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Clegg I, Notebaert L, Richardson C. Negative attention bias and attentional control as mechanisms in the association between insomnia and depression in young people. Behav Res Ther 2024; 179:104569. [PMID: 38761556 DOI: 10.1016/j.brat.2024.104569] [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: 03/05/2024] [Revised: 04/30/2024] [Accepted: 05/10/2024] [Indexed: 05/20/2024]
Abstract
Evidence supports a causal role of insomnia in the development and maintenance of depression, yet mechanisms underlying this association in young people are not well established. Attention biases have been implicated separately in the sleep and depression fields and represents an important candidate mechanism. Poor sleep may lead to a negative attention bias (characteristic of depression) by impacting attentional control. This study assessed the hypothesis that attentional control and negative attention bias would sequentially mediate the relationship between insomnia and depressive symptoms in an unselected sample of young people (17-24 years). Concerns have been raised regarding the psychometric properties of tasks used to measure attention bias, and a Dual-Probe Task is emerging as a more reliable measure. Participants (N = 275, Male = 59, Mage = 19.40) completed the Dual-Probe Task, a behavioural measure of attentional control, and self-report measures of insomnia and depression. Participants completed a one-week sleep diary. Results were consistent with negative attention bias, but not attentional control, as a mechanism which partially accounts for the relationship between sleep (i.e., insomnia severity, sleep duration, sleep efficiency, sleep latency) and depression. This study highlights sleep and negative attention bias as potentially modifiable risk factors to reduce depressive symptoms in young people.
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Affiliation(s)
- Isabel Clegg
- Center for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, 35 Stirling Highway, Crawley, 6009, WA, Australia; Center for Sleep Science, School of Psychological Science, University of Western Australia, 35 Stirling Highway, Crawley, 6009, WA, Australia.
| | - Lies Notebaert
- Center for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, 35 Stirling Highway, Crawley, 6009, WA, Australia.
| | - Cele Richardson
- Center for Sleep Science, School of Psychological Science, University of Western Australia, 35 Stirling Highway, Crawley, 6009, WA, Australia.
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2
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Zhang X, Wang F, Zou L, Lee SY. Depressive symptoms, sleep-wake features, and insomnia among female students: The role of rumination. J Health Psychol 2024:13591053241258252. [PMID: 38898617 DOI: 10.1177/13591053241258252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
Depression symptoms are prevalent among nursing students, especially those in Asia. This study assessed the association between rumination and depression symptoms among female nursing students (N = 148) and the chain mediation role of sleep-wake indexes and insomnia symptoms. The data were collected from a battery of questionnaires and consecutive 7-day actigraphy data for analyzing sleep-wake indexes. About 54.1% of the participants had either mild or moderate depression symptoms. Most students (89.2%) had a delayed circadian phase, and circadian activity rhythm (CAR) was not ideal. The path mediation model underwent analysis using the PROCESS macros. The results showed that rumination in students is directly positively correlated with depressive symptoms (b = 4.831). Moreover, the association between rumination and depressive symptoms is sequent (moderating effect = 0.12, 95% CI [0.017, 0.410]). The proposed model in this study provides a foundation for improving educational programs on sleep hygiene and promoting mental wellness.
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Affiliation(s)
- Xin Zhang
- Chinese Academy of Medical Sciences & Peking Union Medical College, China
| | - Fei Wang
- Chinese Academy of Medical Sciences & Peking Union Medical College, China
| | - Liuni Zou
- Chinese Academy of Medical Sciences & Peking Union Medical College, China
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3
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Wang Y, Lin H, Liu X, Zhu B, He M, Chen C. Associations between capacity of cognitive control and sleep quality: a two-wave longitudinal study. Front Psychol 2024; 15:1391761. [PMID: 38952828 PMCID: PMC11216015 DOI: 10.3389/fpsyg.2024.1391761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/05/2024] [Indexed: 07/03/2024] Open
Abstract
This longitudinal study explored the impact of the upper limit of cognitive control on the sleep quality of high school students. We collected data in two waves to examine four main variables: capacity of cognitive control (CCC), trait mindfulness, emotional distress and sleep quality. At the first time point (T1), trait mindfulness and emotional distress were measured by rating scales, and the CCC was evaluated by revised backward masking majority function task. Sleep quality was rated 5 months later (T2). The results indicated that: (1) the CCC was negatively correlated with trait mindfulness, and trait mindfulness was negatively correlated with emotional stress; (2) there was no simple mediation of either trait mindfulness or emotional distress in the relationship between CCC and sleep quality; (3) instead, the CCC was associated with poor sleep quality in a sequential mediation through trait mindfulness and then emotional stress. The research highlights the importance of trait mindfulness and emotional distress for addressing sleep problems in adolescents.
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Affiliation(s)
- Yongchun Wang
- School of Psychology, South China Normal University, Guangzhou, China
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, South China Normal University, Guangzhou, China
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Huanping Lin
- School of Psychology, South China Normal University, Guangzhou, China
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, South China Normal University, Guangzhou, China
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Xiqin Liu
- School of Foreign Languages, South China University of Technology, Guangzhou, China
| | - Bojia Zhu
- Department of Human Resource, Guangzhou Branch of China Mobile Group Guangdong Company Limited, Guangzhou, China
| | - Meihui He
- School of Psychology, South China Normal University, Guangzhou, China
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, South China Normal University, Guangzhou, China
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Caiqi Chen
- School of Psychology, South China Normal University, Guangzhou, China
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, South China Normal University, Guangzhou, China
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
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4
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Giannotta F, Nilsson KW, Åslund C, Olofdotter S, Vadlin S, Larm P. Anxiety, Sleep Problems, and Vigorous Physical Activity: Bidirectional Associations from Early Adolescence to Early Adulthood in Swedish Adolescents. J Youth Adolesc 2024; 53:1355-1369. [PMID: 38580891 PMCID: PMC11045630 DOI: 10.1007/s10964-024-01980-1] [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: 12/22/2023] [Accepted: 03/25/2024] [Indexed: 04/07/2024]
Abstract
Anxiety symptoms and sleep problems typically emerge during adolescence and are frequently intertwined. However, there is a dearth of knowledge concerning their reciprocal influence and whether physical activity might play a protective role in this relationship. The present study aims at filling this gap exploring also the moderating role of sex. 915 13-year-old Swedish adolescents (56% girls) answered a survey conducted four times: at ages 13 (T1), 16 (T2), 19 (T3), and 22 (T4). A random intercept cross-lagged panel model was used. At within-levels, sleep problems and anxiety symptoms had a bidirectional positive association in middle adolescence. Vigorous physical activity and anxiety symptoms showed a reciprocal negative association from middle adolescence. Vigorous physical activity and sleep problems were reciprocally associated only in late adolescence. Associations were the same for girls and boys. This study demonstrated that the relations between anxiety symptoms, sleep problems, and vigorous physical activity cannot be understood without adopting a developmental perspective and that middle adolescence is a crucial period to plan interventions to reduce anxiety symptoms and sleep problems.
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Affiliation(s)
- F Giannotta
- Division of Public Health, School of Health, Care and Social Welfare, Malardalen University, Box 883, Västerås, Sweden.
- Department of Public Health, Stockholm University, SE-106 91, Stockholm, Sweden.
- Department of Psychology, University of Turin, via Verdi 10, 10124, Turin, Italy.
| | - K W Nilsson
- Division of Public Health, School of Health, Care and Social Welfare, Malardalen University, Box 883, Västerås, Sweden
- Centre for Clinical Research, Västmanland County Hospital Västerås, Uppsala University, S-72189, Västerås, Sweden
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - C Åslund
- Centre for Clinical Research, Västmanland County Hospital Västerås, Uppsala University, S-72189, Västerås, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - S Olofdotter
- Centre for Clinical Research, Västmanland County Hospital Västerås, Uppsala University, S-72189, Västerås, Sweden
| | - S Vadlin
- Centre for Clinical Research, Västmanland County Hospital Västerås, Uppsala University, S-72189, Västerås, Sweden
| | - P Larm
- Department of Public Health, Stockholm University, SE-106 91, Stockholm, Sweden
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5
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Vlahoyiannis A, Andreou E, Bargiotas P, Aphamis G, Sakkas GK, Giannaki CD. Reply- letter to the editor: From diet to sleep and psychological state: Insights and future perspectives. Clin Nutr 2024; 43:1676-1677. [PMID: 38670910 DOI: 10.1016/j.clnu.2024.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024]
Affiliation(s)
- Angelos Vlahoyiannis
- Department of Life Sciences, University of Nicosia, Nicosia, Cyprus; Research Centre for Exercise and Nutrition (RECEN), University of Nicosia, Nicosia, Cyprus
| | - Eleni Andreou
- Department of Life Sciences, University of Nicosia, Nicosia, Cyprus; Research Centre for Exercise and Nutrition (RECEN), University of Nicosia, Nicosia, Cyprus
| | | | - George Aphamis
- Department of Life Sciences, University of Nicosia, Nicosia, Cyprus; Research Centre for Exercise and Nutrition (RECEN), University of Nicosia, Nicosia, Cyprus
| | - Giorgos K Sakkas
- Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
| | - Christoforos D Giannaki
- Department of Life Sciences, University of Nicosia, Nicosia, Cyprus; Research Centre for Exercise and Nutrition (RECEN), University of Nicosia, Nicosia, Cyprus.
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Que J, Chen S, Chan NY, Wu S, Zhang L, Chen Y, Liu J, Chen M, Chen L, Li SX, Lin D, Liu F, Wing YK. Associations of evening-type and insomnia symptoms with depressive symptoms among youths. Sleep Med 2024; 118:81-87. [PMID: 38626648 DOI: 10.1016/j.sleep.2024.04.009] [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] [Received: 01/31/2024] [Revised: 03/23/2024] [Accepted: 04/06/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Evening-type and insomnia symptoms are significantly related to each other and independently associated with depressive symptoms, yet few studies have examined the potential interaction between these two conditions. Therefore, we aimed to examine the associations of evening-type and insomnia symptoms with depressive symptoms among Chinese youths, with a specific focus on the joint effects of the two conditions on depressive symptoms. METHODS Participants aged between 12 and 25 were invited to participate in an online survey from December 15, 2022, to May 26, 2023. Multivariate logistic regression models and additive interaction models were used to examine the independent and joint effects of chronotypes and insomnia symptoms on depressive symptoms, respectively. RESULTS Of the 6145 eligible youths, the prevalence of evening-type and insomnia symptoms were 24.9 % and 29.6 %, respectively. Both evening-type (adjusted OR, [AdjOR]: 3.21, 95 % CI: 2.80-3.67) and insomnia symptoms (AdjOR: 10.53, 95 % CI: 9.14-12.12) were associated with an increased risk of depressive symptoms. In addition, the additive interaction models showed that there is an enhanced risk of depression related to interaction between evening-type and insomnia symptoms (relative excess risk due to interaction, [RERI]: 11.66, 95 % CI: 7.21-16.11). CONCLUSIONS The present study provided additional evidence demonstrating the presence of interaction between evening-type and insomnia symptoms, which can lead to a higher risk of depressive symptoms. Our findings argue the need for addressing both sleep and circadian factors in the management of depressive symptoms in young people.
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Affiliation(s)
- Jianyu Que
- Xiamen Xianyue Hospital, Xianyue Hospital Affiliated with Xiamen Medical College, Fujian Psychiatric Center, Fujian Clinical Research Center for Mental Disorders, Fujian, China
| | - Sijing Chen
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China; Centre de Recherche CERVO/Brain Research Center, École de Psychologie, Université Laval, Quebec City, Quebec, Canada
| | - Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Suying Wu
- Xiamen Xianyue Hospital, Xianyue Hospital Affiliated with Xiamen Medical College, Fujian Psychiatric Center, Fujian Clinical Research Center for Mental Disorders, Fujian, China
| | - Li Zhang
- Inner Mongolia Autonomous Region Mental Health Center, Hohhot, Inner Mongolia, China
| | - Yaoyi Chen
- Xiamen Xianyue Hospital, Xianyue Hospital Affiliated with Xiamen Medical College, Fujian Psychiatric Center, Fujian Clinical Research Center for Mental Disorders, Fujian, China
| | - Jingrou Liu
- Xiamen University of Technology, Xiamen, Fujian, China
| | | | - Lixia Chen
- Inner Mongolia Autonomous Region Mental Health Center, Hohhot, Inner Mongolia, China
| | - Shirley Xin Li
- Department of Psychology, The University of Hong Kong, Hong Kong Special Administrative Region of China; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Duoduo Lin
- Xiamen Xianyue Hospital, Xianyue Hospital Affiliated with Xiamen Medical College, Fujian Psychiatric Center, Fujian Clinical Research Center for Mental Disorders, Fujian, China.
| | - Farong Liu
- Xiamen Xianyue Hospital, Xianyue Hospital Affiliated with Xiamen Medical College, Fujian Psychiatric Center, Fujian Clinical Research Center for Mental Disorders, Fujian, China.
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
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7
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Bauducco S, Gardner LA, Smout S, Champion KE, Chapman C, Gamble A, Teesson M, Gradisar M, Newton NC. Adolescents' trajectories of depression and anxiety symptoms prior to and during the COVID-19 pandemic and their association with healthy sleep patterns. Sci Rep 2024; 14:10764. [PMID: 38730014 PMCID: PMC11087504 DOI: 10.1038/s41598-024-60974-y] [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: 08/02/2023] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
The COVID-19 pandemic has seen a rise in anxiety and depression among adolescents. This study aimed to investigate the longitudinal associations between sleep and mental health among a large sample of Australian adolescents and examine whether healthy sleep patterns were protective of mental health in the context of the COVID-19 pandemic. We used three waves of longitudinal control group data from the Health4Life cluster-randomized trial (N = 2781, baseline Mage = 12.6, SD = 0.51; 47% boys and 1.4% 'prefer not to say'). Latent class growth analyses across the 2 years period identified four trajectories of depressive symptoms: low-stable (64.3%), average-increasing (19.2%), high-decreasing (7.1%), moderate-increasing (9.4%), and three anxiety symptom trajectories: low-stable (74.8%), average-increasing (11.6%), high-decreasing (13.6%). We compared the trajectories on sociodemographic and sleep characteristics. Adolescents in low-risk trajectories were more likely to be boys and to report shorter sleep latency and wake after sleep onset, longer sleep duration, less sleepiness, and earlier chronotype. Where mental health improved or worsened, sleep patterns changed in the same direction. The subgroups analyses uncovered two important findings: (1) the majority of adolescents in the sample maintained good mental health and sleep habits (low-stable trajectories), (2) adolescents with worsening mental health also reported worsening sleep patterns and vice versa in the improving mental health trajectories. These distinct patterns of sleep and mental health would not be seen using mean-centred statistical approaches.
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Affiliation(s)
- Serena Bauducco
- Flinders University, Adelaide, Australia.
- Center for Health and Medical Psychology, Örebro University, Fakultetsgatan 1, 701 82, Örebro, Sweden.
| | - Lauren A Gardner
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Scarlett Smout
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Katrina E Champion
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Cath Chapman
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Amanda Gamble
- The Woolcock Institute, Macquarie University, Sydney, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Michael Gradisar
- WINK Sleep Pty Ltd, Adelaide, Australia
- Sleep Cycle AB, Gothenburg, Sweden
| | - Nicola C Newton
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
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8
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Rollinson R, Cole A, Gee B, Tofan I, Graham A, Hatton J, Lyons J, Reeve S, Wilson J, Beardsworth K, Clarke T. Delivering a sleep intervention across a youth mental health service using non-expert practitioners: A service evaluation. Early Interv Psychiatry 2024. [PMID: 38703076 DOI: 10.1111/eip.13534] [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: 01/10/2024] [Revised: 03/26/2024] [Accepted: 04/08/2024] [Indexed: 05/06/2024]
Abstract
AIMS Poor sleep is highly prevalent in young people and increases risk of mental health difficulties, yet access to sleep interventions remains limited. This paper evaluates the use of a sleep intervention delivered by non-expert practitioners in a secondary care youth mental health service. METHOD Assistant psychologists were trained to deliver a six-session 1:1 cognitive-behavioural sleep intervention adapted for use with young people with mental health difficulties. A within-subject design assessed clinical outcomes relating to sleep (Insomnia Severity Index), psychological distress and personal goals (Goal Based Outcome Measures) at four time points. RESULTS High referral, intervention take-up (82.82%) and completion (70%) rates were reported, together with high baseline levels of insomnia (Insomnia Severity Index mean 20.47, SD 3.68) and poor sleep efficiency (56.36%, SD 17.23). Fifty-six young people (average age 19.2 years, SD 3.25) were included in the outcome analysis. Statistically and clinically significant improvements were seen across all outcome measures, with 68% no longer meeting clinical threshold (ISI ≥15) for insomnia at endpoint. CONCLUSIONS This study demonstrates exceptionally high levels of clinical need and engagement with a sleep intervention adapted specifically for young people with mental health difficulties. Whilst limited by the uncontrolled design, large improvements in insomnia and psychological distress support its effectiveness and utility in clinical settings. More robust implementation and evaluation is warranted in broader youth mental health services to promote earlier access.
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Affiliation(s)
- Rebecca Rollinson
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Amber Cole
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
| | - Brioney Gee
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Ioana Tofan
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
| | - Adam Graham
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
| | - Jude Hatton
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
| | - Jonathan Lyons
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
| | - Sarah Reeve
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK
- Cambridgeshire and Peterborough NHS FoundationTrust, Cambridge, Cambridgeshire, UK
| | - Jonathan Wilson
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | | | - Tim Clarke
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
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Kim S, Casement MD. Promoting adolescent sleep and circadian function: A narrative review on the importance of daylight access in schools. Chronobiol Int 2024; 41:725-737. [PMID: 38616310 DOI: 10.1080/07420528.2024.2341156] [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: 07/06/2023] [Accepted: 04/04/2024] [Indexed: 04/16/2024]
Abstract
Adolescent sleep disturbances and circadian delays pose significant challenges to mood and daytime functioning. In this narrative review, we explore the impact of light on sleep and highlight the importance of monitoring and managing light exposure in adolescents throughout the day and night. The benefits of daylight exposure in mitigating sleep and circadian disruptions are well-established; however, interventions targeting access to daylight in adolescents remain understudied and underutilized. The primary aim of this narrative review is to bring attention to this gap in the literature and propose the need for institutional-level interventions that promote access to daylight, especially considering adolescents' early school start times and substantial time spent indoors on weekdays. School-led interventions, such as active commuting to school and outdoor curriculums, have promising effects on sleep and circadian rhythms. Additionally, practical measures to optimize natural light in classrooms, including managing blinds and designing conducive environments, should also be considered. While future studies are necessary to facilitate the implementation of interventions, the potential for these school-level interventions to support adolescent sleep health is evident. Aiming for integration of individual-level regulation and institutional-level intervention of light exposure is necessary for optimal outcomes.
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Affiliation(s)
- Sojeong Kim
- Department of Psychology, University of Oregon, Eugene, Oregon, USA
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10
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Bauducco S, Pillion M, Bartel K, Reynolds C, Kahn M, Gradisar M. A bidirectional model of sleep and technology use: A theoretical review of How much, for whom, and which mechanisms. Sleep Med Rev 2024; 76:101933. [PMID: 38657359 DOI: 10.1016/j.smrv.2024.101933] [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: 09/30/2023] [Revised: 03/01/2024] [Accepted: 04/05/2024] [Indexed: 04/26/2024]
Abstract
The link between technology and sleep is more complex than originally thought. In this updated theoretical review, we propose a new model informed by the growing body of evidence in the area over the past 10 years. The main theoretical change is the addition of bi-directional links between the use of technology and sleep problems. We begin by reviewing the evidence to date for the originally proposed mechanisms of bright light, arousal, nighttime sleep disruptions, and sleep displacement. Then, in support of the new direction of effect (sleep problems preceding technology use), we propose two new mechanisms: technology before sleep might be used as a time filler and/or as an emotional regulation strategy to facilitate the sleep-onset process. Finally, we present potential moderators of the association between technology and sleep, in recognition of protective and vulnerability factors that may mitigate or exacerbate the effects of technology on sleep and vice versa. The goal of this theoretical review is to update the field, guide future public health messages, and to prompt new research into how much technology and sleep affect each other, for whom it may be problematic, and which mechanisms may explain their association.
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Affiliation(s)
- Serena Bauducco
- Örebro University, School of Behavioural, Social and Legal Sciences, Sweden; Flinders University, College of Education, Psychology and Social Work, Australia.
| | - Meg Pillion
- Flinders University, College of Education, Psychology and Social Work, Australia
| | - Kate Bartel
- WINK Sleep Pty Ltd, Adelaide, Australia; Riverland Academy of Clinical Excellence, Riverland Mallee Coorong Local Health Network, Australia; Flinders University, College of Medicine and Public Health, Australia
| | - Chelsea Reynolds
- Flinders University, College of Education, Psychology and Social Work, Australia; WINK Sleep Pty Ltd, Adelaide, Australia
| | - Michal Kahn
- Tel Aviv University, School of Psychological Sciences, Israel
| | - Michael Gradisar
- WINK Sleep Pty Ltd, Adelaide, Australia; Sleep Cycle AB, Gothenburg, Sweden
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11
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Ghotbi N, Scherff AD, Greimel E, Schulte-Körne G. [Overview of chronobiological and sleep medical aspects of depression in adolescents]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:383-391. [PMID: 38472403 PMCID: PMC10995027 DOI: 10.1007/s00103-024-03853-1] [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: 10/18/2023] [Accepted: 02/21/2024] [Indexed: 03/14/2024]
Abstract
Changes in sleep are reported in adolescents with depression with a frequency of up to 71%. Aspects of chronobiology and sleep based on the current scientific literature are illustrated and summarized in this narrative review. The circadian clock synchronizes organisms to the light-dark structure of the environment. The individual synchronization is called "chronotype." Chronotype changes according to age, among other factors, and adolescents experience the latest chronotypes overall. The potential discrepancy between internal and external time is called "social jetlag." Social jetlag is especially pronounced during adolescence. It is associated with numerous health risks, such as depression. Changes in sleep behavior in affective disorders and its comorbidity to depression have also been well described in the literature. In this article, underlying concepts from chronobiology and sleep medicine are initially summarized. Then, health risks of disrupted sleep-wake behavior are described, and connections to depression specifically during adolescence are drawn. The article concludes with clinical recommendations for sleep disorders and depression during adolescence as well as suggestions for further research.
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Affiliation(s)
- Neda Ghotbi
- Kinder- und Jugendpsychiatrie, Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Nussbaumstr. 5a, 80336, München, Deutschland
| | - Aline Doreen Scherff
- Kinder- und Jugendpsychiatrie, Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Nussbaumstr. 5a, 80336, München, Deutschland
| | - Ellen Greimel
- Kinder- und Jugendpsychiatrie, Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Nussbaumstr. 5a, 80336, München, Deutschland
| | - Gerd Schulte-Körne
- Kinder- und Jugendpsychiatrie, Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Nussbaumstr. 5a, 80336, München, Deutschland.
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12
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Jääkallio P, Kuula L, Pesonen AK. Temporal pathways between circadian rhythm, depression and anxiety in the transition from adolescence to early adulthood. J Affect Disord 2024; 350:656-664. [PMID: 38244801 DOI: 10.1016/j.jad.2024.01.141] [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] [Received: 08/30/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Sleep and circadian rhythm problems intertwine with affective disorders. Adolescents are particularly vulnerable to developing sleep and affective problems. Yet, the temporal pathways between circadian rhythm, depression and anxiety in the transition phase from adolescence to early adulthood are not fully understood. METHODS 233 adolescents (76 % females) participated at two time points (T1 and T2) at an interval of 19-months (aged 16.8 and 18.4 years). We used The Beck Depression Inventory-II, Generalized Anxiety Disorder Assessment, GENEActiv actigraphy across 8 days (delayed sleep phase (DSP), sleep duration, midpoint, and regularity), and iButton 1922L thermologgers across 3 days (intrinsic circadian period length, amplitude, and mesor). RESULTS A shorter sleep duration at T1 associated with an increase in affective problems at T2, and affective problems at T1 associated with an increase in sleep irregularity at T2. A longer circadian period at T1 associated with an increase in males' affective problems at T2. Moderate to severe depression and anxiety at T1 associated with a 2.69-fold risk (95 % CI 1.38-5.26, p = 0.004) and 2.11-fold risk (95 % CI 1.04-4.25, p = 0.038) of poor sleep quality at T2. Moderate to severe generalized anxiety associated with a 3.17-fold risk (95 % CI 1.35-7.41, p = 0.008) of DSP at T2. LIMITATIONS The follow-up period is short. CONCLUSIONS The results revealed bidirectional temporal links between sleep and affective problems. Novel observations include a heightened risk of future DSP following a current anxiety disorder and a heightened risk of affective problems following a longer circadian period measured from the 24-hour temperature variation in males.
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Affiliation(s)
- Pirita Jääkallio
- Faculty of Medicine, SleepWell Research Program, University of Helsinki, Finland
| | - Liisa Kuula
- Faculty of Medicine, SleepWell Research Program, University of Helsinki, Finland
| | - Anu-Katriina Pesonen
- Faculty of Medicine, SleepWell Research Program, University of Helsinki, Finland.
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13
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Li SH, Corkish B, Richardson C, Christensen H, Werner-Seidler A. The role of rumination in the relationship between symptoms of insomnia and depression in adolescents. J Sleep Res 2024; 33:e13932. [PMID: 37198139 DOI: 10.1111/jsr.13932] [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: 12/13/2022] [Revised: 03/30/2023] [Accepted: 04/27/2023] [Indexed: 05/19/2023]
Abstract
There is a strong relationship between the symptoms of insomnia and depression, however, little is understood about the factors that mediate this relationship. An understanding of these underlying mechanisms may inform the advancement of existing treatments to optimise reductions in insomnia and depression when they co-occur. This study examined rumination and unhelpful beliefs about sleep as mediators between symptoms of insomnia and depression. It also evaluated the effect of cognitive behavioural therapy for insomnia (CBT-I) on rumination and unhelpful beliefs about sleep, and whether these factors mediated the effect of CBT-I on depressive symptoms. A series of mediation analyses and linear mixed modelling were conducted on data from 264 adolescents (12-16 years) who participated in a two-arm (intervention vs. control) randomised controlled trial of Sleep Ninja®, a CBT-I smartphone app for adolescents. Rumination, but not unhelpful beliefs about sleep, was a significant mediator between symptoms of insomnia and depression at baseline. CBT-I led to reductions in unhelpful beliefs about sleep, but not in rumination. At the between-group level, neither rumination, nor unhelpful beliefs about sleep emerged as mechanisms underlying improvement in depression symptoms, however, rumination mediated within-subject improvements following CBT-I. The findings suggest rumination links symptoms of insomnia and depression and provide preliminary evidence that reductions in depression following CBT-I occurs via improvements in rumination. Targeting rumination may improve current therapeutic approaches.
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Affiliation(s)
- Sophie H Li
- Black Dog Institute, University of New South Wales, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Brittany Corkish
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Cele Richardson
- Centre for Sleep Science, School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Sydney, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Aliza Werner-Seidler
- Black Dog Institute, University of New South Wales, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
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14
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Wilson DA, Sullivan RM, Smiley JF, Saito M, Raineki C. Developmental alcohol exposure is exhausting: Sleep and the enduring consequences of alcohol exposure during development. Neurosci Biobehav Rev 2024; 158:105567. [PMID: 38309498 PMCID: PMC10923002 DOI: 10.1016/j.neubiorev.2024.105567] [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: 12/07/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
Prenatal alcohol exposure is the leading nongenetic cause of human intellectual impairment. The long-term impacts of prenatal alcohol exposure on health and well-being are diverse, including neuropathology leading to behavioral, cognitive, and emotional impairments. Additionally negative effects also occur on the physiological level, such as the endocrine, cardiovascular, and immune systems. Among these diverse impacts is sleep disruption. In this review, we describe how prenatal alcohol exposure affects sleep, and potential mechanisms of those effects. Furthermore, we outline the evidence that sleep disruption across the lifespan may be a mediator of some cognitive and behavioral impacts of developmental alcohol exposure, and thus may represent a promising target for treatment.
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Affiliation(s)
- Donald A Wilson
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA; Department of Child and Adolescent Psychiatry, NYU School of Medicine, New York, NY, USA.
| | - Regina M Sullivan
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA; Department of Child and Adolescent Psychiatry, NYU School of Medicine, New York, NY, USA
| | - John F Smiley
- Division of Neurochemistry, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA; Department of Psychiatry, New York University Medical Center, New York, NY, USA
| | - Mariko Saito
- Division of Neurochemistry, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA; Department of Psychiatry, New York University Medical Center, New York, NY, USA
| | - Charlis Raineki
- Department of Psychology, Brock University, St. Catharines, ON, Canada; Centre for Neuroscience, Brock University, St. Catharines, ON, Canada
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15
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Campbell IG, Figueroa JG, Bottom VB, Cruz-Basilio A, Zhang ZY, Grimm KJ. Maturational trend of daytime sleep propensity in adolescents. Sleep 2024; 47:zsad263. [PMID: 37798133 DOI: 10.1093/sleep/zsad263] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/30/2023] [Indexed: 10/07/2023] Open
Abstract
STUDY OBJECTIVES The teenage increase in sleepiness is not simply a response to decreasing nighttime sleep duration. Daytime sleepiness increases across adolescence even when prior sleep duration is held constant. Here we determine the maturational trend in daytime sleep propensity assessed with the multiple sleep latency test (MSLT) and assess the trend's relation to pubertal maturation and changes in the sleep electroencephalogram. We also evaluate whether the relation of daytime sleep propensity to prior sleep duration changes between ages 10 and 23 years. METHODS Participants (n = 159) entered the study between ages 9.8 and 22.8 years and were studied annually for up to 3 years. Annually, participants kept each of three sleep schedules in their homes: 7, 8.5, and 10 hours in bed for 4 consecutive nights with polysomnography on nights 2 and 4. MSLT-measured daytime sleep propensity was assessed in the laboratory on the day following the fourth night. RESULTS A two-part linear spline model described the maturation of daytime sleep propensity. MSLT sleep likelihood increased steeply until age 14.3 years, after which it did not change significantly. The maturational trend was strongly associated with the adolescent decline in slow-wave (delta, 1-4 Hz) EEG power during NREM sleep and with pubertal maturation assessed with Tanner stage measurement of breast/genital development. The effect of prior sleep duration on sleep likelihood decreased with age. CONCLUSIONS Adolescent brain changes related to pubertal maturation and those reflected in the delta decline contribute to the adolescent increase in daytime sleep propensity.
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Affiliation(s)
- Ian G Campbell
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA
| | - Jessica G Figueroa
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA
| | - Vincent B Bottom
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA
| | - Alejandro Cruz-Basilio
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Zoey Y Zhang
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA
| | - Kevin J Grimm
- Department of Psychology, Arizona State University, Tempe, AZ, USA
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16
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Ricci A, Fernandez-Mendoza J. Evidence of how the maturing sleeping brain contributes to the sleepy brain of adolescents. Sleep 2024; 47:zsad283. [PMID: 37935893 PMCID: PMC10782484 DOI: 10.1093/sleep/zsad283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Indexed: 11/09/2023] Open
Affiliation(s)
- Anna Ricci
- Department of Neurological Sciences, Robert Larner M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Julio Fernandez-Mendoza
- Sleep Research and Treatment Center, Department of Psychiatry and Behavioral Health, Penn State Health Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, PA, USA
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17
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Grigorian K, Östberg V, Raninen J, Åhlén J, Brolin Låftman S. Prospective associations between psychosomatic complaints in adolescence and depression and anxiety symptoms in young adulthood: A Swedish national cohort study. SSM Popul Health 2023; 24:101509. [PMID: 37720821 PMCID: PMC10500464 DOI: 10.1016/j.ssmph.2023.101509] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/16/2023] [Accepted: 09/03/2023] [Indexed: 09/19/2023] Open
Abstract
Background Psychosomatic complaints are reported by high shares of adolescents in Sweden and elsewhere. Yet, little is known about to the extent to which the frequency, number, and persistence of such complaints in adolescence are associated with subsequent mental health problems. The aim of this study was to examine how the frequency, number, and persistence of psychosomatic complaints in middle and late adolescence are associated with depression and anxiety symptoms in young adulthood. Methods A Swedish national cohort study of adolescents who were surveyed in 2017 (t1; age 15-16), in 2019 (t2; age 17-18) and in 2022 (t3; age 20-21 years) was used. Psychosomatic complaints were measured by questions on stomach ache, headache and difficulties falling asleep at t1 and t2. Depression and anxiety symptoms were measured by the Patient Health Questionnaire-4 (PHQ-4) at t3. Multivariable binary logistic regression analyses stratified by gender were based on data from t1, t2 and t3 (n = 2779). Results The frequency, number, and persistence of psychosomatic complaints during adolescence were associated with symptoms of depression and anxiety in young adulthood. Both earlier (at t1 only) and more recent (at t2 only) complaints were linked to subsequent depression and anxiety symptoms, while persistent (at both t1 and t2) psychosomatic complaints showed stronger associations in girls. Conclusions Psychosomatic complaints in adolescence were associated with depression and anxiety symptoms in young adulthood. This was true for the frequency, number, and persistence of psychosomatic complaints. Among girls, those who reported persistent psychosomatic complaints from middle to late adolescence had the highest likelihood of reporting subsequent depression and anxiety symptoms. Taken together, the results indicate that psychosomatic complaints during adolescence can translate into later depression and anxiety symptoms. Furthermore, repeated measurements of psychosomatic complaints can be used to identify the most vulnerable group.
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Affiliation(s)
- Karina Grigorian
- Department of Public Health Sciences, Stockholm University, Sweden
| | - Viveca Östberg
- Department of Public Health Sciences, Stockholm University, Sweden
| | - Jonas Raninen
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Johan Åhlén
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Sweden
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18
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Lemke T, Hökby S, Wasserman D, Carli V, Hadlaczky G. Associations between sleep habits, quality, chronotype and depression in a large cross-sectional sample of Swedish adolescents. PLoS One 2023; 18:e0293580. [PMID: 37917651 PMCID: PMC10621812 DOI: 10.1371/journal.pone.0293580] [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: 05/17/2023] [Accepted: 10/16/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVE To investigate behavioral sleep habits, self-perceived quality of sleep, and chronotype, and to examine their association with clinically relevant levels of depression in Swedish adolescents. METHOD Questionnaire data were obtained from a representative sample of Swedish adolescents (n = 8449; 50.8% girls; aged 12-16). Depression was defined as >13 BDI-II scores. Logistic regression modelling estimated the effects of sleep duration, sleep quality, and chronotype on depression, adjusted for socio-demographic factors. RESULTS On weekdays, approximately 46% of adolescents slept less than the recommended length of eight hours per night (depressed: 68%, non-depressed: 40%). On weekends, however, only 17% slept shorter than recommended. Short weekday sleep duration was more common among girls than boys (53% vs. 38%) and girls reported worse sleep quality. The regression model showed that depression was predicted by weekday sleep duration (OR = 0.773, p < .0001), sleep quality (OR = 0.327, p < .0001), and late chronotype (OR = 1.126, p = .0017), but not by weekend sleep duration. A 30-minute increase in weekday sleep duration was associated with about 10% lower odds of depression. CONCLUSIONS A substantial proportion of Swedish adolescents do not seem to meet the sleep recommendations of eight hours per night. Short sleep duration on weekdays, poor sleep quality, and late chronotype were associated with increased risk of depression. Interventions promoting longer weekday sleep duration (e.g., later school start times) seem relevant in this context, but further research is needed to investigate the directionality and underlying mechanisms of these associations.
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Affiliation(s)
- Theresa Lemke
- National Centre for Suicide Research and Prevention (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
- National Centre for Suicide Research and Prevention (NASP), Centre for Health Economics, Informatics and Health Services Research (CHIS), Stockholm Health Care Services, Stockholm, Sweden
| | - Sebastian Hökby
- National Centre for Suicide Research and Prevention (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
- National Centre for Suicide Research and Prevention (NASP), Centre for Health Economics, Informatics and Health Services Research (CHIS), Stockholm Health Care Services, Stockholm, Sweden
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
- National Centre for Suicide Research and Prevention (NASP), Centre for Health Economics, Informatics and Health Services Research (CHIS), Stockholm Health Care Services, Stockholm, Sweden
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
- National Centre for Suicide Research and Prevention (NASP), Centre for Health Economics, Informatics and Health Services Research (CHIS), Stockholm Health Care Services, Stockholm, Sweden
| | - Gergö Hadlaczky
- National Centre for Suicide Research and Prevention (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
- National Centre for Suicide Research and Prevention (NASP), Centre for Health Economics, Informatics and Health Services Research (CHIS), Stockholm Health Care Services, Stockholm, Sweden
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19
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Stephens S, Motl RW, Narang I, Weiss S, Finlayson M, Yeh EA. Sleep, physical activity, and psychological outcomes in children and adolescents with pediatric onset multiple sclerosis. Mult Scler Relat Disord 2023; 79:105025. [PMID: 37776826 DOI: 10.1016/j.msard.2023.105025] [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: 05/31/2023] [Revised: 09/06/2023] [Accepted: 09/23/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Sleep, physical activity (PA) and sedentary behavior (SED) have bidirectional associations with mental health in children. The relationships among sleep, PA, SED, with depressive and fatigue symptoms have not been investigated in Pediatric Onset Multiple Sclerosis (POMS) but are needed to inform sleep and PA behavior change interventions. OBJECTIVES (1) To describe sleep quality including: sleep efficiency, latency, total sleep time, number of awakenings, time in bed, and wake after sleep onset using actigraphy in children and adolescents ages 11 to 18 diagnosed with POMS, and to compare these sleep metrics to those of an age- and sex-matched non-MS group (2) To examine the relationship between time spent in sedentary, light (LIPA), moderate and vigorous PA (MVPA), sleep quality, with depression, fatigue, and quality of life in children and adolescents with POMS and an age and sex matched non-MS group. METHODS A cross-sectional study recruited children and adolescents with POMS ages 11 to 18 years followed at a tertiary pediatric hospital (Toronto, Canada) and an age and sex matched non-MS group from the general population. Participants were consented prior to initiation of study procedures. Participants wore an Actiwatch monitor and GT3X accelerometer and completed standardized questionnaires validated to capture data on sleep disturbances, depression, fatigue, and quality of life. Objective sleep data were collected using an Actiwatch including sleep efficiency, total sleep time, number of awakenings, wake after sleep onset (WASO), and sleep latency. A GT3X accelerometer was used to collect PA data including time spent in SED, light (LPA), and moderate to vigorous (MVPA) PA. Correlational analyses and tests of difference were used to compare the groups. RESULTS 25 POMS (21F; 16.6 years ±1.1 yrs., median Expanded Disability Status Scale (EDSS) =1.5, IQR=1) and 25 Non-MS (22 F; 16±1.3 yrs.) took part. POMS had higher BMI (T= -5.1, P<0.001) compared to Non-MS. No differences in sleep efficiency (MS mean = 87%, vs. 88%) sleep time (MS Mean = 7.3 hrs. vs. 7.4 hrs.,), WASO (MS mean=37 mins. vs. 36 mins), latency (MS mean=15 mins vs. 11 mins), SED (MS mean =763 mins. vs. 730 mins) or PA (MS, mean LPA = 68 mins. vs 60 mins; MS mean MVPA = 12.7 mins. vs. 12.4 mins). Within POMS, higher sleep efficiency was associated with more SED (SR= 0.4, p = 0.05), while higher sleep efficiency was associated with less SED in Non-MS (SR = -0.7, p< 0.0). In children with POMS, less sleep time, shorter sleep onset latency and more WASO was associated with more SED (SR range = -0.45 to -0.58, P< 0.01). Higher sleep efficiency was associated with less fatigue. Less WASO was associated with lower depression, lower fatigue (SR = 0.67, p<0.01) and better quality of life (SR= -0.6, p<0.01). Greater LPA was associated with lower sleep onset latency (-0.45, p<0.05). CONCLUSIONS Children with POMS did not differ in Actiwatch monitored sleep quality metrics. However, within the POMS group sleep quality was associated with better fatigue, depression and QOL. Further, total sleep time, WASO and latency associated with time spent SED and LPA, which independently associate with mental health outcome. Longitudinal work should determine the temporal associations between WASO, sleep latency, sleep time, PA, and mental health outcomes and whether reallocation of specific sleep or PA behaviors (time to sleep, total sleep time, sedentary to MVPA) result in improved depression fatigue, or quality of life in children and adolescents with POMS.
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Affiliation(s)
- S Stephens
- The Hospital for Sick Children, Toronto, Canada
| | - R W Motl
- The University of Chicago at Irvine, Illinois, United States
| | - I Narang
- The Hospital for Sick Children, Toronto, Canada; The University of Toronto, Toronto, Canada
| | - S Weiss
- The Hospital for Sick Children, Toronto, Canada; The University of Toronto, Toronto, Canada
| | | | - E A Yeh
- The Hospital for Sick Children, Toronto, Canada; The University of Toronto, Toronto, Canada.
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20
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Conway A, Miller AL. Social jetlag longitudinally predicts internalizing and externalizing behavior for adolescent females, but not males. Chronobiol Int 2023; 40:1404-1418. [PMID: 37814409 DOI: 10.1080/07420528.2023.2265480] [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: 12/09/2021] [Accepted: 09/26/2023] [Indexed: 10/11/2023]
Abstract
Biological changes contribute to preferences for later bed and wake times during adolescence, yet the social constraints of school start times necessitate early wake times. This often results in social jetlag (i.e. misalignment between preferred sleep timing on weekends and school days). We examined whether social jetlag predicts adolescent internalizing and externalizing behavior over time and/or whether associations differ based on sex. We used data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development Study (n = 767) to test whether social jetlag at 6th grade (ages 12-13 years) predicted internalizing and externalizing behavior at age 15 years and whether child sex moderated associations. Controlling for internalizing and externalizing behavior at 6th grade (ages 12-13 years), results were that social jetlag at 6th grade (ages 12-13 years) predicted more internalizing and externalizing behaviors at age 15 for females, but not males. These findings show that social jetlag during early adolescence confers risk for internalizing and externalizing behavior in females at mid-adolescence. Greater attention should be placed on identifying and addressing social jetlag in adolescent females.
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Affiliation(s)
- Anne Conway
- Social Work, University of Tennessee, Knoxville, Knoxville, Tennessee, USA
- Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Alison L Miller
- Public Health, University of Michigan, Ann Abor, Michigan, USA
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21
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Uy JP, Ho TC, Buthmann JL, Coury SM, Gotlib IH. Early life stress, sleep disturbances, and depressive symptoms during adolescence: The role of the cingulum bundle. Dev Cogn Neurosci 2023; 63:101303. [PMID: 37738837 PMCID: PMC10518607 DOI: 10.1016/j.dcn.2023.101303] [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: 05/02/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 09/24/2023] Open
Abstract
Adolescence is often characterized by sleep disturbances that can affect the development of white matter tracts implicated in affective and cognitive regulation, including the cingulate portion of the cingulum bundle (CGC) and the uncinate fasciculus (UF). These effects may be exacerbated in adolescents exposed to early life adversity (ELA). We examined the longitudinal relations between sleep problems and CGC and UF microstructure during adolescence and their relation to depressive symptoms as a function of exposure to ELA. We assessed self-reported sleep disturbances and depressive symptoms and acquired diffusion-weighted MRI scans twice: in early adolescence (9-13 years) and four years later (13-17 years) (N = 72 complete cases). Independent of ELA, higher initial levels and increases in sleep problems were related to increases in depressive symptoms. Further, increases in right CGC fractional anisotropy (FA) mediated the association between sleep problems and depressive symptoms for youth who experienced lower, but not higher, levels of ELA. In youth with higher ELA, higher initial levels of and steeper decreases in sleep problems were associated with greater decreases in right UF FA, but were unrelated to depressive symptoms. Our findings highlight the importance of sleep quality in shaping fronto-cingulate-limbic tract development and depressive symptoms during adolescence.
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Affiliation(s)
- Jessica P Uy
- Department of Psychology, Stanford University, 450 Jane Stanford Way, Stanford, CA 94305, USA.
| | - Tiffany C Ho
- Department of Psychology, University of California, Los Angeles, 1285 Psychology Building, Box 156304, Los Angeles, CA 90095, USA
| | - Jessica L Buthmann
- Department of Psychology, Stanford University, 450 Jane Stanford Way, Stanford, CA 94305, USA
| | - Saché M Coury
- Department of Psychology, Stanford University, 450 Jane Stanford Way, Stanford, CA 94305, USA
| | - Ian H Gotlib
- Department of Psychology, Stanford University, 450 Jane Stanford Way, Stanford, CA 94305, USA
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22
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Boon ME, van Hooff MLM, Vink JM, Geurts SAE. The effect of fragmented sleep on emotion regulation ability and usage. Cogn Emot 2023; 37:1132-1143. [PMID: 37337975 DOI: 10.1080/02699931.2023.2224957] [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: 11/24/2022] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/21/2023]
Abstract
Sleep has a profound effect on our mood, but insight in the mechanisms underlying this association is still lacking. We tested whether emotion regulation is a mediator in the relationship between fragmented sleep and mood disturbance. The effect of fragmented sleep on the emotion regulation strategies, including cognitive reappraisal, distraction, acceptance and suppression ability, was assessed. We further tested whether the use of these strategies, as well as rumination and self-criticism, mediated the association between fragmented sleep and negative and positive affect. Participants (N = 69) wore an actiwatch and filled in a sleep diary for 12 consecutive nights. They had one control night and one sleep fragmentation night. Emotion regulation ability was assessed with an experimental task. Usage of emotion regulation strategies and negative and positive affect were assessed four times during the day with a survey after the control and sleep fragmentation night. Cognitive reappraisal, distraction, acceptance and suppression ability did not differ between the sleep fragmentation and control condition. However, participants reported higher usage of rumination and distraction after the sleep fragmentation night and rumination significantly mediated the negative association between fragmented sleep and negative affect.
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Affiliation(s)
- Merel Elise Boon
- Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands
| | - M L M van Hooff
- Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands
- Faculty of Psychology, Open Universiteit, Heerlen, The Netherlands
| | - J M Vink
- Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands
| | - S A E Geurts
- Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands
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23
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Liu X, Zhang B. Is gradual sleep extension effective for social jetlag in adolescents and college students? Sleep Biol Rhythms 2023; 21:263-264. [PMID: 38476313 PMCID: PMC10899984 DOI: 10.1007/s41105-023-00463-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- Xianchen Liu
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Bin Zhang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
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24
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Moavero R, Di Micco V, Forte G, Voci A, Mazzone L, Valeriani M, Emberti Gialloreti L, Bruni O. Screen exposure and sleep: How the COVID-19 pandemic influenced children and adolescents - A questionnaire-based study. Sleep Med 2023; 107:48-54. [PMID: 37116435 PMCID: PMC10102534 DOI: 10.1016/j.sleep.2023.04.009] [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: 11/13/2022] [Revised: 03/19/2023] [Accepted: 04/10/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND COVID-19 pandemic has drastically increased the exposure to electronic devices in children, influencing their lifestyle and their sleep. This study was conducted to explore the relationship between the augmented screen exposure and sleep habits in children during and after the pandemic. METHODS Using the "Google Forms" tool, we created an online questionnaire addressed to parents of children and adolescents aged 2-18 years. We explored the use of screens before and during/after the lockdown and assessed the presence of sleep disturbances through the Sleep Disturbance Scale for Children (SDSC), referring to the period before and during/after COVID-19 pandemic. RESULTS We collected 1084 valid questionnaires (median age 8.5 ± 4.1 years). We observed a significant increase in screens exposure for school (72%) and for leisure (49.7%) during the pandemic. We reported an increased sleep disturbances prevalence from 22.1% before the pandemic to 33.9% during the outbreak (p < 0.001). Even before the pandemic, the highest risks for sleep disorders were related to daily screen time for school reasons (OR 1.65, p < 0.001) and total screen time after 6 p.m. (OR 1.59, p < 0.001). The augmented exposure to screens for any reasons during the pandemic was significantly related to an increase of sleep disorders, especially regarding the increased exposure after 6 p.m. (OR 1.67, p < 0.001). CONCLUSIONS The augmented use of electronic devices was recognized to be a significant predisposing factor in increasing the rate of sleep disorders during and after the pandemic, thus sleep hygiene recommendations should be highlighted to improve sleep habits.
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Affiliation(s)
- Romina Moavero
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University of Rome, Via Montpellier 1, 00133, Rome, Italy; Developmental Neurology Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Valentina Di Micco
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University of Rome, Via Montpellier 1, 00133, Rome, Italy
| | - Giusy Forte
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University of Rome, Via Montpellier 1, 00133, Rome, Italy
| | - Alessandra Voci
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University of Rome, Via Montpellier 1, 00133, Rome, Italy
| | - Luigi Mazzone
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University of Rome, Via Montpellier 1, 00133, Rome, Italy
| | - Massimiliano Valeriani
- Developmental Neurology Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy; Center for Sensory-Motor Interaction, Aalborg University, Fredrik Bajers Vej 7 D3, Aalborg, DK-9220, Denmark
| | - Leonardo Emberti Gialloreti
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Via Montpellier 1, Rome, 00133, Italy
| | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Rome, Italy
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Insomnia in Infancy, Childhood, and Adolescence. Sleep Med Clin 2023; 18:135-145. [PMID: 37120157 DOI: 10.1016/j.jsmc.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Insomnia is the most prevalent sleep disorder in youth, tends to persist over time, and is associated with a myriad of adverse outcomes. This paper synthesizes the current evidence regarding the phenomenology, prevalence, assessment, consequences, cause, and treatment of pediatric insomnia, highlighting areas that warrant further research and addressing the unique characteristics of this disorder in infants, children, and adolescents.
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26
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Effects of Preoperative Sleep Disorders on Anesthesia Recovery and Postoperative Pain in Patients Undergoing Laparoscopic Gynecological Surgery under General Anesthesia. Mediators Inflamm 2022; 2022:7998104. [PMID: 36570021 PMCID: PMC9779992 DOI: 10.1155/2022/7998104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/15/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
Sleep disorder dramatically affects people's physical and mental health. Here, we investigated the effect of preoperative sleep disorders on anesthesia recovery and postoperative pain in patients undergoing laparoscopic gynecological surgery under general anesthesia. 120 patients who underwent elective laparoscopic gynecological surgery under general anesthesia in Taizhou Central Hospital from November 2021 to March 2022 were included. According to the score of the Pittsburgh sleep quality index (PSQI), the participating patients were divided into four groups: control group (control group), mild sleep disorder group A (group A), moderate sleep disorder group B (group B), and severe sleep disorder group C (group C), with 30 patients in each group. The changes of mean arterial pressure (MAP) and heart rate (HR) at different time points, operation time, anesthesia time, extubation time, the time when Aldrete score reached 10 points, visual analog score (VAS) serum interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-α (TNF-α) were compared among different groups. Our study demonstrated that there were no significant differences in MAP and HR among the four groups at the same time points (all P > 0.05). Significant differences in the time of extubation and Aldrete score reaching 10 points had been found among the four groups (all P < 0.001), indicating more sleep disorder induced longer extubation and recovery time. There were significant differences in VAS scores among the four groups at both different and the same time points (all P < 0.001), suggesting more sleep disorders induced more pain in the sufferers. Serum IL-6 levels were significantly higher in the three sleep disorder groups than the control group at 6 h and 24 h after the operation (all P < 0.05), while group C has the highest IL-6 levels as compared to the other group (P = 0.09 and P < 0.001, respectively). At 6 h after operation, serum levels of TNF-α in group C were significantly higher than in the control group (P = 0.044), but no significant differences were found in the other two groups (all P > 0.05). Positive correlation with preoperative PSQI score has been found with the times of extubation, the time of Aldrete score reaching 10 points, the VAS at 1 h, 6 h, and 24 h after operation, the level of serum IL-6 at 1 day before operation and 6 h and 24 h after operation, and the TNF-α at 6 h and 24 h after operation (all P < 0.001). The present study showed that the degree of preoperative sleep disorders could affect the quality of postoperative awakening and pain of patients undergoing laparoscopic gynecological surgery under general anesthesia, which might be associated with the aggravation of inflammatory reactions in the body.
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