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Ding X, He L, Kang T, Yang Y, Ji H, Zhao H, Lang X, Sun C, Zhang X. The role of the left dorsolateral prefrontal cortex in conflict control during insomnia disorder. J Psychiatr Res 2024; 171:271-276. [PMID: 38330626 DOI: 10.1016/j.jpsychires.2024.02.010] [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: 09/04/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Patients with insomnia are often accompanied by cognitive dysfunction, which seriously affects the quality of life of patients. Repetitive transcranial magnetic stimulation (rTMS) can induce brain neuroplasticity, regulate brain cognitive function and inhibitory control ability. OBJECTIVE To explore the intervention effect of rTMS on conflict control and sleep quality in patients with insomnia. METHODS In this single-blind, randomized controlled trial, 39 people with insomnia disorder were randomly divided into real stimulation group and sham stimulation group. The stimulation parameters were stimulation frequency 1 Hz, stimulation intensity 80 % resting motor threshold (RMT), total pulse number 1500 times, time 25 min, and the whole course of treatment lasted 7 days. The Insomnia Severity Index(ISI)、Pittsburgh Sleep Quality Index(PSQI)、Multidimensional Fatigue Inventory(MFI) and Beck Anxiety Inventory(BAI) were assessed at pretest (baseline) and posttest (day 7 after intervention), and the color-word stroop task was used to measure the conflict control ability of the subjects. RESULTS The sleep quality, correct rate and reaction time of the posttest in the real stimulus group were higher than those in the pretest. However, there was no significant difference between the pretest and posttest in the sham stimulation group. CONCLUSIONS rTMS stimulation of the left dorsolateral prefrontal cortex (LDLPFC) in patients with insomnia can significantly improve the conflict control ability and sleep quality of patients with insomnia.
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Affiliation(s)
- Xiaobin Ding
- School of Psychology, Northwest Normal University, Lanzhou, China
| | - Liang He
- School of Psychology, Northwest Normal University, Lanzhou, China.
| | - Tiejun Kang
- School of Psychology, Northwest Normal University, Lanzhou, China
| | - Yizhuo Yang
- School of Psychology, Northwest Normal University, Lanzhou, China
| | - Haotian Ji
- School of Psychology, Northwest Normal University, Lanzhou, China
| | - He Zhao
- School of Psychology, Northwest Normal University, Lanzhou, China
| | - Xuemei Lang
- School of Psychology, Northwest Normal University, Lanzhou, China
| | - Cong Sun
- School of Psychology, Northwest Normal University, Lanzhou, China
| | - Xiangzi Zhang
- School of Psychology, Northwest Normal University, Lanzhou, China.
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Richter CG, Li CM, Turnbull A, Haft SL, Schneider D, Luo J, Lima DP, Lin FV, Davidson RJ, Hoeft F. Brain imaging studies of emotional well-being: a scoping review. Front Psychol 2024; 14:1328523. [PMID: 38250108 PMCID: PMC10799564 DOI: 10.3389/fpsyg.2023.1328523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/06/2023] [Indexed: 01/23/2024] Open
Abstract
This scoping review provides an overview of previous empirical studies that used brain imaging techniques to investigate the neural correlates of emotional well-being (EWB). We compiled evidence on this topic into one accessible and usable document as a foundation for future research into the relationship between EWB and the brain. PRISMA 2020 guidelines were followed. We located relevant articles by searching five electronic databases with 95 studies meeting our inclusion criteria. We explored EWB measures, brain imaging modalities, research designs, populations studied, and approaches that are currently in use to characterize and understand EWB across the literature. Of the key concepts related to EWB, the vast majority of studies investigated positive affect and life satisfaction, followed by sense of meaning, goal pursuit, and quality of life. The majority of studies used functional MRI, followed by EEG and event-related potential-based EEG to study the neural basis of EWB (predominantly experienced affect, affective perception, reward, and emotion regulation). It is notable that positive affect and life satisfaction have been studied significantly more often than the other three aspects of EWB (i.e., sense of meaning, goal pursuit, and quality of life). Our findings suggest that future studies should investigate EWB in more diverse samples, especially in children, individuals with clinical disorders, and individuals from various geographic locations. Future directions and theoretical implications are discussed, including the need for more longitudinal studies with ecologically valid measures that incorporate multi-level approaches allowing researchers to better investigate and evaluate the relationships among behavioral, environmental, and neural factors. Systematic review registration https://osf.io/t9cf6/.
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Affiliation(s)
- Caroline G. Richter
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
| | - Celine Mylx Li
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Adam Turnbull
- Department of Brain and Cognitive Sciences, University of Rochester, Rochester, NY, United States
- CogT Lab, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Stephanie L. Haft
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Deborah Schneider
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
| | - Jie Luo
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
| | - Denise Pinheiro Lima
- Intensive Care Pediatrician, Pediatric Intensive Care Unit, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Feng Vankee Lin
- CogT Lab, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Richard J. Davidson
- Center for Healthy Minds, University of Wisconsin, Madison, WI, United States
- Department of Psychology, University of Wisconsin, Madison, WI, United States
- Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin, Madison, WI, United States
- Department of Psychiatry, University of Wisconsin, Madison, WI, United States
| | - Fumiko Hoeft
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
- Haskins Laboratories, New Haven, CT, United States
- Brain Imaging Research Center (BIRC), University of Connecticut, Storrs, CT, United States
- Department of Psychiatry and Behavioral Sciences, and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, United States
- Department of Neuropsychiatry, Keio University School of Medicine, Shinanomachi Shinjuku Tokyo, Tokyo, Japan
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Mun CJ, Winsick N, Wegener ST, Youngstedt SD, Campbell CM, Aaron RV. Medium- and Long-Term Effects of Insomnia Severity and Circadian Preference on Pain and Emotional Distress Among Individuals With Chronic Pain. THE JOURNAL OF PAIN 2023; 24:1946-1956. [PMID: 37286095 PMCID: PMC10615674 DOI: 10.1016/j.jpain.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/21/2023] [Accepted: 05/31/2023] [Indexed: 06/09/2023]
Abstract
Studies have identified insomnia as having significant influence on chronic pain. A rising body of research has also underscored the association between eveningness and chronic pain. However, co-assessment of insomnia and eveningness in the context of chronic pain adjustment has been limited. The present study sought to investigate the effects of insomnia and eveningness on pain severity, pain interference, and emotional distress (ie, depressive and anxiety symptoms) over nearly 2 years among adults with chronic pain in the U.S. Adults with chronic pain (N = 884) were surveyed 3 times via Amazon's MTurk online crowdsourcing platform: baseline, 9-month follow-up, and 21-month follow-up. Path analysis was conducted to examine the effects of baseline insomnia severity (Insomnia Severity Index) and eveningness (Morningness and Eveningness Questionnaire), as well as their moderating effects on outcomes. Controlling for select sociodemographic variables and baseline outcome levels, greater insomnia severity at baseline was associated with worsening of all of the pain-related outcomes at 9-month follow-up, and pain interreference and emotional distress at 21-month follow-up. We did not find evidence that evening types are at a higher risk of experiencing worsening pain-related outcomes over time compared to morning and intermediate types. There were also no significant insomnia severity and eveningness moderation effects on any outcome. Our findings suggest that insomnia is a more robust predictor of changes in pain-related outcomes as compared to eveningness. Treatment of insomnia can be important in chronic pain management. Future studies should evaluate the role of circadian misalignment on pain using more accurate biobehavioral makers. PERSPECTIVE: This study examined the effects of insomnia and eveningness on pain and emotional distress in a large sample of individuals with chronic pain. Insomnia severity is a stronger predictor of changes in pain and emotional distress than eveningness, highlighting insomnia as an important clinical target for chronic pain management.
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Affiliation(s)
- Chung Jung Mun
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD.
| | - Nina Winsick
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD
| | - Shawn D Youngstedt
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Rachel V Aaron
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD
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Zou H, Zhou H, Yan R, Yao Z, Lu Q. Chronotype, circadian rhythm, and psychiatric disorders: Recent evidence and potential mechanisms. Front Neurosci 2022; 16:811771. [PMID: 36033630 PMCID: PMC9399511 DOI: 10.3389/fnins.2022.811771] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 06/21/2022] [Indexed: 12/27/2022] Open
Abstract
The circadian rhythm is crucial for physiological and behavioral functions. Chronotype, which represents individual preferences for activity and performance, is associated with human health issues, particularly psychiatric disorders. This narrative review, which focuses on the relationship between chronotype and mental disorders, provides an insight into the potential mechanism. Recent evidence indicates that (1) the evening chronotype is a risk factor for depressive disorders and substance use disorders, whereas the morning chronotype is a protective factor. (2) Evening chronotype individuals with bipolar disorder tend to have more severe symptoms and comorbidities. (3) The evening chronotype is only related to anxiety symptoms. (4) The relationship between chronotype and schizophrenia remains unclear, despite increasing evidence on their link. (5) The evening chronotype is significantly associated with eating disorders, with the majority of studies have focused on binge eating disorders. Furthermore, the underlying mechanisms or influence factors are described in detail, including clock genes, brain characteristics, neuroendocrinology, the light/dark cycle, social factors, psychological factors, and sleep disorders. These findings provide the latest evidence on chronotypes and psychiatric disorders and serve as a valuable reference for researchers.
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Affiliation(s)
- Haowen Zou
- Nanjing Brain Hospital, Medical School, Nanjing University, Nanjing, China
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Hongliang Zhou
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Rui Yan
- Nanjing Brain Hospital, Medical School, Nanjing University, Nanjing, China
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Zhijian Yao
- Nanjing Brain Hospital, Medical School, Nanjing University, Nanjing, China
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China
- *Correspondence: Zhijian Yao,
| | - Qing Lu
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China
- Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, China
- Qing Lu,
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Tubbs AS, Fernandez FX, Grandner MA, Perlis ML. Emerging evidence for sleep instability as a risk mechanism for nonsuicidal self-injury. Sleep 2022; 45:6572076. [PMID: 35446956 PMCID: PMC9189961 DOI: 10.1093/sleep/zsac095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andrew S Tubbs
- Department of Psychiatry, University of Arizona College of Medicine–Tucson , Tucson, AZ , USA
| | | | - Michael A Grandner
- Department of Psychiatry, University of Arizona College of Medicine–Tucson , Tucson, AZ , USA
| | - Michael L Perlis
- Department of Psychiatry, University of Pennsylvania , Philadelphia, PA, USA
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Hisler GC, Pedersen SL, Hasler BP. The 24-hour rhythm in alcohol craving and individual differences in sleep characteristics and alcohol use frequency. Alcohol Res 2022; 46:1084-1093. [PMID: 35383960 DOI: 10.1111/acer.14826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/15/2022] [Accepted: 03/30/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Evidence implicates sleep/circadian factors in alcohol use, suggesting the existence of a 24-h rhythm in alcohol craving, which may vary by individual differences in sleep factors and alcohol use frequency. This study sought to (1) replicate prior findings of a 24-h rhythm in alcohol craving, and (2) examine whether individual differences in sleep timing, sleep duration, or alcohol use frequency are related to differences in the timing of the peak of the craving rhythm (i.e., the acrophase) or magnitude of fluctuation of the rhythm (i.e., amplitude). Finally, whether such associations varied by sex or racial identity was explored. METHODS Two-hundred fifteen adult drinkers (21 to 35 years of age, 72% male, 66% self-identified as White) completed a baseline assessment of alcohol use frequency and then smartphone reports of alcohol craving intensity six times a day across 10 days. Sleep timing was also recorded each morning of the 10-day period. Multilevel cosinor analysis was used to test the presence of a 24-h rhythm and to estimate acrophase and amplitude. RESULTS Multilevel cosinor analysis revealed a 24-h rhythm in alcohol craving. Individual differences in sleep timing or sleep duration did not predict rhythm acrophase or amplitude. However, alcohol use frequency moderated this rhythm wherein individuals who used alcohol more frequently in the 30 days prior to beginning the study had higher mean levels of craving and greater rhythm amplitudes (i.e., greater rhythmic fluctuations). Associations did not vary by sex or racial identity. CONCLUSIONS Results show that alcohol craving exhibits a systematic rhythm over the course of the 24 h and that the frequency of alcohol use may be relevant to the shape of this rhythm. Consideration of daily rhythms in alcohol craving may further our understanding of the mechanisms that drive alcohol use.
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Affiliation(s)
- Garrett C Hisler
- University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sarah L Pedersen
- University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Brant P Hasler
- University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA
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7
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He JK, Jia BH, Wang Y, Li SY, Zhao B, Zhou ZG, Bi YZ, Wu MZ, Li L, Zhang JL, Fang JL, Rong PJ. Transcutaneous Auricular Vagus Nerve Stimulation Modulates the Prefrontal Cortex in Chronic Insomnia Patients: fMRI Study in the First Session. Front Neurol 2022; 13:827749. [PMID: 35401422 PMCID: PMC8987020 DOI: 10.3389/fneur.2022.827749] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/28/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives Transcutaneous auricular vagus nerve stimulation (taVNS) has been reported to be effective for chronic insomnia (CI). However, the appropriate population for taVNS to treat insomnia is unclear. Methods Total twenty-four patients with CI and eighteen health controls (HC) were recruited. Rest-state functional magnetic resonance imaging (Rs-fMRI) was performed before and after 30 min' taVNS at baseline. The activated and deactivated brain regions were revealed by different voxel-based analyses, then the seed-voxel functional connectivity analysis was calculated. In the CI group, 30 min of taVNS were applied twice daily for 4 weeks. Pittsburgh Sleep Quality Index (PSQI) and Flinders Fatigue Scale (FFS) were also assessed before and after 4 weeks of treatment in the CI group. The HC group did not receive any treatment. The correlations were estimated between the clinical scales' score and the brain changes. Results The scores of PSQI (p < 0.01) and FFS (p < 0.05) decreased after 4 weeks in the CI group. Compared to the HC group, the first taVNS session up-regulated left dorsolateral prefrontal cortex (dlPFC) and decreased the functional connectivity (FCs) between dlPFC and bilateral medial prefrontal cortex in the CI group. The CI groups' baseline voxel wised fMRI value in the dlPFC were negatively correlated to the PSQI and the FFS score after 4 weeks treatment. Conclusions It manifests that taVNS has a modulatory effect on the prefrontal cortex in patients with CI. The initial state of dlPFC may predict the efficacy for taVNS on CI.
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Affiliation(s)
- Jia-Kai He
- Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Acupuncture, China Academy of Chinese Medical Sciences Guang'anmen Hospital, Beijing, China
| | - Bao-Hui Jia
- Department of Acupuncture, China Academy of Chinese Medical Sciences Guang'anmen Hospital, Beijing, China
| | - Yu Wang
- Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shao-Yuan Li
- Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Bin Zhao
- Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Acupuncture, Southern Medical University, Guangzhou, China
| | - Zeng-Guang Zhou
- Key Laboratory of Quantitative Remote Sensing Information Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing, China
| | - Yan-Zhi Bi
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Mo-Zheng Wu
- Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Liang Li
- Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jin-Ling Zhang
- Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ji-Liang Fang
- Department of Radiology, China Academy of Chinese Medical Sciences Guang'anmen Hospital, Beijing, China
- *Correspondence: Ji-Liang Fang
| | - Pei-Jing Rong
- Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
- Pei-Jing Rong
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Tubbs AS, Fernandez FX, Grandner MA, Perlis ML, Klerman EB. The Mind After Midnight: Nocturnal Wakefulness, Behavioral Dysregulation, and Psychopathology. FRONTIERS IN NETWORK PHYSIOLOGY 2022; 1:830338. [PMID: 35538929 PMCID: PMC9083440 DOI: 10.3389/fnetp.2021.830338] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
Sufficient sleep with minimal interruption during the circadian/biological night supports daytime cognition and emotional regulation. Conversely, disrupted sleep involving significant nocturnal wakefulness leads to cognitive and behavioral dysregulation. Most studies to-date have examined how fragmented or insufficient sleep affects next-day functioning, but recent work highlights changes in cognition and behavior that occur when someone is awake during the night. This review summarizes the evidence for day-night alterations in maladaptive behaviors, including suicide, violent crime, and substance use, and examines how mood, reward processing, and executive function differ during nocturnal wakefulness. Based on this evidence, we propose the Mind after Midnight hypothesis in which attentional biases, negative affect, altered reward processing, and prefrontal disinhibition interact to promote behavioral dysregulation and psychiatric disorders.
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Affiliation(s)
- Andrew S. Tubbs
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona College of Medicine—Tucson, Tucson, AZ, United States
| | - Fabian-Xosé Fernandez
- Department of Psychology, Evelyn F Mcknight Brain Institute, University of Arizona, Tucson, AZ, United States
| | - Michael A. Grandner
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona College of Medicine—Tucson, Tucson, AZ, United States
| | - Michael L. Perlis
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA, United States
| | - Elizabeth B. Klerman
- Department of Neurology, Division of Sleep Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Kivelä L, Riese H, Fakkel TG, Verkuil B, Penninx BWJH, Lamers F, van der Does W, Antypa N. Chronotype, daily affect and social contact: An ecological momentary assessment study. Psychiatry Res 2022; 309:114386. [PMID: 35033835 DOI: 10.1016/j.psychres.2021.114386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 11/08/2021] [Accepted: 12/31/2021] [Indexed: 11/30/2022]
Abstract
Eveningness is associated with lower daily positive affect (PA). The relationship between negative affect (NA) and chronotype, however, is less consistent in the literature. Eveningness may be further characterized by increased social isolation, which could explain the associations between chronotype and PA/NA. In the present longitudinal study, we used ecological momentary assessment (EMA) to investigate the associations of chronotype with daily PA, NA, and social contact in individuals with current and remitted major depressive disorder (MDD) and healthy controls. As part of the Netherlands Study of Depression and Anxiety (NESDA), 279 participants (n = 49 depressed, n = 172 remitted, n = 58 controls) monitored daily PA, NA, and social contact (i.e., being alone vs. with others) for two weeks, five times per day. Overall, eveningness was associated with less social contact. This effect became nonsignificant, however, after accounting for sociodemographics (gender, age, education, living situation). Chronotype was not related to PA or NA. Less social contact was associated with lower PA and higher NA independent of chronotype. In conclusion, we could not replicate the finding of lower PA among evening types, but found social contact to associate with both daily PA and NA.
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Affiliation(s)
- L Kivelä
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Netherlands
| | - H Riese
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center for Psychopathology and Emotion regulation, Groningen, Netherlands
| | - T G Fakkel
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Netherlands
| | - B Verkuil
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Netherlands
| | - B W J H Penninx
- Amsterdam UMC, Vrije Universiteit, Department of Psychiatry, Amsterdam Public Health research institute, Amsterdam, Netherlands
| | - F Lamers
- Amsterdam UMC, Vrije Universiteit, Department of Psychiatry, Amsterdam Public Health research institute, Amsterdam, Netherlands
| | - W van der Does
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Netherlands; Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
| | - N Antypa
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Netherlands.
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Zhang H, Liu L, Cheng S, Jia Y, Wen Y, Yang X, Meng P, Li C, Pan C, Chen Y, Zhang Z, Zhang J, Zhang F. Assessing the joint effects of brain aging and gut microbiota on the risks of psychiatric disorders. Brain Imaging Behav 2022; 16:1504-1515. [PMID: 35076893 DOI: 10.1007/s11682-022-00630-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2021] [Indexed: 12/20/2022]
Abstract
We aim to explore the potential interaction effects of brain aging and gut microbiota on the risks of sleep, anxiety and depression disorders. The genome-wide association study (GWAS) datasets of brain aging (N = 21,407) and gut microbiota (N = 3,890) were obtained from published studies. Individual level genotype and phenotype data of psychiatric traits (including sleep, anxiety and depression) were all from the UK Biobank (N = 107,947-374,505). We first calculated the polygenic risk scores (PRS) of 62 brain aging modes and 114 gut microbiota taxa as the instrumental variables, and then constructed linear and logistic regression analyses to systematically explore the potential interaction effects of brain aging and gut microbiota on psychiatric disorders. We observed the interaction effects of brain aging and gut microbiota on sleep, anxiety and depression disorders, such as Putamen/caudate T2* vs. Rhodospirillales (β = -0.012, P = 8.4 × 10-4) was negatively associated with chronotype, Fornix MD vs. Holdemanella (β = -0.007, P = 1.76 × 10-2) was negatively related to general anxiety disorder (GAD) scores, and White matter lesions vs. Acidaminococcaceae (β = 0.019, P = 1.29 × 10-3) was positively correlated with self-reported depression. Interestingly, Putamen volume vs. Intestinibacter was associated with all three psychiatric disorders, including chronotype (negative correlation), GAD scores (positive correlation) and self-reported depression (positive correlation). Our study results suggest the significant impacts of brain aging and gut microbiota on the development of sleep, anxiety and depression disorders, providing new clues for clarifying the pathogenesis of these disorders.
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Affiliation(s)
- Huijie Zhang
- Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, 710061, Xi'an, People's Republic of China
| | - Li Liu
- Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, 710061, Xi'an, People's Republic of China
| | - Shiqiang Cheng
- Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, 710061, Xi'an, People's Republic of China
| | - Yumeng Jia
- Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, 710061, Xi'an, People's Republic of China
| | - Yan Wen
- Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, 710061, Xi'an, People's Republic of China
| | - Xuena Yang
- Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, 710061, Xi'an, People's Republic of China
| | - Peilin Meng
- Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, 710061, Xi'an, People's Republic of China
| | - Chun'e Li
- Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, 710061, Xi'an, People's Republic of China
| | - Chuyu Pan
- Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, 710061, Xi'an, People's Republic of China
| | - Yujing Chen
- Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, 710061, Xi'an, People's Republic of China
| | - Zhen Zhang
- Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, 710061, Xi'an, People's Republic of China
| | - Jingxi Zhang
- Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, 710061, Xi'an, People's Republic of China
| | - Feng Zhang
- Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, 710061, Xi'an, People's Republic of China.
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11
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Shetty JJ, Nicholas C, Nelson B, McGorry PD, Lavoie S, Markulev C, Schäfer MR, Thompson A, Yuen HP, Yung AR, Nieman DH, de Haan L, Amminger GP, Hartmann JA. Greater preference for eveningness is associated with negative symptoms in an ultra-high risk for psychosis sample. Early Interv Psychiatry 2021; 15:1793-1798. [PMID: 33538110 DOI: 10.1111/eip.13112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 11/16/2020] [Accepted: 12/15/2020] [Indexed: 01/16/2023]
Abstract
AIM Investigating biological processes in at-risk individuals may help elucidate the aetiological mechanisms underlying psychosis development, refine prediction models and improve intervention strategies. This study examined the associations between sleep disturbances, chronotype, depressive and psychotic symptoms in individuals at ultra-high risk for psychosis. METHODS A sample of 81 ultra-high risk patients completed clinical interviews and self-report assessments of chronotype and sleep during the Neurapro clinical trial. Mixed regression was used to investigate the cross-sectional associations between symptoms and sleep disturbances/chronotype. RESULTS Sleep disturbances were significantly associated with increased depressive and attenuated positive psychotic symptoms. Greater preference for eveningness was significantly associated with increased negative symptoms, but not with depressive or attenuated positive psychotic symptoms. CONCLUSION Sleep disturbances and chronotype may impact the emerging psychopathology experienced by ultra-high risk individuals. Further, the preliminary relationship observed between greater preference for eveningness and negative symptoms offers a unique opportunity to treat negative symptoms through chronobiological approaches.
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Affiliation(s)
- Jashmina J Shetty
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christian Nicholas
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Austin Hospital, Melbourne, Victoria, Australia
| | - Barnaby Nelson
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick D McGorry
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Suzie Lavoie
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Connie Markulev
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Miriam R Schäfer
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Thompson
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hok Pan Yuen
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alison R Yung
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dorien H Nieman
- Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands
| | - G Paul Amminger
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jessica A Hartmann
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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12
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Catoire S, Nourredine M, Lefebvre S, Couraud S, Gronfier C, Rey R, Peter-Derex L, Geoffroy PA, Rolland B. Tobacco-induced sleep disturbances: A systematic review and meta-analysis. Sleep Med Rev 2021; 60:101544. [PMID: 34597890 DOI: 10.1016/j.smrv.2021.101544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 12/26/2022]
Abstract
Even though tobacco-induced sleep disturbances (TISDs) have been reported in previous studies, the present article is the first meta-analysis quantitatively assessing the impact of tobacco on sleep parameters. We conducted a systematic review and meta-analysis of the studies comparing objective (i.e. polysomnography and actigraphy) and/or subjective sleep parameters in chronic tobacco smokers without comorbidities versus healthy controls. Studies were retrieved using PubMed, PsycINFO, and Web of Science. Differences are expressed as standardized mean deviations (SMD) and their 95% confidence intervals (95%CI). Fourteen studies were finally included into the review, among which ten were suitable for meta-analysis. Compared to healthy controls, chronic tobacco users displayed increased N1 percentage (SMD = 0.65, 95%CI: 0.22 to 1.07), N2 percentage (SMD = 1.45, 95%CI: 0.26 to 2.63), wake time after sleep onset (SMD = 6.37, 95%CI: 2.48 to 10.26), and decreased slow-wave sleep (SMD = -2.00, 95%CI: -3.30 to -0.70). Objective TISDs preferentially occurred during the first part of the night. Regarding subjective parameters, only the Pittsburgh Sleep Quality Index (PSQI) total score could be analyzed, with no significant between-groups difference (SMD = 0.53, 95%CI: -0.18 to 1.23). Smoking status should be carefully assessed in sleep medicine, while TISDs should be regularly explored in chronic tobacco users.
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Affiliation(s)
- Sébastien Catoire
- Service Universitaire d'Addictologie de Lyon (SUAL), Pôle MOPHA, CH Le Vinatier, 69500, Bron, France; Unité Michel Jouvet, 69Z19, Pôle Est, CH Le Vinatier, 69500, Bron, France; Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Hôpital Lyon-Sud, CHU Lyon, 69310 Pierre Bénite, France.
| | - Mikail Nourredine
- Service Hospitalo-Universitaire de pharmacotoxicologie, Service de recherche et épidémiologie clinique Hospices Civils de Lyon, 69424, Lyon, France; Faculté de Médecine Lyon-Sud, 69921, Oullins, France
| | - Stéphanie Lefebvre
- Service Universitaire d'Addictologie de Lyon (SUAL), Pôle MOPHA, CH Le Vinatier, 69500, Bron, France; Centre de Recherche en Neuroscience de Lyon (CRNL), Inserm UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, 69000, Lyon, France
| | - Sébastien Couraud
- Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Hôpital Lyon-Sud, CHU Lyon, 69310 Pierre Bénite, France; EMR 3738 Ciblage thérapeutique en Oncologie, Faculté de médecine et de maïeutique Lyon Sud Charles - Mérieux, Université Lyon 1, France
| | - Claude Gronfier
- Centre de Recherche en Neuroscience de Lyon (CRNL), Inserm UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, 69000, Lyon, France
| | - Romain Rey
- Unité Michel Jouvet, 69Z19, Pôle Est, CH Le Vinatier, 69500, Bron, France; Centre de Recherche en Neuroscience de Lyon (CRNL), Inserm UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, 69000, Lyon, France
| | - Laure Peter-Derex
- Centre de Recherche en Neuroscience de Lyon (CRNL), Inserm UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, 69000, Lyon, France; Centre de Médecine du Sommeil et des Maladies Respiratoires, Hospices Civils de Lyon, Université Lyon 1, Lyon, France
| | - Pierre A Geoffroy
- Service de Psychiatrie et d'Addictologie, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Bichat, Paris, France; Université de Paris, NeuroDiderot, Inserm, Paris, France; GHU Paris - Psychiatry & Neurosciences, 1 rue Cabanis, 75014, Paris, France
| | - Benjamin Rolland
- Service Universitaire d'Addictologie de Lyon (SUAL), Pôle MOPHA, CH Le Vinatier, 69500, Bron, France; Centre de Recherche en Neuroscience de Lyon (CRNL), Inserm UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, 69000, Lyon, France; Service d'Addictologie, Hôpital Édouard Herriot, CHU Lyon, 69003, Lyon, France
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13
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Winiger EA, Ellingson JM, Morrison CL, Corley RP, Pasman JA, Wall TL, Hopfer CJ, Hewitt JK. Sleep deficits and cannabis use behaviors: an analysis of shared genetics using linkage disequilibrium score regression and polygenic risk prediction. Sleep 2021; 44:zsaa188. [PMID: 32935850 PMCID: PMC7953210 DOI: 10.1093/sleep/zsaa188] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/27/2020] [Indexed: 12/17/2022] Open
Abstract
STUDY OBJECTIVES Estimate the genetic relationship of cannabis use with sleep deficits and an eveningness chronotype. METHODS We used linkage disequilibrium score regression (LDSC) to analyze genetic correlations between sleep deficits and cannabis use behaviors. Secondly, we generated sleep deficit polygenic risk score (PRS) and estimated their ability to predict cannabis use behaviors using linear and logistic regression. Summary statistics came from existing genome-wide association studies of European ancestry that were focused on sleep duration, insomnia, chronotype, lifetime cannabis use, and cannabis use disorder (CUD). A target sample for PRS prediction consisted of high-risk participants and participants from twin/family community-based studies (European ancestry; n = 760, male = 64%; mean age = 26.78 years). Target data consisted of self-reported sleep (sleep duration, feeling tired, and taking naps) and cannabis use behaviors (lifetime ever use, number of lifetime uses, past 180-day use, age of first use, and lifetime CUD symptoms). RESULTS Significant genetic correlation between lifetime cannabis use and an eveningness chronotype (rG = 0.24, p < 0.001), as well as between CUD and both short sleep duration (<7 h; rG = 0.23, p = 0.017) and insomnia (rG = 0.20, p = 0.020). Insomnia PRS predicted earlier age of first cannabis use (OR = 0.92, p = 0.036) and increased lifetime CUD symptom count (OR = 1.09, p = 0.012). CONCLUSION Cannabis use is genetically associated with both sleep deficits and an eveningness chronotype, suggesting that there are genes that predispose individuals to both cannabis use and sleep deficits.
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Affiliation(s)
- Evan A Winiger
- Institute for Behavioral Genetics, University of Colorado Boulder, CO
- Department of Psychology and Neuroscience, University of Colorado Boulder, CO
| | - Jarrod M Ellingson
- Institute for Behavioral Genetics, University of Colorado Boulder, CO
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO
| | - Claire L Morrison
- Institute for Behavioral Genetics, University of Colorado Boulder, CO
- Department of Psychology and Neuroscience, University of Colorado Boulder, CO
| | - Robin P Corley
- Institute for Behavioral Genetics, University of Colorado Boulder, CO
| | - Joëlle A Pasman
- Behavioural Science Institute, Radboud University Nijmegen, Amsterdam, The Netherlands
| | - Tamara L Wall
- Department of Psychiatry, University of California, San Diego, CA
| | - Christian J Hopfer
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO
| | - John K Hewitt
- Institute for Behavioral Genetics, University of Colorado Boulder, CO
- Department of Psychology and Neuroscience, University of Colorado Boulder, CO
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14
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Höller Y, Gudjónsdottir BE, Valgeirsdóttir SK, Heimisson GT. The effect of age and chronotype on seasonality, sleep problems, and mood. Psychiatry Res 2021; 297:113722. [PMID: 33476898 DOI: 10.1016/j.psychres.2021.113722] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 01/10/2021] [Indexed: 12/15/2022]
Abstract
Seasonal affective disorder has been associated with sleep problems, young age, and an evening chronotype. A chronotype refers to an individual's preference in the timing of their sleep-wake cycle, as well as the time during the sleep-wake cycle when a person is most alert and energetic. Seasonality refers to season-dependent fluctuations in sleep length, social activity, mood, weight, appetite, and energy level. Evening chronotype is more common in young adults and morning chronotype more common in the elderly. This study aimed to estimate the differential contribution of chronotype and age on seasonality. A sample of n=410 participants were included in the study. The age groups showed significantly different results according to sleep parameters, depression, anxiety, stress, seasonality, and chronotype. The oldest group (>59 years) showed the lowest scores on all of these scales. According to a path analysis, chronotype and age predict propensity for seasonality. However, sleep problems were linked to chronotype but not to age. Older adults seem to be more resistant to seasonal changes that are perceived as a problem than young and middle aged adults. Future studies would benefit from considering cultural aspects and examine seasonality, chronotype, depression, and insomnia in longitudinal designs.
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Affiliation(s)
- Yvonne Höller
- Faculty of Psychology, University of Akureyri, Nordurslod 2, 600 Akureyri, Iceland.
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15
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Brandão LEM, Martikainen T, Merikanto I, Holzinger B, Morin CM, Espie CA, Bolstad CJ, Leger D, Chung F, Plazzi G, Dauvilliers Y, Matsui K, De Gennaro L, Sieminski M, Nadorff MR, Chan NY, Wing YK, Mota-Rolim SA, Inoue Y, Partinen M, Benedict C, Bjorvatn B, Cedernaes J. Social Jetlag Changes During the COVID-19 Pandemic as a Predictor of Insomnia - A Multi-National Survey Study. Nat Sci Sleep 2021; 13:1711-1722. [PMID: 34675720 PMCID: PMC8502537 DOI: 10.2147/nss.s327365] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/12/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Lifestyle and work habits have been drastically altered by restrictions due to the COVID-19 pandemic. Whether the associated changes in sleep timing modulate the risk of suffering from symptoms of insomnia, the most prevalent sleep disorder, is however incompletely understood. Here, we evaluate the association between the early pandemic-associated change in 1) the magnitude of social jetlag (SJL) - ie, the difference between sleep timing on working vs free days - and 2) symptoms of insomnia. PATIENTS AND METHODS A total of 14,968 anonymous participants (mean age: 40 years; 64% females) responded to a standardized internet-based survey distributed across 14 countries. Using logistic multivariate regression, we examined the association between the degree of social jetlag and symptoms of insomnia, controlling for important confounders like social restriction extension, country specific COVID-19 severity and psychological distress, for example. RESULTS In response to the pandemic, participants reported later sleep timing, especially during workdays. Most participants (46%) exhibited a reduction in their SJL, whereas 20% increased it; and 34% reported no change in SJL. Notably, we found that both increased and decreased SJL, as a result of the COVID-19 pandemic, were associated with later sleep midpoint (indicating a later chronotype) as well as more recurrent and moderate-to-severe symptoms of insomnia (about 23-54% higher odds ratio than subjects with unchanged SJL). Primarily those with reduced SJL shifted their bedtimes to a later timepoint, compared with those without changes in SJL. CONCLUSION Our findings offer important insights into how self-reported changes to the stability of sleep/wake timing, as reflected by changes in SJL, can be a critical marker of the risk of experiencing insomnia-related symptoms - even when individuals manage to reduce their social jetlag. These findings emphasize the clinical importance of analyzing sleep-wake regularity.
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Affiliation(s)
| | | | - Ilona Merikanto
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.,Orton Orthopaedic Hospital, Helsinki, Finland
| | - Brigitte Holzinger
- ZK-Schlafcoaching, Medical University Vienna, Vienna, Austria.,Institute for Consciousness and Dream Research, Vienna, Austria
| | - Charles M Morin
- École de Psychologie, Université Laval, Québec, Canada.,Centre d'étude des troubles du sommeil, Université Laval, Québec, Canada.,Centre de recherche CERVO/Brain Research Center, Université Laval, Québec, Canada
| | - Colin A Espie
- Sleep & Circadian Institute, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Courtney J Bolstad
- Department of Psychology, Mississippi State University, Starkville, MS, USA
| | - Damien Leger
- APHP, VIFASOM, Hôtel-Dieu, Centre du Sommeil et de la Vigilance, Université de Paris, Paris, France
| | - Frances Chung
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy
| | - Yves Dauvilliers
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, Institute for Neurosciences of Montpellier INM, INSERM, University of Montpellier, Montpellier, France
| | - Kentaro Matsui
- National Center of Neurology and Psychiatry National Institute of Mental Health, Department of Clinical Laboratory and Department of Sleep-Wake Disorders, Tokyo, Japan.,Tokyo Women's Medical University, Department of Psychiatry, Tokyo, Japan
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,IRCCS Fondazione Santa Lucia, Rome, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Mariusz Sieminski
- Department of Emergency Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Michael R Nadorff
- Department of Psychology, Mississippi State University, Starkville, MS, USA.,Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of 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 SAR, People's Republic of China
| | - Sérgio Arthuro Mota-Rolim
- Brain Institute, Federal University of Rio Grande do Norte, Natal, RN, Brazil.,Physiology and Behaviour Department, Federal University of Rio Grande do Norte, Natal, RN, Brazil.,Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Markku Partinen
- Helsinki Sleep Clinic, Vitalmed Research Center, Terveystalo Biobank and Research, Helsinki, Finland.,Department of Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
| | - Christian Benedict
- Sleep Science Laboratory, Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Bjorn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Jonathan Cedernaes
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Department of Medicine, Division of Endocrinology, Metabolism, and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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16
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Hisler GC, Rothenberger SD, Clark DB, Hasler BP. Is there a 24-hour rhythm in alcohol craving and does it vary by sleep/circadian timing? Chronobiol Int 2020; 38:109-121. [PMID: 33167734 DOI: 10.1080/07420528.2020.1838532] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Increasing evidence implicates sleep/circadian factors in alcohol use; however, the role of such factors in alcohol craving has received scant attention. Prior research suggests a 24-hour rhythm in related processes (e.g., reward motivation), but more research directly investigating a rhythm in craving is needed. Moreover, prior evidence is ambiguous whether such a rhythm in alcohol craving may vary by sleep/circadian timing. To examine these possibilities, 36 late adolescents (18-22 years of age; 61% female) with regular alcohol use but without a current alcohol use disorder were recruited to complete smartphone reports of alcohol craving intensity six times a day for two weeks. During these two weeks, participants wore wrist actigraphs and completed two in-lab assessments (on Thursday and Sunday) of dim light melatonin onset (DLMO). Average actigraphically derived midpoint of sleep on weekends and average DLMO were used as indicators of sleep and circadian timing, respectively. Multilevel cosinor analysis revealed a 24-hour rhythm in alcohol craving. Findings across the sleep and circadian timing variables converged to suggest that sleep/circadian timing moderated the 24-hour rhythm in alcohol craving. Specifically, people with later sleep/circadian timing had later timing of peak alcohol craving. These findings add to the growing evidence of potential circadian influences on reward-related phenomena and suggest that greater consideration of sleep and circadian influences on alcohol craving may be useful for understanding alcohol use patterns and advancing related interventions.
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Affiliation(s)
- Garrett C Hisler
- Department of Psychiatry, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania, USA
| | - Scott D Rothenberger
- Division of General Internal Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania, USA
| | - Duncan B Clark
- Department of Psychiatry, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania, USA
| | - Brant P Hasler
- Department of Psychiatry, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania, USA
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17
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Motivation and sensitivity to monetary reward in late-life insomnia: moderating role of sex and the inflammatory marker CRP. Neuropsychopharmacology 2020; 45:1664-1671. [PMID: 32544926 PMCID: PMC7419294 DOI: 10.1038/s41386-020-0735-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/13/2020] [Accepted: 06/08/2020] [Indexed: 11/09/2022]
Abstract
Insomnia is a well-established risk factor for late-life depression, yet the intermediary mechanisms are not known. One plausible mechanism is dysregulation of the reward system, a common feature of depression. The main objective of the current study was to determine whether late-life insomnia is associated with reduced motivation and reduced sensitivity for monetary reward. Secondary exploratory objectives were to test for sex-specific effects and whether elevated inflammation potentiated these associations. Nondepressed community dwelling older adults (n = 104; aged 60-80) who either met (n = 31) or did not meet (n = 73) criteria for insomnia disorder as assessed by the Structured Clinical Interview for DSM-5 completed the Effort Expenditure for Rewards Task and provided blood samples for the assessment of C-reactive protein (CRP). Older adults with late-life insomnia showed reduced reward motivation 95% CI [-0.955, -0.569] and reduced reward sensitivity 95% CI [-0.430, -0.075] relative to comparison controls. In secondary exploratory analyses, late-life insomnia was associated with reduced motivation to a greater degree in males than in females 95% CI [0.072, 0.775], particularly when CRP was also elevated 95% CI [0.672, 1.551]. Late-life insomnia is associated with reduced motivation and sensitivity for monetary reward, which suggests insomnia may confer risk for late-life depression by dysregulation of reward mechanisms. Exploratory analyses suggest that older males with insomnia and elevated CRP may be particularly vulnerable to deficits in reward motivation. Although in need of replication and further study, results suggest that interventions that target insomnia or deficits in reward processing may mitigate the risk of depression in nondepressed older adults, especially older males with insomnia.
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18
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van de Maat R, Lataster J, Verboon P. Why and How to Deal With Diurnal Cyclic Patterns in Ambulatory Assessment of Emotions. EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2020. [DOI: 10.1027/1015-5759/a000579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. The use of ambulatory assessment (AA) based methods in emotion research has steadily increased over the past decades. Although having a number of benefits over other methods, the use and analysis of AA data may pose specific challenges. Among these, the issue of dealing with diurnal cycles in emotion data has received relative scant attention. This article therefore discusses why cyclic models may be considered for analyzing AA data on emotions, and describes how this approach can be applied to an empirical AA dataset. Results suggest that cyclic modeling may be a useful method for describing and accounting for (diurnal) cyclic patterns in AA data, but should be used with a number of considerations in mind.
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Affiliation(s)
- Robin van de Maat
- Faculty of Psychology and Educational Sciences, Open University, Heerlen, The Netherlands
| | - Johan Lataster
- Faculty of Psychology and Educational Sciences, Open University, Heerlen, The Netherlands
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Peter Verboon
- Faculty of Psychology and Educational Sciences, Open University, Heerlen, The Netherlands
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19
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Claudatos S, Baker FC, Hasler BP. Relevance of Sleep and Circadian Rhythms to Adolescent Substance Use. CURRENT ADDICTION REPORTS 2019. [DOI: 10.1007/s40429-019-00277-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Lien M, Bredeli E, Sivertsen B, Kallestad H, Pallesen S, Smith ORF, Faaland P, Ritterband LM, Thorndike FP, Vedaa Ø. Short and long-term effects of unguided internet-based cognitive behavioral therapy for chronic insomnia in morning and evening persons: a post-hoc analysis. Chronobiol Int 2019; 36:1384-1398. [DOI: 10.1080/07420528.2019.1647435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Mats Lien
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Einar Bredeli
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Børge Sivertsen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
- Department of Research and Innovation, Helse Fonna HF, Haugesund, Norway
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håvard Kallestad
- Division of Mental Health Care, Department of Østmarka, St. Olavs University Hospital, Trondheim, Norway
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Otto R. F. Smith
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Patrick Faaland
- Division of Mental Health Care, Department of Østmarka, St. Olavs University Hospital, Trondheim, Norway
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lee M. Ritterband
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health System, Charlottesville, VA, USA
| | | | - Øystein Vedaa
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
- Division of Mental Health Care, Department of Østmarka, St. Olavs University Hospital, Trondheim, Norway
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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21
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Hasler BP, Wallace ML, White SJ, Molina BSG, Pedersen SL. Preliminary Evidence That Real World Sleep Timing and Duration are Associated With Laboratory-Assessed Alcohol Response. Alcohol Clin Exp Res 2019; 43:1575-1584. [PMID: 31070238 DOI: 10.1111/acer.14076] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/29/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Sleep timing and evening chronotype have been implicated in alcohol use problems but research has yet to study them in relation to theory-driven laboratory-based measures of alcohol use disorder risk. The current study examined (i) whether chronotype, sleep timing, and/or sleep duration are associated with alcohol response (subjective stimulation, sedation, and behavioral disinhibition) and (ii) if sex and race moderate these associations. METHODS Adult drinkers (N = 144; 46 female participants) completed 2 counterbalanced beverage administration sessions (alcohol and nonalcohol) during which they rated stimulation/sedation and completed a cued go/no-go task. They reported bed and waketimes over 10 days. RESULTS Later sleep timing was associated with greater increases in alcohol stimulation, but among male and White participants only. Later sleep timing (among male participants) and greater eveningness (examined among White male participants only) were associated with greater overall stimulation on average in the alcohol session relative to the nonalcohol session, irrespective of alcohol consumption. More variable sleep duration was associated with greater increases in sedation. CONCLUSIONS These findings offer preliminary, but novel evidence that sleep characteristics may relate to the relative stimulating and sedating effects of alcohol, thereby influencing the risk for alcohol problems.
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Affiliation(s)
- Brant P Hasler
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Meredith L Wallace
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sarah J White
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Brooke S G Molina
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sarah L Pedersen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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22
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Haraden DA, Mullin BC, Hankin BL. Internalizing symptoms and chronotype in youth: A longitudinal assessment of anxiety, depression and tripartite model. Psychiatry Res 2019; 272:797-805. [PMID: 30832201 PMCID: PMC6498437 DOI: 10.1016/j.psychres.2018.12.117] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/21/2018] [Accepted: 12/22/2018] [Indexed: 12/01/2022]
Abstract
Biological rhythm theories highlight the reciprocal relations between dysregulated circadian patterns and internalizing psychopathology. Chronotype characterizes individuals' diurnal preference, as some exhibit more morningness or eveningness. Previous research suggests that eveningness prospectively predicts depression in adolescence. Anxiety often co-occurs with depression, but little is known about longitudinal, reciprocal associations between chronotype and anxiety, and whether this relationship remains after controlling for depression. We assessed different forms of anxiety (social, panic, separation), positive/negative affect, anxious arousal (from tripartite theory), and depression, in relation to chronotype to better understand the specificity and directionality of associations between chronotype and internalizing problems in adolescence. Community youth participated in three assessment time points: T1, T2 (18-months post-T1), and T3 (30-months post-T1) as part of a larger longitudinal study. Youth completed self-report measures of anxiety, depression, positive and negative affect, and chronotype. Regression analyses showed that eveningness: (1) concurrently associated with decreased separation anxiety, elevated symptoms of depression and low levels of positive affect, (2) was prospectively predicted by elevated depression, (3) did not predict later symptoms of anxiety. The reciprocal, prospective relationship between chronotype and internalizing psychopathology is specific to depression during adolescence.
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Affiliation(s)
- Dustin A. Haraden
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Benjamin C. Mullin
- Department of Psychiatry, University of Colorado School of Medicine, Denver, CO, USA
| | - Benjamin L. Hankin
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
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23
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Abstract
Many processes in the human body - including brain function - are regulated over the 24-hour cycle, and there are strong associations between disrupted circadian rhythms (for example, sleep-wake cycles) and disorders of the CNS. Brain disorders such as autism, depression and Parkinson disease typically develop at certain stages of life, and circadian rhythms are important during each stage of life for the regulation of processes that may influence the development of these disorders. Here, we describe circadian disruptions observed in various brain disorders throughout the human lifespan and highlight emerging evidence suggesting these disruptions affect the brain. Currently, much of the evidence linking brain disorders and circadian dysfunction is correlational, and so whether and what kind of causal relationships might exist are unclear. We therefore identify remaining questions that may direct future research towards a better understanding of the links between circadian disruption and CNS disorders.
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Affiliation(s)
- Ryan W Logan
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - Colleen A McClung
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA.
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24
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Exploring the potential role of mesocorticolimbic circuitry in motivation for and adherence to chronic pain self-management interventions. Neurosci Biobehav Rev 2018; 98:10-17. [PMID: 30543904 DOI: 10.1016/j.neubiorev.2018.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 12/04/2018] [Accepted: 12/08/2018] [Indexed: 12/28/2022]
Abstract
Adherence to pain self-management strategies is associated with favorable psychobehavioral outcomes among individuals with chronic pain. Substantive adherence to treatments teaching these adaptive skills often proves challenging, resulting in poor individual and societal outcomes. Evidence demonstrates motivation for behavior change as a key predictor of treatment adherence. Despite behavioral techniques that target motivation, however, nonadherence persists as a barrier to positive clinical outcomes in chronic pain. Understanding the neurobiological mechanisms underlying treatment motivation might highlight novel avenues for augmentative therapies. The purpose of this review is to present theory and evidence that the mesocorticolimbic system (i.e., brain circuitry associated with reward processing and motivation) contributes to treatment motivation among chronic pain patients, ultimately influencing adherence. We review evidence for motivation as a key adherence determinant, detail neuroimaging findings relating mesocorticolimbic circuitry and motivation, and discuss data supporting mesocorticolimbic dysfunction among chronic pain patients. We propose a neurobehavioral model for adherence to pain self-management interventions, listing testable hypotheses. Finally, we discuss potential research and intervention implications from the proposed model.
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25
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Zhao W, Gao D, Yue F, Wang Y, Mao D, Chen X, Lei X. Response Inhibition Deficits in Insomnia Disorder: An Event-Related Potential Study With the Stop-Signal Task. Front Neurol 2018; 9:610. [PMID: 30131753 PMCID: PMC6090996 DOI: 10.3389/fneur.2018.00610] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 07/09/2018] [Indexed: 12/20/2022] Open
Abstract
Background: Response inhibition is a hallmark of executive function, which was detected impaired in various psychiatric disorders. However, whether insomnia disorder (ID) impairs response inhibition has caused great controversy. Methods: Using the auditory stop-signal paradigm coupled with event-related potentials (ERPs), we carried out this study to examine whether individuals with ID presented response inhibition deficits and further investigated the neural mechanism correlated to these deficits. Twelve individuals with ID and 13 matched good sleepers (GSs) had participated in this study, and then they performed an auditory stop-signal task (SST) in the laboratory setting with high density EEG recordings. Results: The behavioral results revealed that compared to GSs, patients with ID presented significantly longer stop-signal reaction time (SSRT), suggesting the impairment of motor inhibition among insomniacs. Their reaction time in go trials, however, showed no significant between-group difference. Considering the electrophysiological correlate underlying the longer SSRT, we found reduced P3 amplitude in patients with insomnia in the successful stop trials, which might reflect their poor efficiency of response inhibition. Finally, when we performed exploratory analyses in the failed stop and go trials, patients with ID presented reduced Pe and N1 amplitude in the failed sop trials and go trials respectively. Discussion: Taken together, these findings indicate that individuals with ID would present response inhibition deficits. Moreover, the electrophysiological correlate underlying these deficits mainly revolves around the successful stop P3 component. The present study is the first to investigate the electrophysiological correlate underlying the impaired response inhibition among insomniacs.
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Affiliation(s)
- Wenrui Zhao
- Sleep and Neuroimaging Center, Faculty of Psychology, Southwest University, Chongqing, China.,Key Laboratory of Cognition and Personality of Ministry of Education, Chongqing, China
| | - Dong Gao
- Sleep Psychology Center, Daping Hospital, Army Medical University, Chongqing, China
| | - Faguo Yue
- Sleep Psychology Center, Daping Hospital, Army Medical University, Chongqing, China
| | - Yanting Wang
- Sleep Psychology Center, Daping Hospital, Army Medical University, Chongqing, China
| | - Dandan Mao
- Sleep Psychology Center, Daping Hospital, Army Medical University, Chongqing, China
| | - Xinyuan Chen
- Sleep and Neuroimaging Center, Faculty of Psychology, Southwest University, Chongqing, China.,Key Laboratory of Cognition and Personality of Ministry of Education, Chongqing, China
| | - Xu Lei
- Sleep and Neuroimaging Center, Faculty of Psychology, Southwest University, Chongqing, China.,Key Laboratory of Cognition and Personality of Ministry of Education, Chongqing, China
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26
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Smagula SF, Krafty RT, Thayer JF, Buysse DJ, Hall MH. Rest-activity rhythm profiles associated with manic-hypomanic and depressive symptoms. J Psychiatr Res 2018; 102:238-244. [PMID: 29705489 PMCID: PMC6005763 DOI: 10.1016/j.jpsychires.2018.04.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 04/05/2018] [Accepted: 04/18/2018] [Indexed: 11/23/2022]
Abstract
Rest-activity rhythm (RAR) disturbances are associated with mood disorders. But there remains a need to identify the particular RAR profiles associated with psychiatric symptom dimensions. Establishing such profiles would support the development of tools that track the 24-h sleep-wake phenotypes signaling clinical heterogeneity. We used data-driven clustering to identify RAR profiles in 145 adults aged 36-82 years (mean = 60, standard deviation = 9). Then we evaluated psychiatric symptom dimensions (including positive and negative affect, depressive, manic-hypomanic, panic-agoraphobic, and substance use symptoms) associated with these empirically-derived RAR profiles. Clustering identified three sub-groups characterized, on average, by: (1) earlier and more robust RARs ("earlier/robust," n = 55, 38%); (2) later and irregular RARs ("later/irregular," n = 31, 21%); and (3) later RARs and a narrower active period ("later/narrower," n = 59, 41%). Compared with the "earlier/robust" group: the "later/irregular" group had higher levels of lifetime manic-hypomanic symptoms (β (standard error) = 0.80 (0.22) higher standardized symptom units, p = 0.0004) and lifetime depression symptoms (β (standard error) = 0.73 (0.21) higher standardized symptom units, p = 0.0009); the "later/narrower" group had more lifetime depression symptoms (β (standard error) = 0.48 (0.18) higher standardized symptom units, p = 0.0076). These associations persisted after adjustments for sleep continuity and duration, suggesting that RARs are distinct behavioral correlates of clinical heterogeneity. Longitudinal studies are needed to confirm whether RAR characteristics contribute to the risk of manic and/or depressive episodes, and whether they reflect the consequences of psychiatric disturbance (e.g., on quality of life or disability). Opportunities to monitor or intervene on objectively-assessed RARs could facilitate better mental health related outcomes.
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Affiliation(s)
- Stephen F Smagula
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Robert T Krafty
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Julian F Thayer
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Martica H Hall
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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27
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Logan RW, Hasler BP, Forbes EE, Franzen PL, Torregrossa MM, Huang YH, Buysse DJ, Clark DB, McClung CA. Impact of Sleep and Circadian Rhythms on Addiction Vulnerability in Adolescents. Biol Psychiatry 2018; 83:987-996. [PMID: 29373120 PMCID: PMC5972052 DOI: 10.1016/j.biopsych.2017.11.035] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 10/18/2017] [Accepted: 11/22/2017] [Indexed: 12/11/2022]
Abstract
Sleep homeostasis and circadian function are important maintaining factors for optimal health and well-being. Conversely, sleep and circadian disruptions are implicated in a variety of adverse health outcomes, including substance use disorders. These risks are particularly salient during adolescence. Adolescents require 8 to 10 hours of sleep per night, although few consistently achieve these durations. A mismatch between developmental changes and social/environmental demands contributes to inadequate sleep. Homeostatic sleep drive takes longer to build, circadian rhythms naturally become delayed, and sensitivity to the phase-shifting effects of light increases, all of which lead to an evening preference (i.e., chronotype) during adolescence. In addition, school start times are often earlier in adolescence and the use of electronic devices at night increases, leading to disrupted sleep and circadian misalignment (i.e., social jet lag). Social factors (e.g., peer influence) and school demands further impact sleep and circadian rhythms. To cope with sleepiness, many teens regularly consume highly caffeinated energy drinks and other stimulants, creating further disruptions in sleep. Chronic sleep loss and circadian misalignment enhance developmental tendencies toward increased reward sensitivity and impulsivity, increasing the likelihood of engaging in risky behaviors and exacerbating the vulnerability to substance use and substance use disorders. We review the neurobiology of brain reward systems and the impact of sleep and circadian rhythms changes on addiction vulnerability in adolescence and suggest areas that warrant additional research.
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Affiliation(s)
- Ryan W Logan
- Translational Neuroscience Program, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Center for Neuroscience, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; The Jackson Laboratory, Bar Harbor, Maine
| | - Brant P Hasler
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Erika E Forbes
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Peter L Franzen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Mary M Torregrossa
- Translational Neuroscience Program, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Center for Neuroscience, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Yanhua H Huang
- Translational Neuroscience Program, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Center for Neuroscience, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Duncan B Clark
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Colleen A McClung
- Translational Neuroscience Program, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Center for Neuroscience, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; The Jackson Laboratory, Bar Harbor, Maine.
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28
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Simor P, Harsányi A, Csigó K, Miklós G, Lázár AS, Demeter G. Eveningness is associated with poor sleep quality and negative affect in obsessive-compulsive disorder. J Behav Addict 2018; 7:10-20. [PMID: 29415552 PMCID: PMC6035014 DOI: 10.1556/2006.7.2018.07] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/18/2018] [Accepted: 01/21/2018] [Indexed: 11/19/2022] Open
Abstract
Background Obsessive-compulsive disorder (OCD) is characterized by intrusive thoughts and repetitive behaviors that severely encumber daily functioning. OCD patients seem to exhibit sleep disturbances, especially delayed bedtimes that reflect disrupted circadian rhythmicity. Morningness-eveningness is a fundamental factor reflecting individual variations in diurnal preferences related to sleep and waking activities. Eveningness reflecting a delayed sleep-wake timing has repeatedly been associated with sleep problems and negative affect (NA). Therefore, the aim of this study was to examine the associations between morningness-eveningness, sleep complaints, and symptom severity in OCD patients and compared with a mixed psychiatric control group. Materials and methods The data of 49 OCD and 49 mixed psychiatric inpatients (with unipolar depression and anxiety disorders) were analyzed. Patients completed questionnaires regarding morningness-eveningness, sleep quality, nightmare frequency, depression, anxiety, and affective states. Obsessive and compulsive symptom severity was also assessed within the OCD group by clinician-rated scales. Results Eveningness preference was associated with impaired sleep quality and higher NA in OCD patients. In addition, impaired sleep quality showed a moderate correlation with anxiety and strong correlations with depressive symptoms and NA. Interestingly, in the mixed psychiatric group, eveningness was not linked to NA, and sleep quality also showed weaker associations with depressive symptoms and NA. Within the OCD group, eveningness preference was predictive of poorer sleep quality regardless the influence of depressive symptoms. Conclusion Our findings suggest that eveningness and sleep complaints are predictive of affective dysfunctions, and should be carefully considered in the evaluation and treatment of OCD patients.
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Affiliation(s)
- Péter Simor
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
- Nyírő Gyula Hospital, National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - András Harsányi
- Nyírő Gyula Hospital, National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - Kata Csigó
- Nyírő Gyula Hospital, National Institute of Psychiatry and Addictions, Budapest, Hungary
| | | | - Alpár Sándor Lázár
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Gyula Demeter
- Department of Cognitive Sciences, Budapest University of Technology and Economics, Budapest, Hungary
- Rehabilitation Department of Brain Injuries, National Institute of Medical Rehabilitation, Budapest, Hungary
- Learning and Memory Disorders Research Group, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
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29
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Díaz-Morales JF, Randler C, Arrona-Palacios A, Adan A. Validation of the MESSi among adult workers and young students: General health and personality correlates. Chronobiol Int 2017; 34:1288-1299. [DOI: 10.1080/07420528.2017.1361437] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | - Christoph Randler
- Department of Biology, Eberhard Karls Universität Tübigen, Tübingen, Germany
| | - Arturo Arrona-Palacios
- Department of Criminology, UAMR-A, Autonomous University of Tamaulipas, Reynosa, Tamaulipas, Mexico
| | - Ana Adan
- Department of Clinical Psychology and Psychobiology, School of Psychology, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
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30
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Time of Day Differences in Neural Reward Functioning in Healthy Young Men. J Neurosci 2017; 37:8895-8900. [PMID: 28842409 DOI: 10.1523/jneurosci.0918-17.2017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 07/05/2017] [Accepted: 07/31/2017] [Indexed: 11/21/2022] Open
Abstract
Reward function appears to be modulated by the circadian system, but little is known about the neural basis of this interaction. Previous research suggests that the neural reward response may be different in the afternoon; however, the direction of this effect is contentious. Reward response may follow the diurnal rhythm in self-reported positive affect, peaking in the early afternoon. An alternative is that daily reward response represents a type of prediction error, with neural reward activation relatively high at times of day when rewards are unexpected (i.e., early and late in the day). The present study measured neural reward activation in the context of a validated reward task at 10.00 h, 14.00 h, and 19.00 h in healthy human males. A region of interest BOLD fMRI protocol was used to investigate the diurnal waveform of activation in reward-related brain regions. Multilevel modeling found, as expected, a highly significant quadratic time-of-day effect focusing on the left putamen (p < 0.001). Consistent with the "prediction error" hypothesis, activation was significantly higher at 10.00 h and 19.00 h compared with 14.00 h. It is provisionally concluded that the putamen may be particularly important in endogenous priming of reward motivation at different times of day, with the pattern of activation consistent with circadian-modulated reward expectancies in neural pathways (i.e., greater activation to reward stimuli at unexpected times of day). This study encourages further research into circadian modulation of reward and underscores the methodological importance of accounting for time of day in fMRI protocols.SIGNIFICANCE STATEMENT This is one of the first studies to use a repeated-measures imaging procedure to explore the diurnal rhythm of reward activation. Although self-reported reward (most often operationalized as positive affect) peaks in the afternoon, the present findings indicate that neural activation is lowest at this time. We conclude that the diurnal neural activation pattern may reflect a prediction error of the brain, where rewards at unexpected times (10.00 h and 19.00 h) elicit higher activation in reward brain regions than at expected (14.00 h) times. These data also have methodological significance, suggesting that there may be a time of day influence, which should be accounted for in neural reward studies.
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31
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Eveningness among late adolescent males predicts neural reactivity to reward and alcohol dependence 2 years later. Behav Brain Res 2017; 327:112-120. [PMID: 28254633 DOI: 10.1016/j.bbr.2017.02.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 01/26/2017] [Accepted: 02/14/2017] [Indexed: 01/04/2023]
Abstract
Eveningness, a preference for later sleep-wake timing, is linked to altered reward function, which may explain a consistent association with substance abuse. Notably, the extant literature rests largely on cross-sectional data, yet both eveningness and reward function show developmental changes. We examined whether circadian preference during late adolescence predicted the neural response to reward 2 years later. A sample of 93 males reported circadian preference and completed a monetary reward fMRI paradigm at ages 20 and 22. Primary analyses examined longitudinal paths from circadian preference to medial prefrontal cortex (mPFC) and ventral striatal (VS) reward responses. We also explored whether reward responses mediated longitudinal associations between circadian preference and alcohol dependence, frequency of alcohol use, and/or frequency of cannabis use. Age 20 eveningness was positively associated with age 22 mPFC and VS responses to win, but not associated with age 22 reactivity to reward anticipation. Age 20 eveningness was indirectly related to age 22 alcohol dependence via age 22 mPFC response to win. Our findings provide novel evidence that altered reward-related brain function could underlie associations between eveningness and alcohol use problems. Eveningness may be an under-recognized but modifiable risk factor for reward-related problems such as mood and substance use disorders.
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32
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Passos GS, Santana MG, Poyares D, D'Aurea CV, Teixeira AA, Tufik S, de Mello MT. Chronotype and anxiety are associated in patients with chronic primary insomnia. ACTA ACUST UNITED AC 2017; 39:183-186. [PMID: 28076650 PMCID: PMC7111444 DOI: 10.1590/1516-4446-2016-2007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 09/26/2016] [Indexed: 11/22/2022]
Abstract
Objective: To assess the interaction of chronotype with anxiety in patients with chronic primary insomnia. Methods: Sixty-four patients (50 women) with mean age 43.9±8.1 years were investigated with the Horne and Östberg Morningness-Eveningness Questionnaire (MEQ) and State-Trait Anxiety Inventory (STAI). Results: Significant negative correlations of chronotype-MEQ score with STAI state-anxiety (r = -0.40, p < 0.05), STAI trait-anxiety (r = -0.40, p < 0.05), and STAI pre-sleep state anxiety (r = -0.30, p < 0.05) were observed. Eveningness preference was associated with higher trait, state, and pre-sleep state anxiety. Conclusions: These results suggest that chronotype may be an important parameter to identifying the origin and significance of a vicious anxiety-insomnia-depression cycle in patients with chronic primary insomnia.
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Affiliation(s)
- Giselle S Passos
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Programa de Mestrado em Ciências Aplicadas à Saúde, Universidade Federal de Goiás (UFG), Regional Jataí, Jataí, GO, Brazil
| | - Marcos G Santana
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Programa de Mestrado em Ciências Aplicadas à Saúde, Universidade Federal de Goiás (UFG), Regional Jataí, Jataí, GO, Brazil
| | - Dalva Poyares
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Carolina V D'Aurea
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Alexandre A Teixeira
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Marco T de Mello
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Escola de Educação Física, Fisioterapia e Terapia Ocupacional (EEFFTO), Universidade Federal de Minas Gerais (UFMG), Campus Pampulha, Belo Horizonte, MG, Brazil
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33
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Clinical Sleep-Wake Disorders II: Focus on Insomnia and Circadian Rhythm Sleep Disorders. Handb Exp Pharmacol 2017; 253:261-276. [PMID: 28707143 DOI: 10.1007/164_2017_40] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Insomnia and circadian rhythm sleep disorders affect large proportions of the population and have pronounced effects on quality of life and daytime performance. While the neurobiology of insomnia is not yet fully understood, circadian rhythm sleep disorders are assumed to be caused by a mismatch between the individual circadian phase position and the desired sleep-wake schedule. Benzodiazepines and non-benzodiazepine positive allosteric GABAA receptor modulators improve sleep onset and maintenance in the short-term treatment of insomnia. However, tolerance and dependence are important side effects. Sedating antidepressants are frequently prescribed for insomnia, however, only few randomised controlled trials have been published so far. Melatonin and melatonin receptor agonists are considered to be an option for the treatment of insomnia especially because of their minimal abuse potential and safety. First data on orexin (aka hypocretin) receptor antagonists are promising, however, the risk-benefit ratio needs to be further evaluated. With respect to circadian rhythm sleep disorders, there is solid evidence from meta-analyses supporting the use of melatonin in jet lag disorder to accelerate entrainment to the new time zone, and in delayed sleep phase disorder to advance sleep-wake rhythms. In addition to that, there is evidence supporting the use of melatonin in patients with shift work disorder in order to promote daytime sleep after night shifts.
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34
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Sun JJ, Liu XM, Shen CY, Zhang XQ, Sun GX, Feng K, Xu B, Ren XJ, Ma XY, Liu PZ. Reduced prefrontal activation during verbal fluency task in chronic insomnia disorder: a multichannel near-infrared spectroscopy study. Neuropsychiatr Dis Treat 2017; 13:1723-1731. [PMID: 28721053 PMCID: PMC5501642 DOI: 10.2147/ndt.s136774] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Daytime complaints such as memory and attention deficits and failure to accomplish daily tasks are common in insomnia patients. However, objective psychological tests to detect cognitive impairment are equivocal. Neural function associated with cognitive performance may explain the discrepancy. The aim of this study was to investigate the hemodynamic response patterns of patients with chronic insomnia disorder (CID) using the noninvasive and low-cost functional neuroimaging technique of multichannel near-infrared spectroscopy (NIRS) in order to identify changes of neural function associated with cognitive performance. PATIENTS AND METHODS Twenty-four CID patients and twenty-five healthy controls matched for age, right-hand dominance, educational level, and gender were examined during verbal fluency tasks (VFT) using NIRS. A covariance analysis was conducted to analyze differences of oxygenated hemoglobin (oxy-Hb) changes in prefrontal cortex (PFC) between the two groups and reduce the influence of the severity of depression. Pearson correlation coeffcients were calculated to examine the relationship between the oxy-Hb changes, with the severity of insomnia and depressive symptoms assessed by the Pittsburgh Sleep Quality Index (PSQI) and the Hamilton Rating Scale for Depression (HAMD). RESULTS The number of words generated during the VFT in CID groups showed no statistical differences with healthy controls. CID patients showed hypoactivation in the PFC during the cognitive task. In addition, we found that the function of left orbitofrontal cortex (OFC) during the VFT was significantly negatively correlated with the PSQI scores and the function of right dorsolateral PFC (DLPFC) was significantly negatively correlated with the HAMD scores. CONCLUSION The present study detected dysfunctions in PFC in spite of intact performance which indicates the role of PFC in the neurophysiological underpinnings. Left OFC function is associated with insomnia symptoms and right DLPFC function is associated with depressive symptoms.
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Affiliation(s)
- Jing-Jing Sun
- Medical Center, Tsinghua University, Beijing, China.,Department of Psychiatry, YuQuan Hospital, Tsinghua University, Beijing, China
| | - Xiao-Min Liu
- Department of Psychiatry, YuQuan Hospital, Tsinghua University, Beijing, China
| | - Chen-Yu Shen
- Department of Psychiatry, YuQuan Hospital, Tsinghua University, Beijing, China
| | - Xiao-Qian Zhang
- Medical Center, Tsinghua University, Beijing, China.,Department of Psychiatry, YuQuan Hospital, Tsinghua University, Beijing, China
| | - Gao-Xiang Sun
- Department of Psychiatry, YuQuan Hospital, Tsinghua University, Beijing, China
| | - Kun Feng
- Department of Psychiatry, YuQuan Hospital, Tsinghua University, Beijing, China
| | - Bo Xu
- Department of Psychiatry, YuQuan Hospital, Tsinghua University, Beijing, China
| | - Xia-Jin Ren
- Medical Center, Tsinghua University, Beijing, China.,Department of Psychiatry, YuQuan Hospital, Tsinghua University, Beijing, China
| | - Xiang-Yun Ma
- Medical Center, Tsinghua University, Beijing, China.,Department of Psychiatry, YuQuan Hospital, Tsinghua University, Beijing, China
| | - Po-Zi Liu
- Department of Psychiatry, YuQuan Hospital, Tsinghua University, Beijing, China
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35
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Ng TH, Chung KF, Lee CT, Yeung WF, Ho FYY. Eveningness and Its Associated Impairments in Remitted Bipolar Disorder. Behav Sleep Med 2016; 14:650-64. [PMID: 26549008 DOI: 10.1080/15402002.2015.1065407] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Sleep-wake and circadian rhythm disturbances are common in remitted bipolar disorder. These disturbances include difficulty initiating and maintaining sleep, daytime sleepiness, sleep irregularity, and a circadian tendency toward eveningness. To date, few studies have examined the impact of eveningness on impairments in remitted bipolar disorder. Ninety-eight adults diagnosed with bipolar disorder I, II, or not otherwise specified were evaluated. Hierarchical linear regression analyses showed that eveningness was associated with greater sleep-wake disturbances, more unhealthy dietary habits, worse quality of life, more impaired interpersonal relationships, and more dysfunctional sleep-related cognitions and behaviors, controlling for age, gender, and years of education. Targeted intervention on dysfunctional sleep-related cognitions and behaviors may reverse eveningness and improve functioning in bipolar disorder.
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Affiliation(s)
- Tommy H Ng
- a Department of Psychiatry University of Hong Kong, Hong Kong Special Administrative Region , China
| | - Ka-Fai Chung
- a Department of Psychiatry University of Hong Kong, Hong Kong Special Administrative Region , China
| | - Chit-Tat Lee
- b Department of Psychiatry Queen Mary Hospital, Hong Kong Special Administrative Region , China
| | - Wing-Fai Yeung
- c School of Chinese Medicine University of Hong Kong, Hong Kong Special Administrative Region , China
| | - Fiona Y Y Ho
- d Department of Psychology University of Hong Kong, Hong Kong Special Administrative Region , China
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Antypa N, Vogelzangs N, Meesters Y, Schoevers R, Penninx BWJH. CHRONOTYPE ASSOCIATIONS WITH DEPRESSION AND ANXIETY DISORDERS IN A LARGE COHORT STUDY. Depress Anxiety 2016; 33:75-83. [PMID: 26367018 DOI: 10.1002/da.22422] [Citation(s) in RCA: 165] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 08/07/2015] [Accepted: 08/16/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The chronotype, being a morning or an evening type, can influence an individual's psychological health. Studies have shown a link between depressed mood and being an evening type; however, most studies have used symptom scales and not diagnostic criteria, and confounding factors such as sleep patterns and somatic health factors have often not been considered. This study aims to examine the association between chronotype and depressive (major depressive disorder (MDD), dysthymia) and anxiety (generalized anxiety disorder, panic disorder, agoraphobia, and social phobia) disorders diagnosed using clinical interviews, while taking into account relevant sociodemographic, clinical, somatic health, and sleep parameters. METHODS Data from a large cohort, the Netherlands Study of Depression and Anxiety were used (n = 1,944), which included 676 currently depressed and/or anxious patients, 831 remitted patients, and 437 healthy controls. Chronotype was assessed using the Munich Chronotype Questionnaire. RESULTS Our results showed that current depressive and/or anxiety disorders were associated with a late chronotype (β = .10, P = .004) even when adjusting for sociodemographic, somatic health, and sleep-related factors (β = .09, P = .03). When examining each type of disorder separately, MDD only, but not dysthymia or specific anxiety disorders, was associated with the late chronotype. The late chronotype also reported significant diurnal mood variation (worse mood in the morning). CONCLUSIONS Our findings show a clear association between MDD and late chronotype (being an evening type), after controlling for a range of pertinent factors. A late chronotype is therefore associated with a current status of MDD and deserves the relevant clinical attention when considering treatments.
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Affiliation(s)
- Niki Antypa
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Nicole Vogelzangs
- Department of Psychiatry, EMGO Institute for Health and Care Research and Neuroscience Campus Amsterdam, The Netherlands
| | - Ybe Meesters
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Robert Schoevers
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, EMGO Institute for Health and Care Research and Neuroscience Campus Amsterdam, The Netherlands
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Hasler BP, Buysse DJ, Germain A. Shifts Toward Morningness During Behavioral Sleep Interventions Are Associated With Improvements in Depression, Positive Affect, and Sleep Quality. Behav Sleep Med 2016; 14:624-35. [PMID: 26549156 PMCID: PMC4867300 DOI: 10.1080/15402002.2015.1048452] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Morningness-eveningness (M-E) is typically considered to be a trait-like construct. However, M-E could plausibly shift in concert with changes in circadian or homeostatic processes. We examined M-E changes across three studies employing behavioral or pharmacological sleep treatments. Baseline and posttreatment M-E scores were strongly correlated across all three samples. M-E showed small but systematic changes toward morningness in sleep-disturbed military veterans receiving behavioral interventions. No systematic M-E changes were observed in the two pharmacological studies (sleep-disturbed military veterans and adults with primary insomnia, respectively). In the behavioral study, M-E changes correlated with changes in depression, positive affect, and sleep quality. M-E changes also correlated with changes in positive affect in the adult insomnia group. M-E appears to exhibit state-like aspects in addition to trait-like aspects.
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Affiliation(s)
- Brant P. Hasler
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Daniel J. Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Anne Germain
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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38
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Finan PH, Quartana PJ, Smith MT. The Effects of Sleep Continuity Disruption on Positive Mood and Sleep Architecture in Healthy Adults. Sleep 2015; 38:1735-42. [PMID: 26085289 PMCID: PMC4813351 DOI: 10.5665/sleep.5154] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 05/05/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The purpose of this study was to test an experimental model of the effects of sleep continuity disturbance on sleep architecture and positive mood in order to better understand the mechanisms linking insomnia and depression. DESIGN Participants were randomized to receive 3 consecutive nights of sleep continuity disruption via forced nocturnal awakenings (FA, n = 21), or one of two control conditions: restricted sleep opportunity (RSO, n = 17) or uninterrupted sleep (US, n = 24). SETTING The study was set in an inpatient clinical research suite. PARTICIPANTS Healthy, good-sleeping men and women were included. MEASUREMENT AND RESULTS Polysomnography was used to measure sleep architecture, and mood was assessed via self-report each day. Compared to restricted sleep opportunity controls, forced awakenings subjects had significantly less slow wave sleep (P < 0.05) after the first night of sleep deprivation, and significantly lower positive mood (P < 0.05) after the second night of sleep deprivation. The differential change in slow wave sleep statistically mediated the observed group differences in positive mood (P = 0.002). CONCLUSIONS To our knowledge, this is the first human experimental study to demonstrate that, despite comparable reductions in total sleep time, partial sleep loss from sleep continuity disruption is more detrimental to positive mood than partial sleep loss from delaying bedtime, even when controlling for concomitant increases in negative mood. With these findings, we provide temporal evidence in support of a putative biologic mechanism (slow wave sleep deficit) that could help explain the strong comorbidity between insomnia and depression.
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Affiliation(s)
- Patrick H. Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Phillip J. Quartana
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research
| | - Michael T. Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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Hasler BP, Soehner AM, Clark DB. Sleep and circadian contributions to adolescent alcohol use disorder. Alcohol 2015; 49:377-87. [PMID: 25442171 DOI: 10.1016/j.alcohol.2014.06.010] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 06/27/2014] [Accepted: 06/30/2014] [Indexed: 11/16/2022]
Abstract
Adolescence is a time of marked changes across sleep, circadian rhythms, brain function, and alcohol use. Starting at puberty, adolescents' endogenous circadian rhythms and preferred sleep times shift later, often leading to a mismatch with the schedules imposed by secondary education. This mismatch induces circadian misalignment and sleep loss, which have been associated with affect dysregulation, increased drug and alcohol use, and other risk-taking behaviors in adolescents and adults. In parallel to developmental changes in sleep, adolescent brains are undergoing structural and functional changes in the circuits subserving the pursuit and processing of rewards. These developmental changes in reward processing likely contribute to the initiation of alcohol use during adolescence. Abundant evidence indicates that sleep and circadian rhythms modulate reward function, suggesting that adolescent sleep and circadian disturbance may contribute to altered reward function, and in turn, alcohol involvement. In this review, we summarize the relevant evidence and propose that these parallel developmental changes in sleep, circadian rhythms, and neural processing of reward interact to increase risk for alcohol use disorder (AUD).
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Affiliation(s)
- Brant P Hasler
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
| | - Adriane M Soehner
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Duncan B Clark
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
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40
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Pace-Schott EF, Germain A, Milad MR. Sleep and REM sleep disturbance in the pathophysiology of PTSD: the role of extinction memory. BIOLOGY OF MOOD & ANXIETY DISORDERS 2015; 5:3. [PMID: 26034578 PMCID: PMC4450835 DOI: 10.1186/s13587-015-0018-9] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 05/12/2015] [Indexed: 01/04/2023]
Abstract
Post-traumatic stress disorder (PTSD) is accompanied by disturbed sleep and an impaired ability to learn and remember extinction of conditioned fear. Following a traumatic event, the full spectrum of PTSD symptoms typically requires several months to develop. During this time, sleep disturbances such as insomnia, nightmares, and fragmented rapid eye movement sleep predict later development of PTSD symptoms. Only a minority of individuals exposed to trauma go on to develop PTSD. We hypothesize that sleep disturbance resulting from an acute trauma, or predating the traumatic experience, may contribute to the etiology of PTSD. Because symptoms can worsen over time, we suggest that continued sleep disturbances can also maintain and exacerbate PTSD. Sleep disturbance may result in failure of extinction memory to persist and generalize, and we suggest that this constitutes one, non-exclusive mechanism by which poor sleep contributes to the development and perpetuation of PTSD. Also reviewed are neuroendocrine systems that show abnormalities in PTSD, and in which stress responses and sleep disturbance potentially produce synergistic effects that interfere with extinction learning and memory. Preliminary evidence that insomnia alone can disrupt sleep-dependent emotional processes including consolidation of extinction memory is also discussed. We suggest that optimizing sleep quality following trauma, and even strategically timing sleep to strengthen extinction memories therapeutically instantiated during exposure therapy, may allow sleep itself to be recruited in the treatment of PTSD and other trauma and stress-related disorders.
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Affiliation(s)
- Edward F. Pace-Schott
- />Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital—East, CNY 149 13th Street Room 2624, Charlestown, MA 02129 USA
| | - Anne Germain
- />Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA USA
| | - Mohammed R. Milad
- />Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital—East, CNY 149 13th Street Room 2624, Charlestown, MA 02129 USA
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41
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Zeng Y, Yang J, Du J, Pu X, Yang X, Yang S, Yang T. Strategies of Functional Foods Promote Sleep in Human Being. ACTA ACUST UNITED AC 2015; 9:148-155. [PMID: 26005400 PMCID: PMC4440346 DOI: 10.2174/1574362410666150205165504] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 02/03/2015] [Accepted: 02/04/2015] [Indexed: 02/07/2023]
Abstract
Sleep is a vital segment of life, however, the mechanisms of diet promoting sleep are
unclear and are the focus of research. Insomnia is a general sleep disorder and functional foods are
known to play a key role in the prevention of insomnia. A number of studies have demonstrated that
major insomnia risk factors in human being are less functional foods in dietary. There are higher
functional components in functional foods promoting sleep, including tryptophan, GABA, calcium,
potassium, melatonin, pyridoxine, L-ornithine and hexadecanoic acid; but wake-promoting neurochemical
factors include serotonin, noradrenalin, acetylcholine, histamine, orexin and so on. The factors promoting sleep in human
being are the functional foods include barley grass powder, whole grains, maca, panax, Lingzhi, asparagus powder,
lettuce, cherry, kiwifruits, walnut, schisandra wine, and milk; Barley grass powder with higher GABA and calcium, as
well as potassium is the most ideal functional food promoting sleep, however, the sleep duration for modern humans is
associated with food structure of ancient humans. In this review, we put forward possible mechanisms of functional
components in foods promoting sleep. Although there is clear relevance between sleep and diet, their molecular
mechanisms need to be studied further.
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Affiliation(s)
- Yawen Zeng
- Biotechnology and Genetic Resources Institute, Yunnan Academy of Agricultural Sciences, Kunming 650205, P.R. China
| | - Jiazhen Yang
- Biotechnology and Genetic Resources Institute, Yunnan Academy of Agricultural Sciences, Kunming 650205, P.R. China; ; Kuming Tiankang Science & Technology Limited Company, Kunming 650231, P.R. China
| | - Juan Du
- Biotechnology and Genetic Resources Institute, Yunnan Academy of Agricultural Sciences, Kunming 650205, P.R. China
| | - Xiaoying Pu
- Biotechnology and Genetic Resources Institute, Yunnan Academy of Agricultural Sciences, Kunming 650205, P.R. China
| | - Xiaomen Yang
- Biotechnology and Genetic Resources Institute, Yunnan Academy of Agricultural Sciences, Kunming 650205, P.R. China
| | - Shuming Yang
- Biotechnology and Genetic Resources Institute, Yunnan Academy of Agricultural Sciences, Kunming 650205, P.R. China
| | - Tao Yang
- Biotechnology and Genetic Resources Institute, Yunnan Academy of Agricultural Sciences, Kunming 650205, P.R. China
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42
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Miller MA, Rothenberger SD, Hasler BP, Donofry SD, Wong PM, Manuck SB, Kamarck TW, Roecklein KA. Chronotype predicts positive affect rhythms measured by ecological momentary assessment. Chronobiol Int 2014; 32:376-84. [PMID: 25410882 DOI: 10.3109/07420528.2014.983602] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Evening chronotype, a correlate of delayed circadian rhythms, is associated with depression. Altered positive affect (PA) rhythms may mediate the association between evening chronotype and depression severity. Consequently, a better understanding of the relationship between chronotype and PA may aid in understanding the etiology of depression. Recent studies have found that individuals with evening chronotype show delayed and blunted PA rhythms, although these studies are relatively limited in sample size, representativeness and number of daily affect measures. Further, published studies have not included how sleep timing changes on workday and non-workdays, or social jet lag (SJL) may contribute to the chronotype-PA rhythm link. Healthy non-depressed adults (n = 408) completed self-report affect and chronotype questionnaires. Subsequently, positive and negative affects were measured hourly while awake for at least two workdays and one non-workday by ecological momentary assessment (EMA). Sleep variables were collected via actigraphy and compared across chronotype groups. A cosinor variant of multilevel modeling was used to model individual and chronotype group rhythms and to calculate two variables: (1) amplitude of PA, or the absolute amount of daily variation from peak to trough during one period of the rhythm and (2) acrophase, or the time at which the peak amplitude of affect rhythms occurred. On workdays, individuals with evening chronotype had significantly lower PA amplitudes and later workday acrophase times than their morning type counterparts. In contrast to predictions, SJL was not found to be a mediator in the relationship between chronotype and PA rhythms. The association of chronotype and PA rhythms in healthy adults may suggest the importance of daily measurement of PA in depressed individuals and would be consistent with the hypothesis that evening chronotype may create vulnerability to depression via delayed and blunted PA rhythms.
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Abstract
PURPOSE OF REVIEW This article explores recent research in adolescent circadian rhythms, neurobiological changes influencing affective regulation and reward responding, and the emergence of substance use and related problems. RECENT FINDINGS Recent findings have confirmed that adolescents with drug and alcohol problems are also beset by sleep problems, and have advanced our understanding of the relationship between sleep problems and substance involvement in this developmental period. During adolescence, a shift to later preferred sleep times interacts with early school start times to cause sleep loss and circadian misalignment. Sleep loss and circadian misalignment may disrupt reward-related brain function and impair inhibitory control. Deficits or delays in mature reward and inhibitory functions may contribute to adolescent alcohol use and other substance involvement. SUMMARY An integration of the available research literature suggests that changes in sleep and circadian rhythms during adolescence may contribute to accelerated substance use and related problems.
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44
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Hasler BP, Forbes EE, Franzen PL. Time-of-day differences and short-term stability of the neural response to monetary reward: a pilot study. Psychiatry Res 2014; 224:22-7. [PMID: 25092525 PMCID: PMC4157087 DOI: 10.1016/j.pscychresns.2014.07.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 05/28/2014] [Accepted: 07/11/2014] [Indexed: 12/20/2022]
Abstract
Human and animal studies indicate that reward function is modulated by the circadian clock that governs our daily sleep/wake rhythm. For example, a robust circadian rhythm exists in positive affect, which is lower in the morning hours and peaks in the afternoon. A handful of functional neuroimaging studies suggest that systematic diurnal variation exists in brain activity related to other functions, but no published human studies have examined daily variation in the neural processing of reward. In the present study, we attempt to advance this literature by using functional neuroimaging methods to examine time-of-day changes in the responsivity of the reward circuit. Using a within-person design and a functional magnetic resonance imaging (fMRI) monetary reward task, we compared morning and afternoon reward-related brain activation in a sample of healthy young adults within 24h. Region of interest analyses focused on the striatum, and we hypothesized greater reward activation in the afternoon, concordant with the circadian peak in positive affect. Results were consistent with our hypothesis. In addition, we counterbalanced the order of morning and afternoon scans in order to explore the short-term stability of the neural response. Whole-brain analyses showed a markedly higher reactivity to reward throughout the brain in the first scan relative to the second scan, consistent with habituation to the monetary reward stimuli. However, these effects did not appear to explain the time-of-day findings. In summary, we report the first preliminary evidence of circadian variation in the neural processing of reward. These findings have both methodological and theoretical implications.
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Affiliation(s)
- Brant P. Hasler
- Correspondence and reprint requests may be sent to: Brant P. Hasler,
Ph.D., University of Pittsburgh School of Medicine, Department of Psychiatry, 3811
O’Hara Street, Pittsburgh, PA 15213; Phone: 412-246-6674; Fax: 412-246-5300;
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Díaz-Morales JF, Escribano C, Jankowski KS. Chronotype and time-of-day effects on mood during school day. Chronobiol Int 2014; 32:37-42. [DOI: 10.3109/07420528.2014.949736] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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46
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Simor P, Zavecz Z, Pálosi V, Török C, Köteles F. The influence of sleep complaints on the association between chronotype and negative emotionality in young adults. Chronobiol Int 2014; 32:1-10. [DOI: 10.3109/07420528.2014.935786] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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47
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Logan RW, Williams WP, McClung CA. Circadian rhythms and addiction: mechanistic insights and future directions. Behav Neurosci 2014; 128:387-412. [PMID: 24731209 DOI: 10.1037/a0036268] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Circadian rhythms are prominent in many physiological and behavioral functions. Circadian disruptions either by environmental or molecular perturbation can have profound health consequences, including the development and progression of addiction. Both animal and humans studies indicate extensive bidirectional relationships between the circadian system and drugs of abuse. Addicted individuals display disrupted rhythms, and chronic disruption or particular chronotypes may increase the risk for substance abuse and relapse. Moreover, polymorphisms in circadian genes and an evening chronotype have been linked to mood and addiction disorders, and recent efforts suggest an association with the function of reward neurocircuitry. Animal studies are beginning to determine how altered circadian gene function results in drug-induced neuroplasticity and behaviors. Many studies suggest a critical role for circadian rhythms in reward-related pathways in the brain and indicate that drugs of abuse directly affect the central circadian pacemaker. In this review, we highlight key findings demonstrating the importance of circadian rhythms in addiction and how future studies will reveal important mechanistic insights into the involvement of circadian rhythms in drug addiction.
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Affiliation(s)
- Ryan W Logan
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Wilbur P Williams
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Colleen A McClung
- Department of Psychiatry, University of Pittsburgh School of Medicine
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48
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Dijk DJ. Imaging and monitoring sleep and its disorders: local sleep, circadian rhythms and variability. J Sleep Res 2014; 21:485-6. [PMID: 23004937 DOI: 10.1111/j.1365-2869.2012.01057.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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49
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Hasler BP, Sitnick SL, Shaw DS, Forbes EE. An altered neural response to reward may contribute to alcohol problems among late adolescents with an evening chronotype. Psychiatry Res 2013; 214:357-64. [PMID: 24144507 PMCID: PMC3852171 DOI: 10.1016/j.pscychresns.2013.08.005] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 06/14/2013] [Accepted: 08/10/2013] [Indexed: 12/17/2022]
Abstract
Evening chronotypes not only differ from morning-types in their sleep and circadian timing, but they are prone to problematic outcomes involving reward function, including affective disturbance, sensation seeking, and substance involvement. We explored the neural mechanisms underlying these chronotype differences by comparing the neural response to reward in morning- and evening-types. Using a monetary reward fMRI paradigm, we compared the neural response to reward in 13 morning-types and 21 evening-types (all 20 y/o males). Region-of-interest (ROI) analyses focused on the medial prefrontal cortex (mPFC) and ventral striatum (VS), comparing the chronotype groups in these ROIs during anticipation and outcome conditions, and adjusting for time of scan. Chronotype groups were also compared on measures of sensation-seeking, substance involvement, and sleep quality. Evening-types reported significantly greater levels of alcohol dependence and worse sleep quality. Furthermore, evening-types showed an altered neural response to reward relative to morning-types, specifically, reduced mPFC reactivity during reward anticipation and increased VS reactivity during win outcome. In turn, less activation in the mPFC region in response to reward was associated with greater alcohol consumption, while increased activation in the VS in response to reward was associated with more symptoms of alcohol dependence. Increased reward-related problems among evening-types may be accompanied by altered neural responses to reward.
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Affiliation(s)
- Brant P. Hasler
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA USA,Correspondence and reprint requests may be sent to: Brant P. Hasler, Ph.D., University of Pittsburgh School of Medicine, Department of Psychiatry, 3811 O’Hara Street, Pittsburgh, PA 15213; Phone: 412-246-5537; Fax: 412-246-5300;
| | | | - Daniel S. Shaw
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA USA
| | - Erika E. Forbes
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
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50
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Abstract
Chronic insomnia is one of the most prevalent psychiatric disorders and has a significant impact on individual's health. However, the pathophysiology of the disorder is poorly understood. The current review focuses on neuroimaging findings in insomnia. In summary, the current data suggest the following: (1) insomnia is characterized by corticolimbic overactivity during sleep and wakefulness that interferes with sleep initiation and/or maintenance; (2) insomnia patients' daytime performance is associated with a hypoactivation of task-related areas; (3) neurochemically, insomnia patients are probably characterized by reduced cortical GABA levels; (4) insomnia may be associated with abnormal brain morphometry in the frontal cortex, hippocampus and/or anterior cingulate cortex. Future investigations should include larger sample sizes or longitudinal within-subject comparisons. Other possible methodological improvements are discussed.
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Affiliation(s)
- Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Hauptstraße 5, 79104, Freiburg, Germany,
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