.
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Affiliation(s)
- Michael A Feder
- Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at NYU Langone, NYC H+H/Bellevue, New York, NY, USA; Child Study Center, One Park Avenue, 7th Floor, New York, NY 10016, USA
| | - Argelinda Baroni
- Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at NYU Langone, NYC H+H/Bellevue, New York, NY, USA; Child Study Center, One Park Avenue, 7th Floor, New York, NY 10016, USA.
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20
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Trosman I, Ivanenko A. Classification and Epidemiology of Sleep Disorders in Children and Adolescents. Child Adolesc Psychiatr Clin N Am 2021; 30:47-64. [PMID: 33223068 DOI: 10.1016/j.chc.2020.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Sleep disturbances are common in children and adolescents but still remain unrecognized and undertreated. Several classification systems of sleep disorders are available, which include recent attempts to develop more specific nosologic categories that reflect developmental aspects of sleep. The prevalence of sleep disorders has been studied across various samples of healthy, typically developing children and those with special medical, psychiatric, and neurodevelopmental needs. Sleep disorders are highly prevalent in children and adolescents with psychiatric disorders, making it important for mental health professionals to be aware of sleep problems and to address them in the context of psychiatric comorbidities.
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Affiliation(s)
- Irina Trosman
- Division of Pulmonary and Sleep Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue Box 43, Chicago, IL 60611-2991, USA
| | - Anna Ivanenko
- Division of Child and Adolescent Psychiatry, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
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21
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Steele TA, St Louis EK, Videnovic A, Auger RR. Circadian Rhythm Sleep-Wake Disorders: a Contemporary Review of Neurobiology, Treatment, and Dysregulation in Neurodegenerative Disease. Neurotherapeutics 2021; 18:53-74. [PMID: 33844152 PMCID: PMC8116400 DOI: 10.1007/s13311-021-01031-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 12/22/2022] Open
Abstract
Circadian rhythms oscillate throughout a 24-h period and impact many physiological processes and aspects of daily life, including feeding behaviors, regulation of the sleep-wake cycle, and metabolic homeostasis. Misalignment between the endogenous biological clock and exogenous light-dark cycle can cause significant distress and dysfunction, and treatment aims for resynchronization with the external clock and environment. This article begins with a brief historical context of progress in the understanding of circadian rhythms, and then provides an overview of circadian neurobiology and the endogenous molecular clock. Various tools used in the diagnosis of circadian rhythm sleep-wake disorders, including sleep diaries and actigraphy monitoring, are then discussed, as are the therapeutic applications of strategically timed light therapy, melatonin, and other behavioral and pharmacological therapies including the melatonin agonist tasimelteon. Management strategies towards each major human circadian sleep-wake rhythm disorder, as outlined in the current International Classification of Sleep Disorders - Third Edition, including jet lag and shift work disorders, delayed and advanced sleep-wake phase rhythm disorders, non-24-h sleep-wake rhythm disorder, and irregular sleep-wake rhythm disorder are summarized. Last, an overview of chronotherapies and the circadian dysregulation of neurodegenerative diseases is reviewed.
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Affiliation(s)
- Tyler A Steele
- Mayo Center for Sleep Medicine, Rochester, Minnesota, USA
- Department of Neurology, Rochester, Minnesota, USA
- Rochester Technical and Community College, Rochester, Minnesota, USA
| | - Erik K St Louis
- Mayo Center for Sleep Medicine, Rochester, Minnesota, USA.
- Department of Neurology, Rochester, Minnesota, USA.
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rochester, Minnesota, USA.
- Mayo Clinic Health System, La Crosse, Wisconsin, USA.
| | - Aleksandar Videnovic
- Massachusetts General Hospital, Department of Neurology and Harvard Medical School, Boston, Massachusetts, USA
| | - R Robert Auger
- Mayo Center for Sleep Medicine, Rochester, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rochester, Minnesota, USA
- Department of Psychiatry, Rochester, Minnesota, USA
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22
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Relationships Among Delayed Sleep Phase Disorder, Emotional Dysregulation, and Affective Temperaments in Adults With Attention Deficit Hyperactivity Disorder and Cyclothymia. J Nerv Ment Dis 2020; 208:857-862. [PMID: 32769692 DOI: 10.1097/nmd.0000000000001209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
This study aims to explore the relationships between delayed sleep phase disorder (DSPD) and emotional dysregulation in 240 patients (134 with cyclothymia, 81 with attention deficit hyperactivity disorder [ADHD] and 25 with both conditions). DSPD was assessed using the Morningness-Eveningness Questionnaire, followed by a clinical evaluation. Affective temperaments and emotional dysregulation were also investigated through the brief version of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego and the Reactivity, Intensity, Polarity, Stability questionnaires, respectively. Clinical variables were compared in patients with and without DSPD, and a logistic regression model was used to identify the predictive value of the clinical characteristics on the presence of DSPD. DSPD patients (19% of the total sample) were significantly younger than patients without DSPD, showed an about 4 times higher lifetime history of comorbid ADHD and cyclothymia, and reported higher scores in the irritable and cyclothymic temperamental subscales and in the affective instability and impulsivity dimensions. In the multiple logistic regression, we found a negative predictive value of increasing age on the presence of DSPD, whereas comorbid cyclothymia and ADHD and cyclothymic temperament seem to represent risk factors for DSPD.
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23
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Emens JS, Berman AM, Thosar SS, Butler MP, Roberts SA, Clemons NA, Herzig MX, McHill AW, Morimoto M, Bowles NP, Shea SA. Circadian rhythm in negative affect: Implications for mood disorders. Psychiatry Res 2020; 293:113337. [PMID: 32777620 PMCID: PMC8053038 DOI: 10.1016/j.psychres.2020.113337] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 07/18/2020] [Accepted: 07/26/2020] [Indexed: 02/02/2023]
Abstract
In humans, there is an endogenous, near 24-h (i.e., circadian) variation in mood with the best mood occurring during the circadian day and the worst mood occurring during the circadian night. Only positive affect, and not negative affect, has been shown to contribute to this circadian rhythm. We discovered a sharp circadian peak in negative affect during the circadian night coincident with a circadian trough in positive affect. These findings may help explain the association of depression with insomnia, the increased risk of suicide with nocturnal wakefulness, and the correlation between circadian misalignment and symptom severity in Major Depressive Disorder.
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Affiliation(s)
- Jonathan S. Emens
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, Oregon 97239,Oregon Institute of Occupational Health Sciences, 3181 SW Sam Jackson Park Rd., Portland, Oregon 97239,VA Portland Health Care System, 3710 SW US Veterans Hospital Rd., Portland, OR 97239,Corresponding Author: Jonathan Emens, MD, VA Portland Health Care System, 3710 SW US Veterans Hospital Rd., Mailcode: P3-MHADM, Portland, OR 97239, , 503-220-8262, ext. 58490
| | - Alec M. Berman
- Oregon Institute of Occupational Health Sciences, 3181 SW Sam Jackson Park Rd., Portland, Oregon 97239
| | - Saurabh S. Thosar
- Oregon Institute of Occupational Health Sciences, 3181 SW Sam Jackson Park Rd., Portland, Oregon 97239,School of Nursing, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, Oregon 97239
| | - Matthew P. Butler
- Oregon Institute of Occupational Health Sciences, 3181 SW Sam Jackson Park Rd., Portland, Oregon 97239
| | - Sally A. Roberts
- Oregon Institute of Occupational Health Sciences, 3181 SW Sam Jackson Park Rd., Portland, Oregon 97239
| | - Noal A. Clemons
- Oregon Institute of Occupational Health Sciences, 3181 SW Sam Jackson Park Rd., Portland, Oregon 97239
| | - Maya X. Herzig
- Oregon Institute of Occupational Health Sciences, 3181 SW Sam Jackson Park Rd., Portland, Oregon 97239
| | - Andrew W. McHill
- Oregon Institute of Occupational Health Sciences, 3181 SW Sam Jackson Park Rd., Portland, Oregon 97239
| | - Miki Morimoto
- Oregon Institute of Occupational Health Sciences, 3181 SW Sam Jackson Park Rd., Portland, Oregon 97239
| | - Nicole P. Bowles
- Oregon Institute of Occupational Health Sciences, 3181 SW Sam Jackson Park Rd., Portland, Oregon 97239
| | - Steven A. Shea
- Oregon Institute of Occupational Health Sciences, 3181 SW Sam Jackson Park Rd., Portland, Oregon 97239
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24
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Cox RC, Parmar AM, Olatunji BO. Sleep in obsessive-compulsive and related disorders: a selective review and synthesis. Curr Opin Psychol 2020; 34:23-26. [DOI: 10.1016/j.copsyc.2019.08.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/07/2019] [Accepted: 08/16/2019] [Indexed: 02/07/2023]
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25
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26
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Gao Q, Sheng J, Qin S, Zhang L. Chronotypes and affective disorders: A clock for mood? BRAIN SCIENCE ADVANCES 2020. [DOI: 10.26599/bsa.2019.9050018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Affective disorders are often accompanied by circadian rhythm disruption and the major symptoms of mental illness occur in a rhythmic manner. Chronotype, also known as circadian preference for rest or activity, is believed to exert a substantial influence on mental health. Here, we review the connection between chronotypes and affective disorders, and discuss the potential underlying mechanisms between these two phenomena.
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Affiliation(s)
- Qian Gao
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology and the Collaborative Innovation Center for Brain Science, Huazhong University of Science and Technology, Wuhan 430074, Hubei, China
| | - Juan Sheng
- Jingzhou Mental Health Center, Jingzhou 434000, Hubei, China
| | - Song Qin
- Jingzhou Mental Health Center, Jingzhou 434000, Hubei, China
| | - Luoying Zhang
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology and the Collaborative Innovation Center for Brain Science, Huazhong University of Science and Technology, Wuhan 430074, Hubei, China
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27
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Cox RC, Olatunji BO. Differential associations between chronotype, anxiety, and negative affect: A structural equation modeling approach. J Affect Disord 2019; 257:321-330. [PMID: 31302521 PMCID: PMC6711779 DOI: 10.1016/j.jad.2019.07.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/23/2019] [Accepted: 07/04/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Increasing evidence implicates circadian rhythms, including chronotype, in anxiety symptoms and disorders. However, it remains unclear whether this relation is accounted for by sleep disturbance. Likewise, given overlap between anxiety and negative affect, a unique link between chronotype and anxiety remains to be established. The present study addressed these questions using a multimethod approach to determine whether there is a unique relation between chronotype and anxiety symptoms, controlling for sleep disturbance. METHODS Indicators of chronotype, sleep disturbance, anxiety, and negative affect were collected in a sample of adults (N = 151) using a combination of subjective and behavioral measures both within and outside the laboratory over a 9-day period. Structural equation modeling was used to examine associations between latent constructs. RESULTS Results revealed significant associations between sleep disturbance and both anxiety and negative affect. A significant association was found between chronotype and anxiety, over and above the effect of sleep disturbance. In contrast, the relation between chronotype and negative affect was nonsignificant after controlling for sleep disturbance. LIMITATIONS Unselected sample, lack of experimental manipulation, cross-sectional design. CONCLUSIONS These findings suggest a unique role of chronotype in anxiety and point to circadian disruption as a potential biological mechanism in anxiety-related disorders.
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Affiliation(s)
- Rebecca C. Cox
- Correspondence concerning this article should be addressed to Rebecca Cox, Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN 37240,
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28
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Wilson S, Anderson K, Baldwin D, Dijk DJ, Espie A, Espie C, Gringras P, Krystal A, Nutt D, Selsick H, Sharpley A. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: An update. J Psychopharmacol 2019; 33:923-947. [PMID: 31271339 DOI: 10.1177/0269881119855343] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This British Association for Psychopharmacology guideline replaces the original version published in 2010, and contains updated information and recommendations. A consensus meeting was held in London in October 2017 attended by recognised experts and advocates in the field. They were asked to provide a review of the literature and identification of the standard of evidence in their area, with an emphasis on meta-analyses, systematic reviews and randomised controlled trials where available, plus updates on current clinical practice. Each presentation was followed by discussion, aiming to reach consensus where the evidence and/or clinical experience was considered adequate, or otherwise to flag the area as a direction for future research. A draft of the proceedings was circulated to all speakers for comments, which were incorporated into the final statement.
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Affiliation(s)
- Sue Wilson
- 1 Centre for Psychiatry, Imperial College London, London, UK
| | - Kirstie Anderson
- 2 Regional Sleep Service, Freeman Hospital, Newcastle Upon Tyne, UK
| | - David Baldwin
- 3 Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Derk-Jan Dijk
- 4 Sleep Research Centre, University of Surrey, Guildford, UK
| | - Audrey Espie
- 5 Psychology Department, NHS Fife, Dunfermline, UK
| | - Colin Espie
- 6 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Paul Gringras
- 7 Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andrew Krystal
- 8 Psychiatry and Behavioral Science, University of California, San Francisco, CA, USA
| | - David Nutt
- 1 Centre for Psychiatry, Imperial College London, London, UK
| | - Hugh Selsick
- 9 Royal London Hospital for Integrated Medicine, London, UK
| | - Ann Sharpley
- 10 Department of Psychiatry, University of Oxford, Oxford, UK
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Abstract
This article reviews delayed and advanced sleep-wake phase disorders. Diagnostic procedures include a clinical interview to verify the misalignment of the major nocturnal sleep episode relative to the desired and social-normed timing of sleep, a 3-month or greater duration of the sleep-wake disturbance, and at least a week of sleep diary data consistent with the sleep timing complaint. Treatment options include gradual, daily shifting of the sleep schedule (chronotherapy); shifting circadian phase with properly timed light exposure (phototherapy); or melatonin administration. Future directions are discussed to conclude the article.
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Affiliation(s)
- Elizabeth Culnan
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612-3833, USA
| | - Lindsay M McCullough
- Department of Medicine, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612-3833, USA
| | - James K Wyatt
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612-3833, USA. https://twitter.com/Chisleeper
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30
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Baroni A. Teens Who Can't Sleep: Insomnia or Circadian Rhythm Disorder? J Am Acad Child Adolesc Psychiatry 2019; 58:307-312. [PMID: 30832901 DOI: 10.1016/j.jaac.2018.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/16/2018] [Accepted: 12/20/2018] [Indexed: 01/19/2023]
Abstract
Maggie is a 16-year-old girl who came to see me because she wanted help with her longstanding difficulties falling asleep at night and waking up in the morning. She goes to bed between midnight and 3 am and usually lies awake worrying until falling asleep at 3 to 4 am. She often video-calls or texts her boyfriend before sleep. Her wakeup time is 8 am; she typically wakes exhausted, having slept 4 to 5 hours. Although a good student, she is often late for classes. On weekends, she wakes around noon. She is tired, anxious, and demoralized. She cannot concentrate as well as she did prior to the onset of her sleep symptoms at age 10 to 11 years. Her psychiatric history includes a diagnosis of anxiety and depression, both in remission, treated with fluoxetine 30 mg daily for several years. Difficulties falling asleep and waking in the morning are common complaints among adolescents and young adults. Before my additional year of training in sleep medicine, I would have misdiagnosed Maggie as having insomnia rather than delayed sleep phase disorder (DSPD), a circadian rhythm disorder.
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Affiliation(s)
- Argelinda Baroni
- Child Study Center, Hassenfeld Children's Hospital at NYU Langone, New York, NY.
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31
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Danielsson K, Sakarya A, Jansson-Fröjmark M. The reduced Morningness–Eveningness Questionnaire: Psychometric properties and related factors in a young Swedish population. Chronobiol Int 2019; 36:530-540. [DOI: 10.1080/07420528.2018.1564322] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | - Aysegül Sakarya
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Markus Jansson-Fröjmark
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Kaufmann CN, Gershon A, Depp CA, Miller S, Zeitzer JM, Ketter TA. Daytime midpoint as a digital biomarker for chronotype in bipolar disorder. J Affect Disord 2018; 241:586-591. [PMID: 30172210 PMCID: PMC6436809 DOI: 10.1016/j.jad.2018.08.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/23/2018] [Accepted: 08/07/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Bipolar disorder (BD) is associated with later sleep and daily activity (evening rather than morning chronotype). Objective chronotype identification (e.g., based on actigraphs/smartphones) has potential utility, but to date, chronotype has mostly been assessed by questionnaires. Given the ubiquity of accelerometer-based devices (e.g. actigraphs/smartphones) worn/used during daytime and tendency to recharge rather than wear at night, we assessed chronotype using daytime (rather than sleep) interval midpoints. METHODS Sixty-one participants with BD type I (BD-I) or II (BD-II) and 61 healthy controls completed 25-50 days of continuous actigraphy. The Composite Scale of Morningness (CSM) was completed by a subset of this group. Daytime activity midpoint was calculated for each daytime interval, excluding naps. Evening chronotype was defined as having a daytime interval midpoint at or after 16:15:00 (4:15:00 PM). RESULTS BD versus controls had delayed daytime midpoint (mean ± standard deviation) (16:49:07 ± 01:26:19 versus 16:12:51 ± 01:02:14, p < 0.01), and greater midpoint variability (73.3 ± 33.9 min versus 58.1 ± 18.3 min, p < 0.01). Stratifying by gender and age, females and adolescents with BD had delayed and more variable daytime midpoints versus controls. Adults with BD had greater midpoint variability than controls. Within-person mean and standard deviations of daytime midpoints were highly correlated with sleep midpoints (r = 0.99, p < 0.01 and r = 0.86, p < 0.01, respectively). Daytime midpoint mean was also significantly correlated with the CSM (r = -0.56, p < 0.01). LIMITATIONS Small sample size; analyses not fully accounting for daytime napping. CONCLUSIONS Wrist actigraphy for determination of daytime midpoints is a potential tool to identify objective chronotype. Exploration of the use of consumer devices (wearables/smartphones) is needed.
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Affiliation(s)
- Christopher N. Kaufmann
- Division of Geriatrics and Gerontology, Department of Medicine, University of California San Diego, La Jolla, CA,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA
| | - Anda Gershon
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA
| | - Colin A. Depp
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA,Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Shefali Miller
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA
| | - Jamie M. Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA
| | - Terence A. Ketter
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA
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Wilson J, Reid KJ, Braun RI, Abbott SM, Zee PC. Habitual light exposure relative to circadian timing in delayed sleep-wake phase disorder. Sleep 2018; 41:5078613. [PMID: 30423177 PMCID: PMC6231529 DOI: 10.1093/sleep/zsy166] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 07/16/2018] [Indexed: 12/16/2022] Open
Abstract
Study Objectives To compare melatonin timing, a well-validated marker for endogenous circadian phase, and habitual light-exposure patterns in adults with delayed sleep-wake phase disorder (DSWPD) and intermediate chronotype controls. Methods Twelve individuals with DSWPD (five females, mean age: 31.1) and 12 age-matched controls (six females, mean age: 33.6) underwent a minimum of 7 days of light and activity monitoring followed by an inpatient hospital stay, where blood was taken to assess melatonin timing (calculated as dim light melatonin onset-DLMO). Habitual light-exposure patterns were then compared with a human phase-response curve (PRC) to light. Results Relative to clock time, individuals with DSWPD had a later light-exposure pattern compared with controls, but their light-exposure pattern was earlier relative to DLMO. According to the human PRC to light, individuals with DSWPD had less daily advancing light exposure compared with controls. The primary difference was seen in the late portion of the advancing window, in which individuals with DSWPD were exposed to fewer pulses of light of equivalent duration and intensity compared with controls. Conclusions Diminished advancing light exposure may play a role in the development and perpetuation of delayed sleep-wake timing in individuals with DSWPD. Enhancing light exposure during the later portion of the advancing window represents an innovative and complementary strategy that has the potential to improve the effectiveness of bright light therapy in DSWPD.
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Affiliation(s)
- John Wilson
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL
- Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Kathryn J Reid
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL
- Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Rosemary I Braun
- Biostatistics Division (Preventive Medicine), Northwestern University, Feinberg School of Medicine, Chicago, IL
- Department of Engineering Sciences and Applied Mathematics, Northwestern University, Evanston, IL
| | - Sabra M Abbott
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL
- Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Phyllis C Zee
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL
- Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL
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Snitselaar MA, Smits MG, Spijker J. ADHD symptoms in adults with delayed sleep phase disorder. Sleep Biol Rhythms 2018. [DOI: 10.1007/s41105-018-0188-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Danielsson K, Jansson-Fröjmark M, Broman JE, Markström A. Light Therapy With Scheduled Rise Times in Young Adults With Delayed Sleep Phase Disorder: Therapeutic Outcomes and Possible Predictors. Behav Sleep Med 2018; 16:325-336. [PMID: 27712107 DOI: 10.1080/15402002.2016.1210150] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Clinical trials with light therapy (LT) for delayed sleep phase disorder (DSPD) are sparse and little is known about factors that are favorable for improvements. In this study, LT with scheduled rise times was conducted at home for 14 days by 44 participants with DSPD aged 16-26 years. Primary outcomes were sleep onset and sleep offset. Potential predictors were demographic characteristics, chronotype, dim light melatonin onset, the number of days the LT lamp was used, the daily duration of LT, daytime sleepiness, anxiety, depression, worry, and rumination. Significant advances were observed in sleep onset and sleep offset from baseline to the end of treatment. The number of days of LT predicted earlier sleep onset and sleep offset.
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Affiliation(s)
- Katarina Danielsson
- a Department of Neuroscience , Psychiatry, Uppsala University , Uppsala , Sweden
| | | | - Jan-Erik Broman
- c Department of Neuroscience, Psychiatry, Department of Medical Sciences, Lung, Allergy and Sleep Research , Uppsala University , Uppsala , Sweden
| | - Agneta Markström
- d Department of Medical Sciences, Lung, Allergy, and Sleep Research , Uppsala University , Uppsala , Sweden
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Abstract
PURPOSE OF REVIEW Chronotype, reflecting interindividual differences in daily activity patterns and sleep-wake cycles, is intrinsically connected with well-being. Research indicates increased risk of many adverse mental health outcomes for evening-type individuals. Here, we provide an overview of the current evidence available on the relationship between chronotype and psychiatric disorders. RECENT FINDINGS The association between eveningness and depression is well established cross-sectionally, with preliminary support from longitudinal studies. The mechanisms underlying this relationship warrant further research; deficient cognitive-emotional processes have recently been implicated. Eveningness is associated with unhealthy lifestyle habits, and the propensity of evening types to addiction has been recognized. Chronotype may also be implicated in disordered eating. SUMMARY Eveningness is associated with depression-including seasonal affective disorder (SAD)-and substance dependence, while support for a relation with anxiety disorders and psychosis is lacking. In bipolar disorder, chronotype is linked to depression but not mania. Eveningness is also related to sleep disturbances and poor lifestyle habits, which may increase risk for psychiatric disorders.
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Affiliation(s)
- Liia Kivelä
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
| | - Marinos Rodolfos Papadopoulos
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
| | - Niki Antypa
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
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A randomised controlled trial of bright light therapy and morning activity for adolescents and young adults with Delayed Sleep-Wake Phase Disorder. Sleep Med 2018; 45:114-123. [PMID: 29680419 DOI: 10.1016/j.sleep.2018.02.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/16/2018] [Accepted: 02/01/2018] [Indexed: 12/17/2022]
Abstract
A randomised controlled trial evaluated bright light therapy and morning activity for the treatment of Delayed Sleep-Wake Phase Disorder (DSWPD) in young people. 60 adolescents and young adults (range = 13-24 years, mean = 15.9 ± 2.2 y, 63% f) diagnosed with DSWPD were randomised to receive three weeks of post-awakening Green Bright Light Therapy (∼507 nm) and Sedentary Activity (sitting, watching TV), Green Bright Light Therapy and Morning Activity (standing, playing motion-sensing videogame), Red Light Therapy (∼643 nm) and Sedentary Activity or Red Light Therapy and Morning Activity. Sleep (ie sleep onset time, wake up time, sleep onset latency, total sleep time) and daytime functioning (ie morning alertness, daytime sleepiness, fatigue, functional impairment) were measured pre-treatment, post-treatment and at one and three month follow-up. Contrary to predictions, there were no significant differences in outcomes between treatment groups; and interaction effects between treatment group and time for all outcome variables were not statistically significant. However, adolescents and young adults in morning activity conditions did not meaningfully increase their objective activity (ie movement frequency). Overall, adolescents reported significantly improved sleep timing (d = 0.30-0.46), sleep onset latency (d = 0.32) and daytime functioning (d = 0.45-0.87) post-treatment. Improvements in sleep timing (d = 0.53-0.61), sleep onset latency (d = 0.57), total sleep time (d = 0.51), and daytime functioning (d = 0.52-1.02) were maintained, or improved upon, at the three month follow-up. However, relapse of symptomology was common and 38% of adolescents and young adults requested further treatment in addition to the three weeks of light therapy. Although there is convincing evidence for the short-term efficacy of chronobiological treatments for DSWPD, long-term treatment outcomes can be improved. To address this gap in our current knowledge, avenues for future research are discussed. CLINICAL TRIAL Australian & New Zealand Clinical Trials Registry, https://www.anzctr.org.au, ACTRN12614000308695.
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Baroni A, Bruzzese JM, Di Bartolo CA, Ciarleglio A, Shatkin JP. Impact of a sleep course on sleep, mood and anxiety symptoms in college students: A pilot study. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2018; 66:41-50. [PMID: 28820661 DOI: 10.1080/07448481.2017.1369091] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To examine the impact of a sleep course on sleep-related behaviors, mood, and anxiety in college students. PARTICIPANTS Participants were 145 students enrolled in either the sleep course (n = 70) or a psychology course (n = 75); data were collected in September 2014, November 2014, and February 2015. METHODS Sleep characteristics and symptoms of depression and anxiety were assessed using validated questionnaires and sleep logs. Linear, logistic and proportional odds regression models were used to test course effects. RESULTS In November, sleep course students reported significant differences in sleep hygiene (SHI; p < .001), perceived sleep latency (PSQI; p < .05), and circadian sleep phase (MEQ; p < .05), compared to controls. In February, the sleep course students maintained most of the aforementioned gains and reported fewer symptoms of depression (CES-D; p = .05) and anxiety (BAI; p < .05). CONCLUSIONS These positive preliminary results indicate that focused education has the potential to improve sleep among college students.
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Affiliation(s)
- Argelinda Baroni
- a Department of Child and Adolescent Psychiatry , New York University School of Medicine , New York City , New York , USA
| | | | - Christina A Di Bartolo
- a Department of Child and Adolescent Psychiatry , New York University School of Medicine , New York City , New York , USA
| | - Adam Ciarleglio
- c Department of Psychiatry , Columbia University , New York City , New York , USA
| | - Jess P Shatkin
- a Department of Child and Adolescent Psychiatry , New York University School of Medicine , New York City , New York , USA
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Duncan WC, Slonena EE, Hejazi NS, Brutsche N, Park LT, Henter ID, Ballard ED, Zarate CA. Are 24-hour motor activity patterns associated with continued rapid response to ketamine? Neuropsychiatr Dis Treat 2018; 14:2739-2748. [PMID: 30410340 PMCID: PMC6200084 DOI: 10.2147/ndt.s172089] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
PURPOSE This study examined the links between 24-hour activity patterns (specifically, amplitude and timing of wrist activity) and the persisting qualities of clinical antidepressant response to the glutamatergic modulator ketamine. METHODS Twenty-four-hour activity patterns were compared across 5 days of 24-hour activity rhythms in patients with major depressive disorder who displayed either a brief antidepressant response (24-48 hours), a continued antidepressant response (>72 hours), or no antidepressant response to ketamine. These postinfusion-response profiles were then used retrospectively to examine cohort-specific fitted parameters at baseline, postinfusion day 1 (D1), and postinfusion D3. RESULTS Relative to the nonresponders, the cohort experiencing a brief antidepressant response had blunted 24-hour amplitude that extended from baseline through D3 and postketamine phase advance of activity on D1 that reverted to baseline on D3. Relative to the nonresponders, the cohort experiencing a continued antidepressant response to ketamine had phase-advanced activity at both baseline and D1, as well as increased amplitude on D1 and D3. CONCLUSION Taken together, the results suggest that the time course of antidepressant response to ketamine is influenced by underlying biological differences in motor activity timekeeping. These differences may provide clues that link durable mood response with the molecular machinery of the circadian system, thus leading to more effective interventions. In addition, biomarkers of preinfusion motor activity (eg, amplitude, timing) may be useful for recommending future individualized treatment interventions, to the extent that they help identify patients who may relapse quickly after treatment.
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Affiliation(s)
- Wallace C Duncan
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA,
| | - Elizabeth E Slonena
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA,
| | - Nadia S Hejazi
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA,
| | - Nancy Brutsche
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA,
| | - Lawrence T Park
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA,
| | - Ioline D Henter
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA,
| | - Elizabeth D Ballard
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA,
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA,
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Abstract
Delayed sleep-wake phase disorder (DSWPD) is the most commonly encountered of the circadian rhythm sleep-wake disorders (CRSDs), and is often confused with sleep initiation insomnia. It typically emerges in teenage years and persists into adulthood. In essence, people with the disorder have an abnormally delayed major sleep episode relative to the dark phase of the solar cycle, and hence great difficulty initiating sleep at an appropriately early time, and, as a knock-on effect, waking at a desirable time in the morning, leading to chronic, and often quite severe sleep restriction trying to conform to a 9 to 5 schedule. As a result, sleep on free days is often extended in compensation. When released from such schedule constraints, sleep duration and quality is normal; it is just delayed. This review highlights elements of our current understanding of the epidemiology, associations and pathophysiology of the disorder, before discussing how some of our knowledge of sleep and circadian physiology can be applied to guide treatment of it.
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Affiliation(s)
- Alexander D Nesbitt
- Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Neurology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,SleepCity, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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41
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Melroy-Greif WE, Gizer IR, Wilhelmsen KC, Ehlers CL. Genetic Influences on Evening Preference Overlap with Those for Bipolar Disorder in a Sample of Mexican Americans and American Indians. Twin Res Hum Genet 2017; 20:499-510. [PMID: 29192581 PMCID: PMC6013261 DOI: 10.1017/thg.2017.62] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Diurnal preference (e.g., being an owl or lark) has been associated with several psychiatric disorders including bipolar disorder (BP), major depressive disorder, and substance use disorders. Previous large-scale genome-wide association studies (GWAS) aimed at identifying genetic influences on diurnal preference have exclusively included subjects of European ancestry. This study examined the genetic architecture of diurnal preference in two minority samples: a young adult sample of Mexican Americans (MAs), and a family-based sample of American Indians (AIs). Typed or imputed variants from exome chip data from the MA sample and low pass whole-genome sequencing from the AI cohort were analyzed using a mixed linear model approach for association with being an owl, as defined by a usual bedtime after 23:00 hrs. Genetic risk score (GRS) profiling detected shared genetic risk between evening preference and related disorders. Four variants in KIAA1549 like (KIAA1549L), a gene previously associated with attempted suicide in bipolar patients, were suggestively associated with being an owl at p < 1.82E-05; post hoc analyses showed the top variant trending in both the MA and AI cohorts at p = 2.50E-05 and p = .030, respectively. Variants associated with BP at p < .03 from the Psychiatric Genomics Consortium nominally predicted being an owl in the MA/AI cohort at p = .012. This study provides some additional evidence that genetic risk factors for BP also confer risk for being an owl in MAs/AIs and that evening preference may be a useful endophenotype for future studies of BP.
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Affiliation(s)
| | - Ian R. Gizer
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA
| | - Kirk C. Wilhelmsen
- Renaissance Computing Institute (RENCI), Chapel Hill, NC 27517, USA
- Departments of Genetics and Neurology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Cindy L. Ehlers
- Department of Neuroscience, The Scripps Research Institute, La Jolla, CA 92037, USA
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Duncan WC, Slonena E, Hejazi NS, Brutsche N, Yu KC, Park L, Ballard ED, Zarate CA. Motor-Activity Markers of Circadian Timekeeping Are Related to Ketamine's Rapid Antidepressant Properties. Biol Psychiatry 2017; 82:361-369. [PMID: 28457485 PMCID: PMC5546993 DOI: 10.1016/j.biopsych.2017.03.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/06/2017] [Accepted: 03/08/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND The rapid clinical antidepressant effects of the glutamatergic modulator ketamine may be due to its ability to restore synaptic plasticity and related effects on sleep-wake and circadian systems. Preclinical studies indicate that ketamine alters expression of circadian clock-associated molecules, and clinical studies of ketamine on plasticity-related biomarkers further suggest an association with sleep slow waves and sleep homeostasis. METHODS Wrist-activity monitors were used to examine the pharmacologic and rapid antidepressant effects of ketamine on markers of circadian timekeeping (amplitude and timing) in mood disorders. Circadian amplitude and timing of activity at baseline, postinfusion day 1 (D1), and day 3 (D3) were measured in 51 patients with major depressive disorder or bipolar disorder. RESULTS Compared with either placebo or baseline, a mood-independent decrease of the central circadian value (mesor) was present on D1 after ketamine treatment. Mood-associated circadian effects between rapid (D1) responders and nonresponders were found at baseline, D1, and D3. At baseline, a phase-advanced activity pattern and lower mesor distinguished subsequent responders from nonresponders. On D1, ketamine nonresponders had a lower mesor and a blunted 24-hour amplitude relative to baseline. On D3, patients with a persisting clinical response exhibited a higher amplitude and mesor compared with nonresponders. CONCLUSIONS The findings are the first to demonstrate an association between ketamine's clinical antidepressant effects and circadian timekeeping. The results suggest that traitlike circadian activity patterns indicate rapid mood response to ketamine, and that mediators of continuing ketamine-induced mood changes include altered timing and amplitude of the circadian system.
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Affiliation(s)
- Wallace C Duncan
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland.
| | - Elizabeth Slonena
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Nadia S Hejazi
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Nancy Brutsche
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Kevin C Yu
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Lawrence Park
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Elizabeth D Ballard
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
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The Lausanne-Geneva cohort study of offspring of parents with mood disorders: methodology, findings, current sample characteristics, and perspectives. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1041-1058. [PMID: 28396906 DOI: 10.1007/s00127-017-1382-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 03/29/2017] [Indexed: 01/26/2023]
Abstract
PURPOSE Studies focusing on the offspring of affected parents utilize the well-established familial aggregation of mood disorders as a powerful tool for the identification of risk factors, early clinical manifestations, and prodromes of mood disorders in these offspring. The major goals of the Lausanne-Geneva mood cohort study are to: (1) assess the familial aggregation of bipolar and unipolar mood disorders; (2) prospectively identify risk factors for mood disorders as well as their early signs and prodromes; (3) identify their endophenotypes including cognitive features, alterations in brain structure, HPA-axis dysregulation, and abnormalities of the circadian rhythm of activity. METHODS Probands with bipolar disorders, major depressive disorder, and controls with at least one child aged from 4 to 17.9 years at study intake, their offspring, as well as their spouses are invited to take part in follow-up assessments at predetermined ages of the offspring. Direct semi-structured diagnostic interviews have been used for all participants. Probands, spouses, and adult offspring also undergo neurocognitive testing, anthropomorphic measures and biochemical exams, structural Magnetic Resonance Imaging, as well as objective assessments of physical activity using accelerometers in combination with ecological momentary assessments. RESULTS Currently, our study has up to seven follow-up assessments extending over a period of 20 years. There are 214 probands and 389 offspring with one direct interview before age 18 as well as a second assessment over follow-up. Data on 236 co-parents are also available from whom 55% have been directly interviewed. First publications support the specificity of the familial aggregation of BPD and the strong influence of an early onset of the parental BPD, which amplifies the risk of developing this disorder in offspring. CONCLUSIONS Information from clinical, biological, cognitive, and behavioral measures, based on contemporary knowledge, should further enhance our understanding of mood disorder psychopathology, its consequences, and underlying mechanisms.
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Circadian phase, dynamics of subjective sleepiness and sensitivity to blue light in young adults complaining of a delayed sleep schedule. Sleep Med 2017; 34:148-155. [DOI: 10.1016/j.sleep.2017.03.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/07/2017] [Accepted: 03/03/2017] [Indexed: 01/05/2023]
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45
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Timing of light exposure and activity in adults with delayed sleep-wake phase disorder. Sleep Med 2017; 32:259-265. [DOI: 10.1016/j.sleep.2016.09.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 09/06/2016] [Accepted: 09/15/2016] [Indexed: 01/24/2023]
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46
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The direction of the relationship between symptoms of insomnia and psychiatric disorders in adolescents. J Affect Disord 2017; 207:167-174. [PMID: 27723540 DOI: 10.1016/j.jad.2016.08.032] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/20/2016] [Accepted: 08/27/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study assessed the direction of the relationship between symptoms of insomnia disorder, depression, various anxiety disorders and obsessive compulsive disorder (OCD) in adolescents after controlling for age, gender, chronotype, and outcome variable at baseline. METHODS Data was collected in eight high schools in Adelaide, South Australia, at two time-points approximately 6 months apart. The study was completed by 318 and 255 high school students at baseline and follow-up, respectively, aged 12-18 (M=14.96, SD=1.34) in grades 7-11 at baseline. Hierarchical regression analyses were used to assess each relationship, the first model controlling for age, gender and chronotype, and the second controlling for outcome variable at baseline. RESULTS Insomnia symptoms predicted and were predicted by symptoms of each psychiatric disorder in model 1. In model 2, insomnia symptoms predicted symptoms of depression, and vice-versa. Symptoms of insomnia also predicted symptoms of separation anxiety disorder (SAD) once SAD, but not vice-versa, in model 2. Symptoms of obsessive compulsive disorder (OCD) and social phobia (SP) predicted symptoms of insomnia disorder in model 2, but not vice-versa. Insomnia symptoms were no longer related to symptoms of other anxiety disorders in model 2. LIMITATIONS The use of self-report measures, and potential predisposing, precipitating, perpetuating or preventative factors were not assessed. CONCLUSIONS Symptoms of insomnia disorder are bidirectionally related to depressive symptoms independent from baseline symptoms, and unidirectionally related to symptoms of OCD and SP where OCD and SP are independent risk-factors of the development of insomnia symptoms.
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La mélatonine et ses agonistes : un traitement adjuvant d’intérêt dans le trouble bipolaire ? ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.msom.2016.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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48
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Kolomeichuk SN, Randler C, Shabalina I, Fradkova L, Borisenkov M. The influence of chronotype on the academic achievement of children and adolescents – evidence from Russian Karelia. BIOL RHYTHM RES 2016. [DOI: 10.1080/09291016.2016.1207352] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Sergey N. Kolomeichuk
- Russian Academy of Sciences, Institute of Biology, Karelian Research Centre, Petrozavodsk, Russia
| | | | - Irina Shabalina
- Department of Applied Mathematics and Cybernetics, Petrozavodsk State University, Russia
| | | | - Mikhail Borisenkov
- Ural Branch of Russian Academy of Sciences, Institute of Physiology, Komi Science Centre, Syktyvkar, Russia
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Magee M, Marbas EM, Wright KP, Rajaratnam SMW, Broussard JL. Diagnosis, Cause, and Treatment Approaches for Delayed Sleep-Wake Phase Disorder. Sleep Med Clin 2016; 11:389-401. [PMID: 27542884 DOI: 10.1016/j.jsmc.2016.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Delayed sleep-wake phase disorder (DSWPD) is commonly defined as an inability to fall asleep and wake at societal times resulting in excessive daytime sleepiness. Although the cause is multifaceted, delays in sleep time are largely driven by misalignment between the circadian pacemaker and the desired sleep-wake timing schedule. Current treatment approaches focus on correcting the circadian delay; however, there is a lack of data investigating combined therapies for treatment of DSWPD.
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Affiliation(s)
- Michelle Magee
- Cooperative Research Centre for Alertness, Safety and Productivity, School of Psychological Sciences, Monash University, BASE Facility, Ground Level 264 Ferntree Gully Road, Notting Hill, Victoria 3168, Australia; Monash Institute of Cognitive and Clinical Neurosciences, Monash University, 18 Innovation Walk, Wellington Road, Clayton, Victoria 3800, Australia.
| | - Emily M Marbas
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado, 1725 Pleasant Street, Clare Small 114, Boulder, CO 80309-0354, USA
| | - Kenneth P Wright
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado, 1725 Pleasant Street, Clare Small 114, Boulder, CO 80309-0354, USA
| | - Shantha M W Rajaratnam
- Cooperative Research Centre for Alertness, Safety and Productivity, School of Psychological Sciences, Monash University, BASE Facility, Ground Level 264 Ferntree Gully Road, Notting Hill, Victoria 3168, Australia; Monash Institute of Cognitive and Clinical Neurosciences, Monash University, 18 Innovation Walk, Wellington Road, Clayton, Victoria 3800, Australia; Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Division of Sleep Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Josiane L Broussard
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado, 1725 Pleasant Street, Clare Small 114, Boulder, CO 80309-0354, USA
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Danielsson K, Jansson-Fröjmark M, Broman JE, Markström A. Cognitive Behavioral Therapy as an Adjunct Treatment to Light Therapy for Delayed Sleep Phase Disorder in Young Adults: A Randomized Controlled Feasibility Study. Behav Sleep Med 2016; 14:212-32. [PMID: 26244417 DOI: 10.1080/15402002.2014.981817] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Delayed sleep phase disorder (DSPD) is common among young people, but there is still no evidence-based treatment available. In the present study, the feasibility of cognitive behavioral therapy (CBT) was evaluated as an additive treatment to light therapy (LT) in DSPD. A randomized controlled trial with participants aged 16 to 26 years received LT for two weeks followed by either four weeks of CBT or no treatment (NT). LT advanced sleep-wake rhythm in both groups. Comparing LT+CBT with LT+NT, no significant group differences were observed in the primary endpoints. Although anxiety and depression scores were low at pretreatment, they decreased significantly more in LT+CBT compared to LT+NT. The results are discussed and some suggestions are given for further studies.
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Affiliation(s)
- Katarina Danielsson
- a Department of Neuroscience, Psychiatry , Uppsala University University Hospital
| | | | - Jan-Erik Broman
- c Department of Neuroscience, Psychiatry , Uppsala University
| | - Agneta Markström
- d Department of Medical Sciences, Respiratory Medicine and Allergology Uppsala University
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