1
|
Nakajima S, Otsuka Y, Itani O, Kaneko Y, Suzuki M, Kaneita Y. Association between commuting and mental health among Japanese adolescents. Psychiatry Clin Neurosci 2024. [PMID: 39049611 DOI: 10.1111/pcn.13714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 06/08/2024] [Accepted: 06/26/2024] [Indexed: 07/27/2024]
Abstract
AIM Mental health issues in adolescence contribute to various disease burdens later in life and are associated with violence, crime, and suicide. Activities such as sleep, diet, exercise, and time spent using electronic devices are related to declining mental health. However, few studies have examined the association between commuting times to school and mental health. This study tested the hypothesis that high school students' long commuting times are associated with poor mental health. METHOD A cross-sectional study was conducted between October and December 2022 among 2067 students at two private high schools. Survey items included participant information (sex, grade, school), commuting time, mental health status (Patient Health Questionnaire 9 [PHQ-9]: depressive symptoms, and Generalized Anxiety Disorder 7 [GAD-7]: anxiety symptoms), lifestyle factors, and sleep-related factors. RESULTS Data from 1899 high school students were analyzed. The prevalence of depressive and anxiety symptoms was 17.3% and 19.0%, respectively. A commuting time of ≥1 h was significantly associated with depressive symptoms (adjusted odds ratio: 1.60 [95% confidence interval]: 1.14-2.24) and anxiety symptoms (adjusted odds ratio: 1.51 [95% confidence interval]: 1.09-2.10). Sex, grade, use of ≥8 h/day of electronic devices, and chronotype were significantly associated with depressive symptoms, while sex, grade, use of ≥8 h/day of electronic devices, and insomnia were significantly associated with anxiety symptoms. CONCLUSION It is suggested that long commuting times are associated with poor mental health in high school students. Parents and schools should consider commuting time when advising students on school selection to maintain their mental health.
Collapse
Affiliation(s)
- Suguru Nakajima
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Yuichiro Otsuka
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Osamu Itani
- Department of Public Health, International University of Health and Welfare, Chiba, Japan
| | - Yoshiyuki Kaneko
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Masahiro Suzuki
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshitaka Kaneita
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| |
Collapse
|
2
|
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.
Collapse
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.
| |
Collapse
|
3
|
Duraccio KM, Kamhout S, Baron KG, Reutrakul S, Depner CM. Sleep extension and cardiometabolic health: what it is, possible mechanisms and real-world applications. J Physiol 2024:10.1113/JP284911. [PMID: 38268197 PMCID: PMC11266528 DOI: 10.1113/jp284911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024] Open
Abstract
Short sleep duration is associated with heightened cardiometabolic disease risk and has reached epidemic proportions among children, adolescents and adults. Potential mechanisms underlying this association are complex and multifaceted, including disturbances in circadian timing, food intake and appetitive hormones, brain regions linked to control of hedonic eating, physical activity, an altered microbiome and impaired insulin sensitivity. Sleep extension, or increasing total sleep duration, is an emerging and ecologically relevant intervention with significant potential to advance our understanding of the mechanisms underlying the association between short sleep duration and the risk of cardiometabolic disease. If effective, sleep extension interventions have potential to improve cardiometabolic health across the lifespan. Existing data show that sleep extension is feasible and might have potential cardiometabolic health benefits, although there are limitations that the field must overcome. Notably, most existing studies are short term (2-8 weeks), use different sleep extension strategies, analyse a wide array of cardiometabolic health outcomes in different populations and, frequently, lack adequate statistical power, thus limiting robust scientific conclusions. Overcoming these limitations will require fully powered, randomized studies conducted in people with habitual short sleep duration and existing cardiometabolic risk factors. Additionally, randomized controlled trials comparing different sleep extension strategies are essential to determine the most effective interventions. Ongoing and future research should focus on elucidating the potential cardiometabolic health benefits of sleep extension. Such studies have high potential to generate crucial knowledge with potential to improve health and quality of life for those struggling with short sleep duration.
Collapse
Affiliation(s)
- Kara M. Duraccio
- Department of Psychology, Brigham Young University, Provo, Utah, USA
| | - Sarah Kamhout
- Department of Psychology, Brigham Young University, Provo, Utah, USA
| | - Kelly G. Baron
- Division of Public Health, Department of Family and Preventative Medicine, University of Utah, Salt Lake City, 84112, USA
| | - Sirimon Reutrakul
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine; and Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Christopher M. Depner
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, 84112, USA
| |
Collapse
|
4
|
Dolsen EA, Dong L, Harvey AG. Transdiagnostic Sleep and Circadian Intervention for Adolescents Plus Text Messaging: Randomized Controlled Trial 12-month Follow-up. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:750-762. [PMID: 34936528 PMCID: PMC9213566 DOI: 10.1080/15374416.2021.1978295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The Transdiagnostic Sleep and Circadian Intervention for Youth (TranS-C) was developed to improve sleep and circadian functioning in adolescents. This study examined the 12-month effects for TranS-C compared with psychoeducation (PE). We also investigated whether a text messaging intervention can promote maintenance of treatment effects. METHOD At the baseline, adolescents (58% female, average age = 14.8 years) with an eveningness chronotype were randomized to TranS-C (n = 89) or PE (n = 87). At 6-month follow-up, participants were randomized to receive text messages that had repeated treatment information (n = 47), text messages that prompted the recall of treatment information (n = 50), or no text messages (n = 47). RESULTS Relative to PE, TranS-C was associated with a reduced eveningness (b = 2.06, p = .005, d = 0.29) from the baseline to a 12-month follow-up. TranS-C treatment effects, relative to PE, were augmented by receiving text messages, compared to no text messages, for eveningness from baseline to 12-month follow-up (b = 1.38, p = .008, d = 0.28) and from 6- to 12-month follow-up (b = 1.07, p = .046, d = 0.21). Neither TranS-C nor text messages were significantly associated with other primary outcomes. TranS-C and text messages were significantly associated with improvements on selected secondary sleep and health outcomes through follow-up. CONCLUSIONS For adolescents with an eveningness chronotype, improved sleep and circadian functioning on selected outcomes were maintained over 12 months for TranS-C compared with PE. Text messages boosted the effects of TranS-C through 12-month follow-up.
Collapse
Affiliation(s)
- Emily A. Dolsen
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
- Mental Illness Research Education and Clinical Centers, San Francisco VA Healthcare System. San Francisco, CA, USA
| | - Lu Dong
- RAND Corporation, Santa Monica, CA, USA
| | - Allison G. Harvey
- Department of Psychology, University of California, Berkeley, CA, Berkeley, CA, USA
| |
Collapse
|
5
|
Reeve S, Bell V. Sleep disorders predict the 1-year onset, persistence, but not remission of psychotic experiences in preadolescence: a longitudinal analysis of the ABCD cohort data. Eur Child Adolesc Psychiatry 2023; 32:1609-1619. [PMID: 35294630 PMCID: PMC10460317 DOI: 10.1007/s00787-022-01966-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 02/19/2022] [Indexed: 11/03/2022]
Abstract
The relationship between sleep disorder and psychotic experiences in preadolescence has not been extensively studied despite the potential for intervention. The current study addressed this relationship using the Adolescent Brain and Cognitive Development (ABCD) cohort, which provided baseline data from 11,830 10- to 11-year-old; for 4910 of these, 1-year follow-up data were also available. A set of pre-registered multi-level regression models were applied to test whether (a) sleep disorder is associated with psychotic experiences at baseline; (b) baseline sleep disorder predicts psychotic experiences at follow-up; (c) the persistence of sleep disorder predicts persistence of psychotic experiences at follow-up; d) the remission of sleep disorder predicts the remission of psychotic experiences at follow-up. After controlling for potential confounders, sleep disorder was associated with psychotic experiences cross-sectionally (OR = 1.40, 95% CI 1.20-1.63), at 1-year follow-up (OR = 1.32, 95% CI 1.11-1.57), and the persistence of sleep disorder predicted the persistence of psychotic experiences (OR = 1.72, 95% CI 1.44-2.04). However, remission of sleep problems did not predict remission of psychotic experiences (OR = 1.041, 95% CI 0.80-1.35). The results indicate that sleep disorders in preadolescence are common and associated with psychotic experiences, although the lack of co-remission raises questions about the mechanism of association. However, given these findings, and existing evidence in later adolescence and adults, further investigation of sleep as a preventative mental health intervention target in this age group is warranted.
Collapse
Affiliation(s)
- Sarah Reeve
- Norwich Medical School, University of East Anglia, Norwich, UK.
| | - Vaughan Bell
- Department of Clinical, Educational, and Health Psychology, University College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
6
|
Arnison T. Prevention is better than cure: why early interventions for insomnia and chronic pain during adolescence should be a priority. Front Psychol 2023; 14:1206977. [PMID: 37359854 PMCID: PMC10285456 DOI: 10.3389/fpsyg.2023.1206977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
|
7
|
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.
Collapse
Affiliation(s)
- Rebecca C Cox
- Vanderbilt University, United States of America; University of Colorado Boulder, United States of America.
| | | |
Collapse
|
8
|
Akbar SA, Mattfeld AT, Laird AR, McMakin DL. Sleep to Internalizing Pathway in Young Adolescents (SIPYA): A proposed neurodevelopmental model. Neurosci Biobehav Rev 2022; 140:104780. [PMID: 35843345 PMCID: PMC10750488 DOI: 10.1016/j.neubiorev.2022.104780] [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] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/28/2022] [Accepted: 07/12/2022] [Indexed: 01/28/2023]
Abstract
The prevalence of internalizing disorders, i.e., anxiety and depressive disorders, spikes in adolescence and has been increasing amongst adolescents despite the existence of evidence-based treatments, highlighting the need for advancing theories on how internalizing disorders emerge. The current review presents a theoretical model, called the Sleep to Internalizing Pathway in Young Adolescents (SIPYA) Model, to explain how risk factors, namely sleep-related problems (SRPs), are prospectively associated with internalizing disorders in adolescence. Specifically, SRPs during late childhood and early adolescence, around the initiation of pubertal development, contribute to the interruption of intrinsic brain networks dynamics, both within the default mode network and between the default mode network and other networks in the brain. This interruption leaves adolescents vulnerable to repetitive negative thought, such as worry or rumination, which then increases vulnerability to internalizing symptoms and disorders later in adolescence. Sleep-related behaviors are observable, modifiable, low-stigma, and beneficial beyond treating internalizing psychopathology, highlighting the intervention potential associated with understanding the neurodevelopmental impact of SRPs around the transition to adolescence. This review details support for the SIPYA Model, as well as gaps in the literature and future directions.
Collapse
Affiliation(s)
- Saima A Akbar
- Department of Psychology, Florida International University, Miami, FL, USA.
| | - Aaron T Mattfeld
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Angela R Laird
- Department of Physics, Florida International University, Miami, FL, USA
| | - Dana L McMakin
- Department of Psychology, Florida International University, Miami, FL, USA
| |
Collapse
|
9
|
Garbuio ALP, Carvalhal TAO, Tomcix MFR, dos Reis IGM, Messias LHD. Sleep quality, latency, and sleepiness are positively correlated with depression symptoms of Brazilians facing the pandemic-associated stressors of COVID-19. Medicine (Baltimore) 2022; 101:e28185. [PMID: 35984148 PMCID: PMC9387658 DOI: 10.1097/md.0000000000028185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus has implicated on mental health and psychopathological sequelae through viral infection. Suggestively, the pandemic-associated stressors (e.g., isolation, fear of illness, inadequate information and supply) may affect the sleep and feedback the depression symptoms, ultimately decreasing the immune system and offering further opportunities for severe acute respiratory syndrome coronavirus infection. Nevertheless, this association still requires investigation. Therefore, this study aimed to correlate the depression symptoms with sleep variables from subjects facing the restrictions of the ongoing pandemic in Brazil. One hundred sixty-two volunteers (age = 31 ± 13 years; body mass = 69.8 ± 14.9 kg; height = 168 ± 9 cm) answered the Beck Depression Inventory, Pittsburgh Sleep Quality Index/Epworth Sleepiness Scale for determination of depression symptoms and sleep variables, respectively. Significant and positive correlations were obtained between Beck score and sleep quality (r = 0.53; P = .000), sleep latency (r = 0.29; P = .000), and sleepiness (r = 0.22; P = .003), but not with sleep time (r = -0.10; P = .175). This report concluded that Brazilians struggling with pandemic-associated stressors with high depression symptoms may have negative impacts on sleep, mainly regarding its quality, latency, and sleepiness.
Collapse
Affiliation(s)
- Ana Luíza Paula Garbuio
- Research Group on Technology Applied to Exercise Physiology (GTAFE), Postgraduate Program in Health Sciences, University of São Francisco, Bragança Paulista, Brazil
| | - Talita Albertin Oliveira Carvalhal
- Research Group on Technology Applied to Exercise Physiology (GTAFE), Postgraduate Program in Health Sciences, University of São Francisco, Bragança Paulista, Brazil
| | - Mariana Fatima Ribeiro Tomcix
- Research Group on Technology Applied to Exercise Physiology (GTAFE), Postgraduate Program in Health Sciences, University of São Francisco, Bragança Paulista, Brazil
| | - Ivan Gustavo Masseli dos Reis
- Research Group on Technology Applied to Exercise Physiology (GTAFE), Postgraduate Program in Health Sciences, University of São Francisco, Bragança Paulista, Brazil
| | - Leonardo Henrique Dalcheco Messias
- Research Group on Technology Applied to Exercise Physiology (GTAFE), Postgraduate Program in Health Sciences, University of São Francisco, Bragança Paulista, Brazil
- *Correspondence: Leonardo Henrique Dalcheco Messias, Postgraduate Program in Health Sciences, São Francisco de Assis av, 218, Taboão, Bragança Paulista, São Paulo, 12916-900, Brazil (e-mail: )
| |
Collapse
|
10
|
Kuula L, Halonen R, Lipsanen J, Pesonen AK. Adolescent circadian patterns link with psychiatric problems: A multimodal approach. J Psychiatr Res 2022; 150:219-226. [PMID: 35397335 DOI: 10.1016/j.jpsychires.2022.03.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/04/2022] [Accepted: 03/31/2022] [Indexed: 11/20/2022]
Abstract
Circadian rhythms orchestrate brain function and mental wellbeing. We compared circadian patterns derived from continuous measurements of body temperature, sleep actigraphy and self-reported circadian preference in relation to different psychiatric disorders. 342 adolescents (70% females) aged 17.4y underwent M.I.N.I. psychiatric interviews, wore Ibutton 1922L skin temperature loggers (n = 281; 3 days), completed one-week GeneActiv Original actigraphy measurements (n = 306) and responded to Morningness-Eveningness Questionnaire (MEQ; n = 330). We derived circadian period length and amplitude from the temperature loggers. Actigraphy measures included sleep duration, midpoint, efficiency, and irregularity as well as Delayed Sleep Phase (DSP) characteristics (bedtime after 1 a.m. 3 times/week). M.I.N.I. psychiatric interviews suggested that 36% of participants had one or more psychiatric problem, with 21% suffering from comorbidity. Severe depression was associated with longer circadian period (p = 0.002). Suicidality was associated with later midpoint (p = 0.007) and more irregular sleep (p = 0.007). Those with agoraphobia slept longer (p = 0.013). Manic episodes and psychotic disorders were associated with irregular sleep (p-values <0.02). DSP was related to suicidality (p = 0.026), panic disorder (p = 0.022), and greater comorbidity (p = 0.026). Preference for eveningness was similarly related to higher prevalence of Generalized Anxiety Disorder (p = 0.014), social anxiety (p = 0.03), agoraphobia (p = 0.026), panic disorder (p = 0.004), suicidality (p = 0.018), severe depression (p < 0.001), and comorbidity (p < 0.001). Deviations in circadian rhythms were widely associated with psychiatric problems, whereas sleep duration was not. Especially suicidality linked with several markers of circadian disruption: later sleep midpoint, irregular sleep, and DSP characteristics. Longer circadian period length was associated with severe depression.
Collapse
Affiliation(s)
- Liisa Kuula
- SleepWell Research Program, Faculty of Medicine, University of Helsinki, Finland.
| | - Risto Halonen
- SleepWell Research Program, Faculty of Medicine, University of Helsinki, Finland
| | - Jari Lipsanen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anu-Katriina Pesonen
- SleepWell Research Program, Faculty of Medicine, University of Helsinki, Finland
| |
Collapse
|
11
|
Becker SP, Duraccio KM, Sidol CA, Fershtman CEM, Byars KC, Harvey AG. Impact of a Behavioral Sleep Intervention in Adolescents With ADHD: Feasibility, Acceptability, and Preliminary Effectiveness From a Pilot Open Trial. J Atten Disord 2022; 26:1051-1066. [PMID: 34738484 DOI: 10.1177/10870547211056965] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE An open trial tested the feasibility, acceptability, and preliminary effectiveness of a behavioral sleep intervention in adolescents with ADHD. METHOD Fourteen adolescents (ages 13-17 years; 50% male) with ADHD and co-occurring sleep problems received the cognitive-behavioral-based Transdiagnostic Sleep and Circadian Intervention for Youth (TranS-C). Adolescent, parent, and teacher ratings, actigraphy, and daily sleep diaries were collected at pre-intervention, post-intervention, and 3-month follow-up. RESULTS Adolescents experienced moderate to large improvements in sleep, mental health symptoms, and daily life executive functioning from pre-treatment to post-treatment, and improvements were generally maintained at 3 months. Pre-intervention, 71.4% of adolescents were classified as poor sleepers and this was reduced to 21.4% and 28.6% at post-treatment and follow-up, respectively. CONCLUSION This study provides strong preliminary evidence that TranS-C improves sleep and associated outcomes in adolescents with ADHD and co-occurring sleep problems. A randomized controlled trial is needed to rigorously test the efficacy of TranS-C in this population.
Collapse
Affiliation(s)
- Stephen P Becker
- Cincinnati Children's Hospital Medical Center, OH, USA.,University of Cincinnati College of Medicine, OH, USA
| | | | - Craig A Sidol
- Cincinnati Children's Hospital Medical Center, OH, USA
| | | | - Kelly C Byars
- Cincinnati Children's Hospital Medical Center, OH, USA.,University of Cincinnati College of Medicine, OH, USA
| | | |
Collapse
|
12
|
Comsa M, Anderson KN, Sharma A, Yadav VC, Watson S. The relationship between sleep and depression and bipolar disorder in children and young people. BJPsych Open 2022; 8:e27. [PMID: 35027099 PMCID: PMC8811784 DOI: 10.1192/bjo.2021.1076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Sleep difficulties are often reported in practice, and are part of the diagnostic criteria for depression and bipolar disorder. AIMS To inform the understanding of the relationship between sleep and both depression and bipolar disorder. METHOD We conducted a narrative literature review of affective disorders and sleep difficulties in children and young people. RESULTS Specific sleep disorders, such as parasomnias, narcolepsy and sleep-related movement disorders, are associated with depression, whereas insomnia, obstructive sleep apnoea and circadian rhythm disorders are associated with both depression and bipolar disorder in children and young people. Conversely, children and young people with depression can present with a number of sleep difficulties, and these are associated with higher depression severity and greater fatigue, suicidal ideation, physical complaints, pain and decreased concentration. Sleep disturbances among adolescents with bipolar disorder can affect the severity of depressive and manic symptoms, are a poor prognostic indicator and have been associated with social and academic impairment. Antidepressants and antipsychotics can directly affect sleep architecture, which clinicians need to be aware of. Non-pharmacological interventions for sleep problems could prevent and/or minimise the risk of relapse in affective disorders. CONCLUSIONS Sleep difficulties can occur before, during and after an episode of depression or bipolar disorder, and have a higher prevalence in affective disorders compared with the general population. A multi-modal approach would include the treatment of both the affective and specific sleep disorder. Further research is needed in this field to understand the impact of combined interventions on clinical outcomes.
Collapse
Affiliation(s)
- Monica Comsa
- Child and Adolescent Mental Health Service, Cumbria Northumberland, Tyne and Wear NHS Foundation Trust, UK
| | | | - Aditya Sharma
- Translational and Clinical Research Institute, Newcastle University, UK; and Child and Adolescent Mental Health Service, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK
| | - Vanishri C Yadav
- Child and Adolescent Mental Health Service, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK
| | - Stuart Watson
- Translational and Clinical Research Institute, Newcastle University, UK; and Specialist Services, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK
| |
Collapse
|
13
|
Gumport NB, Gasperetti CE, Silk JS, Harvey AG. The Impact of Television, Electronic Games, and Social Technology Use on Sleep and Health in Adolescents with an Evening Circadian Preference. J Youth Adolesc 2021; 50:2351-2362. [PMID: 33948831 PMCID: PMC8566326 DOI: 10.1007/s10964-021-01429-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/21/2021] [Indexed: 10/21/2022]
Abstract
There are mixed findings when examining if technology use is harmful for adolescent sleep and health. This study builds on these mixed findings by examining the association between technology use with sleep and health in a high-risk group of adolescents. Adolescents with an evening circadian preference (N = 176; 58% female, mean age = 14.77, age range = 10-18) completed measures over one week. Sleep was measured via actigraphy. Technology use and health were measured using ecological momentary assessment. Technology use was associated with an increase in sleep onset latency; with better emotional, social, cognitive, and physical health; and with worse behavioral health. This study offers support for technology use having some benefits and expands research on technology use to adolescents with an evening circadian preference.
Collapse
|
14
|
Carmona NE, Usyatynsky A, Kutana S, Corkum P, Henderson J, McShane K, Shapiro C, Sidani S, Stinson J, Carney CE. A Transdiagnostic Self-management Web-Based App for Sleep Disturbance in Adolescents and Young Adults: Feasibility and Acceptability Study. JMIR Form Res 2021; 5:e25392. [PMID: 34723820 PMCID: PMC8694239 DOI: 10.2196/25392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/06/2021] [Accepted: 09/13/2021] [Indexed: 01/26/2023] Open
Abstract
Background Sleep disturbance and its daytime sequelae, which comprise complex, transdiagnostic sleep problems, are pervasive problems in adolescents and young adults (AYAs) and are associated with negative outcomes. Effective interventions must be both evidence based and individually tailored. Some AYAs prefer self-management and digital approaches. Leveraging these preferences is helpful, given the dearth of AYA treatment providers trained in behavioral sleep medicine. We involved AYAs in the co-design of a behavioral, self-management, transdiagnostic sleep app called DOZE (Delivering Online Zzz’s with Empirical Support). Objective This study tests the feasibility and acceptability of DOZE in a community AYA sample aged 15-24 years. The secondary objective is to evaluate sleep and related outcomes in this nonclinical sample. Methods Participants used DOZE for 4 weeks (2 periods of 2 weeks). They completed sleep diaries, received feedback on their sleep, set goals in identified target areas, and accessed tips to help them achieve their goals. Measures of acceptability and credibility were completed at baseline and end point. Google Analytics was used to understand the patterns of app use to assess feasibility. Participants completed questionnaires assessing fatigue, sleepiness, chronotype, depression, anxiety, and quality of life at baseline and end point. Results In total, 83 participants created a DOZE account, and 51 completed the study. During the study, 2659 app sessions took place with an average duration of 3:02 minutes. AYAs tracked most days in period 1 (mean 10.52, SD 4.87) and period 2 (mean 9.81, SD 6.65), with a modal time of 9 AM (within 2 hours of waking). DOZE was appraised as highly acceptable (mode≥4) on the items “easy to use,” “easy to understand,” “time commitment,” and “overall satisfaction” and was rated as credible (mode≥4) at baseline and end point across all items (logic, confident it would work, confident recommending it to a friend, willingness to undergo, and perceived success in treating others). The most common goals set were decreasing schedule variability (34/83, 41% of participants), naps (17/83, 20%), and morning lingering in bed (16/83, 19%). AYAs accessed tips on difficulty winding down (24/83, 29% of participants), being a night owl (17/83, 20%), difficulty getting up (13/83, 16%), and fatigue (13/83, 16%). There were significant improvements in morning lingering in bed (P=.03); total wake time (P=.02); sleep efficiency (P=.002); total sleep time (P=.03); and self-reported insomnia severity (P=.001), anxiety (P=.002), depression (P=.004), and energy (P=.01). Conclusions Our results support the feasibility, acceptability, credibility, and preliminary efficacy of DOZE. AYAs are able to set and achieve goals based on tailored feedback on their sleep habits, which is consistent with research suggesting that AYAs prefer autonomy in their health care choices and produce good results when given tools that support their autonomy. Trial Registration ClinicalTrials.gov NCT03960294; https://clinicaltrials.gov/ct2/show/NCT03960294
Collapse
Affiliation(s)
- Nicole E Carmona
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | | | - Samlau Kutana
- Department of Psychology, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Penny Corkum
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.,Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Joanna Henderson
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Kelly McShane
- Department of Psychology, Ryerson University, Toronto, ON, Canada.,Human Resource Management and Organizational Behaviour, Ted Rogers School of Management, Ryerson University, Toronto, ON, Canada
| | - Colin Shapiro
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Ophthamology, University of Toronto, Toronto, ON, Canada
| | - Souraya Sidani
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada
| | - Jennifer Stinson
- Chronic Pain Program, Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Colleen E Carney
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| |
Collapse
|
15
|
Arns M, Kooij JJS, Coogan AN. Review: Identification and Management of Circadian Rhythm Sleep Disorders as a Transdiagnostic Feature in Child and Adolescent Psychiatry. J Am Acad Child Adolesc Psychiatry 2021; 60:1085-1095. [PMID: 33556454 DOI: 10.1016/j.jaac.2020.12.035] [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: 06/16/2020] [Revised: 11/24/2020] [Accepted: 12/10/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Sleep disturbances are highly frequent features in a range of child and adolescent psychiatric conditions. However, it is commonly not clear if such sleep problems represent symptomatic features of, comorbidities of, or risk factors for these conditions. It is believed that underlying dysfunction in the daily biological (circadian) clock may play important roles in the etiology of many sleep disorders, and circadian rhythm changes are reported in a number of neuropsychiatric conditions. The aim of this review was to explore the key identifying features of circadian rhythm disorders (CRDs) in child and adolescent psychiatry and address how such disorders may be managed in the clinic. METHOD A narrative review was conducted of the extant literature of CRDs in children and adolescents with psychiatric conditions. RESULTS Key biological and social factors that contribute to CRDs in children and adolescents, and the cognitive and neurobehavioral consequences resulting from insufficient sleep were outlined. The roles of melatonin and other chronotherapeutic and behavioral interventions for the management of CRDs were also outlined. Further, the importance of careful investigation of circadian rhythm abnormalities in shaping the most effective treatment plan according to chronobiological principles was highlighted. CONCLUSION CRDs are common in children and adolescents with psychiatric conditions and arise out of complex interactions between biological and social factors. Careful clinical attention to and management of CRDs in child and adolescent psychiatry have the potential for significant benefit not only in the domain of sleep but also in a range of cognitive, affective, and behavioral outcomes.
Collapse
Affiliation(s)
- Martijn Arns
- Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, and Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.
| | - J J Sandra Kooij
- Amsterdam University Medical Center, Amsterdam, and PsyQ, Expertise Center Adult ADHD, the Hague, the Netherlands
| | | |
Collapse
|
16
|
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.
Collapse
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.
| |
Collapse
|
17
|
Dong L, Fine ER, Michie S, Zhou Q, Mullin AC, Alvarado-Martinez CG, Hilmoe HE, Tran M, Harvey AG. Open trial of the Parent Behavior Change Intervention (PBC-I): Study protocol. Health Psychol 2020; 39:785-795. [PMID: 32833480 DOI: 10.1037/hea0000873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Parents have profound impacts on adolescents' health behaviors. Yet parents receive minimal training in the elements of conversations that optimally inspire their children toward engaging in healthy behaviors. The current study examines a novel interpersonal target: parent-adolescent conversations about adolescent health behavior change. Derived from advances in the science of behavior change, the Parent Behavior Change Intervention (PBC-I) contains conversational elements (e.g., behavior change techniques, positive communication strategies) hypothesized to reduce parent-adolescent coercion and conflict and facilitate upward spirals of healthy behavior change in adolescents. METHOD/DESIGN The first phase of the study involves the development of the PBC-I in a small case series (N = 12 dyads). The second phase involves an open trial of the PBC-I (N = 36 dyads). Adolescents will receive six 50-min sessions of the Transdiagnostic Sleep and Circadian Intervention to improve sleep while their parents receive six50-min sessions of the PBC-I. Parent-adolescent dyads will be assessed before and after the intervention. The primary analysis will examine whether postintervention use of behavior change techniques and positive communication strategies by parents is higher than preintervention use and whether increased use by parents predicts more positive conversational behaviors, less parent-adolescent conflict, higher adolescent motivation for change, and improved adolescent sleep. DISCUSSION This research provides an initial test of the hypothesis that improving the parent-adolescent conversation will improve adolescent sleep health behavior. While sleep-related health behaviors are the focus of this study, the research is designed to be relevant to a broad range of health behavior change in young people. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Collapse
Affiliation(s)
- Lu Dong
- Department of Psychology, University of California, Berkeley
| | - Eve R Fine
- Department of Psychology, University of California, Berkeley
| | - Susan Michie
- Centre for Behaviour Change, University College London
| | - Qing Zhou
- Department of Psychology, University of California, Berkeley
| | - Alice C Mullin
- Department of Psychology, University of California, Berkeley
| | | | | | - Melanie Tran
- Department of Psychology, University of California, Berkeley
| | | |
Collapse
|
18
|
Blake MJ, Allen NB. Prevention of internalizing disorders and suicide via adolescent sleep interventions. Curr Opin Psychol 2020; 34:37-42. [DOI: 10.1016/j.copsyc.2019.08.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 08/10/2019] [Accepted: 08/30/2019] [Indexed: 12/28/2022]
|
19
|
Dong L, Dolsen EA, Martinez AJ, Notsu H, Harvey AG. A transdiagnostic sleep and circadian intervention for adolescents: six-month follow-up of a randomized controlled trial. J Child Psychol Psychiatry 2020; 61:653-661. [PMID: 31773734 PMCID: PMC7242125 DOI: 10.1111/jcpp.13154] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/30/2019] [Accepted: 10/10/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study examined the 6-month follow-up outcomes of the Transdiagnostic Sleep and Circadian Intervention (TranS-C), compared to Psychoeducation about sleep and health (PE). METHODS Adolescents (mean [SD] = 14.77 [1.84] years) with eveningness chronotype and "at-risk" in at least one of five health domains were randomized to receive TranS-C (n = 89) or PE (n = 87) at a university-based clinic. Primary outcomes were average weeknight total sleep time and bedtime calculated from sleep diary, a questionnaire measure of circadian preference, and composite risks in five health domains. Secondary outcomes were selected sleep diary indices, sleepiness, and self- and parent-reported sleep, parent-reported risks in five health domains. RESULTS Relative to PE, TranS-C showed treatment effects through 6-month follow-up on only one primary outcome; namely eveningness circadian preference. TranS-C also showed treatment effects on two sleep and circadian secondary outcomes, including the Pittsburgh Sleep Quality Index and sleep-diary measured weeknight-weekend discrepancy in wakeup time. TranS-C did not show treatment effects on self-report or parent-report composite risks in five health domains. PE showed benefit, relative to TranS-C, from posttreatment to 6-month follow-up for reducing parent-reported behavioral health risk (secondary outcome). CONCLUSIONS In at-risk adolescents, the evidence supports the TranS-C treatment effects over six months on improving sleep and circadian functioning on selected outcomes but not on reducing risk in five health domains.
Collapse
Affiliation(s)
- Lu Dong
- Department of Psychology University of California, Berkeley Berkeley CA USA
- RAND Corporation Santa Monica CA USA
| | - Emily A. Dolsen
- Department of Psychology University of California, Berkeley Berkeley CA USA
| | | | - Haruka Notsu
- Department of Psychology University of California, Berkeley Berkeley CA USA
| | - Allison G. Harvey
- Department of Psychology University of California, Berkeley Berkeley CA USA
| |
Collapse
|
20
|
Bioulac S, Taillard J, Philip P, Sagaspe P. Excessive Daytime Sleepiness Measurements in Children With Attention Deficit Hyperactivity Disorder. Front Psychiatry 2020; 11:3. [PMID: 32174847 PMCID: PMC7055535 DOI: 10.3389/fpsyt.2020.00003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/02/2020] [Indexed: 12/22/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed neurodevelopmental disorder in childhood. It is a heterogeneous disorder in terms of clinical presentation that is probably due to the frequent occurrence of comorbidity. Children with ADHD more frequently report sleep disorders (notably delayed sleep phase syndrome) and excessive daytime sleepiness (EDS) than typically developing children. The aim of this article is to propose a narrative review of the assessment of EDS in the context of ADHD with first a summary of the subjective and objective tools used to measure it. Secondly, perspectives in terms of electroencephalogram (EEG) markers and neurofeedback are proposed. Then, possibilities for new kinds of evaluation are discussed (virtual reality, ecological momentary assessment, etc.). Lastly, we discuss specific clinical situations with EDS in the context of ADHD as links with narcolepsy, the comorbidity with other psychiatric disorders, and the context of sluggish cognitive tempo.
Collapse
Affiliation(s)
- Stéphanie Bioulac
- CHU Pellegrin, Clinique du Sommeil, Bordeaux, France
- Université de Bordeaux, Sommeil, Attention et Neuropsychiatrie, USR 3413, Bordeaux, France
- CNRS, SANPSY, USR 3413, Bordeaux, France
| | - Jacques Taillard
- Université de Bordeaux, Sommeil, Attention et Neuropsychiatrie, USR 3413, Bordeaux, France
- CNRS, SANPSY, USR 3413, Bordeaux, France
| | - Pierre Philip
- CHU Pellegrin, Clinique du Sommeil, Bordeaux, France
- Université de Bordeaux, Sommeil, Attention et Neuropsychiatrie, USR 3413, Bordeaux, France
- CNRS, SANPSY, USR 3413, Bordeaux, France
| | - Patricia Sagaspe
- CHU Pellegrin, Clinique du Sommeil, Bordeaux, France
- CNRS, SANPSY, USR 3413, Bordeaux, France
| |
Collapse
|
21
|
Linking inhibition and anxiety symptoms following sleep restriction: The moderating role of prior sleep efficiency. Behav Res Ther 2020; 127:103575. [PMID: 32085985 DOI: 10.1016/j.brat.2020.103575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 11/21/2022]
Abstract
Although sleep loss increases state anxiety, the effects of partial sleep restriction on specific anxiety symptoms and mechanisms that may influence this relation remain unknown. It is also unknown whether prior sleep buffers the impact of sleep restriction on anxiety symptoms. Thus, the present study examined the relations between inhibition and repetitive negative thinking (RNT), obsessions, and other OCD symptoms following sleep restriction and the moderating role of prior night's sleep efficiency. Healthy sleeping adults (n = 73) completed measures of inhibition, anxiety symptoms, and sleep before and after one night of sleep restriction (4 h between 4:00am and 8:00am). Results indicate significant associations between decreased post-sleep restriction inhibition and increased post-sleep restriction RNT and obsessions. Prior night's subjective and objective sleep efficiency significantly moderated these relations, such that the highest post-sleep restriction anxiety symptoms were reported by those with the lowest post-sleep restriction inhibition and the lowest pre-sleep restriction sleep efficiency. These findings suggest decreased inhibition may be one mechanism by which sleep loss affects anxiety, and those with worse sleep prior to acute sleep loss may be particularly vulnerable. The implications for the prevention and treatment of anxiety-related disorders characterized by intrusive cognition are discussed.
Collapse
|
22
|
Pinato L, Galina Spilla CS, Markus RP, da Silveira Cruz-Machado S. Dysregulation of Circadian Rhythms in Autism Spectrum Disorders. Curr Pharm Des 2020; 25:4379-4393. [DOI: 10.2174/1381612825666191102170450] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 10/31/2019] [Indexed: 12/12/2022]
Abstract
Background:
The alterations in neurological and neuroendocrine functions observed in the autism
spectrum disorder (ASD) involves environmentally dependent dysregulation of neurodevelopment, in interaction
with multiple coding gene defects. Disturbed sleep-wake patterns, as well as abnormal melatonin and glucocorticoid
secretion, show the relevance of an underlying impairment of the circadian timing system to the behavioral
phenotype of ASD. Thus, understanding the mechanisms involved in the circadian dysregulation in ASD could
help to identify early biomarkers to improve the diagnosis and therapeutics as well as providing a significant
impact on the lifelong prognosis.
Objective:
In this review, we discuss the organization of the circadian timing system and explore the connection
between neuroanatomic, molecular, and neuroendocrine responses of ASD and its clinical manifestations. Here
we propose interconnections between circadian dysregulation, inflammatory baseline and behavioral changes in
ASD. Taking into account, the high relevancy of melatonin in orchestrating both circadian timing and the maintenance
of physiological immune quiescence, we raise the hypothesis that melatonin or analogs should be considered
as a pharmacological approach to suppress inflammation and circadian misalignment in ASD patients.
Strategy:
This review provides a comprehensive update on the state-of-art of studies related to inflammatory
states and ASD with a special focus on the relationship with melatonin and clock genes. The hypothesis raised
above was analyzed according to the published data.
Conclusion:
Current evidence supports the existence of associations between ASD to circadian dysregulation,
behavior problems, increased inflammatory levels of cytokines, sleep disorders, as well as reduced circadian
neuroendocrine responses. Indeed, major effects may be related to a low melatonin rhythm. We propose that
maintaining the proper rhythm of the circadian timing system may be helpful to improve the health and to cope
with several behavioral changes observed in ASD subjects.
Collapse
Affiliation(s)
- Luciana Pinato
- Department of Speech, Language and Hearing Sciences, São Paulo State University (UNESP), 17525-900, Marilia, SP, Brazil
| | - Caio Sergio Galina Spilla
- Department of Speech, Language and Hearing Sciences, São Paulo State University (UNESP), 17525-900, Marilia, SP, Brazil
| | - Regina Pekelmann Markus
- Laboratory of Chronopharmacology, Department of Physiology, Institute of Biosciences, University of São Paulo (USP), 05508-090, São Paulo, SP, Brazil
| | - Sanseray da Silveira Cruz-Machado
- Laboratory of Chronopharmacology, Department of Physiology, Institute of Biosciences, University of São Paulo (USP), 05508-090, São Paulo, SP, Brazil
| |
Collapse
|