Evaluation of Chronotype Among Children and Associations With BMI, Sleep, Anxiety, and Depression

Depression, Anxiety and Poor Sleep Quality are Associated with Chronotype and Financial Wellness in University Students

Background: Evidence suggests the importance of a person's chronotype in predicting various aspects of an individual's physical and mental health. While the effect of depression on sleep is well established, the impact of a person's specific sleep timing and chronotype on the prevalence of both depression and anxiety has yet to be fully understood, especially among university students, vulnerable to mental health problems. In addition, other factors also seem to influence the occurrence of depression and anxiety among students as well as their quality of sleep, one of which being the students' financial wellness. The objective was to evaluate the association between chronotype and the severity and prevalence of depression among Lebanese university students, while also taking into account the possible connection between chronotype and financial wellness and both anxiety and sleep quality. Methods: This cross-sectional study was conducted between December 2021 and February 2022; 330 Lebanese university students was included (mean age 21.75 ± 2.43; 67.3% females). Results: The majority of the Lebanese university students in our sample were found to have an intermediate typology (63.0%), followed by the evening typology, which appeared to constitute 28.2% of the sample, while only 8.8% possessed a morning typology. In this study, having an intermediate or evening typology compared to a morning one was significantly associated with higher depression and worse sleep quality. In addition, having an evening chronotype compared to a morningness propensity was significantly associated with more anxiety. Conclusion: This study found a positive association between an evening typology (chronotype) and higher depression and anxiety and poorer quality of sleep. Although preliminary and based on cross-sectional data, this research could help provide a better understanding of the different chronotypes among university students, and of the possible increased susceptibility of some of these typologies (i.e., evening-type) to mental health problems.

Sex-specific associations between circadian-related genes and depression in UK Biobank participants highlight links to glucose metabolism, inflammation and neuroplasticity pathways

Depressive disorders have increased in global prevalence, making improved management of these disorders a public health priority. Prior research has linked circadian clock genes to depression, either through direct interactions with mood-related pathways in the brain or by modulating the phase of circadian rhythms. Using machine learning and statistical techniques, we explored associations between 157,347 SNP variants from 51 circadian-related genes and depression scores from the patient health questionnaire 9 (PHQ-9) in 99,939 UK Biobank participants. Our results highlight multiple pathways linking the circadian system to mood, including metabolic, monoamine, immune, and stress-related pathways. Notably, genes regulating glucose metabolism and inflammation (GSK3B, LEP, RORA, and NOCT) were prominent factors in females, in addition to DELEC1 and USP46, two genes of unknown function. In contrast, FBXL3 and DRD4 emerged as significant risk factors for male depression. We also found epistatic interactions involving RORA, NFIL3, and ZBTB20 as either risk or protective factors for depression, underscoring the importance of transcription factors (ZBTB20, NFIL3) and hormone receptors (RORA) in depression etiology. Understanding the complex, sex-specific links between circadian genes and mood disorders will facilitate the development of therapeutic interventions and enhance the efficacy of multi-target treatments for depression.

Shorter night-time sleep duration and later sleep timing from infancy to adolescence

BACKGROUND

Here, we (a) examined the trajectories of night-time sleep duration, bedtime and midpoint of night-time sleep (MPS) from infancy to adolescence, and (b) explored perinatal risk factors for persistent poor sleep health.

METHODS

This study used data from 12,962 participants in the Avon Longitudinal Study of Parents and Children (ALSPAC). Parent or self-reported night-time sleep duration, bedtime and wake-up time were collected from questionnaires at 6, 18 and 30 months, and at 3.5, 4-5, 5-6, 6-7, 9, 11 and 15-16 years. Child's sex, birth weight, gestational age, health and temperament, together with mother's family adversity index (FAI), age at birth, prenatal socioeconomic status and postnatal anxiety and depression, were included as risk factors for persistent poor sleep health. Latent class growth analyses were applied first to detect trajectories of night-time sleep duration, bedtime and MPS, and we then applied logistic regressions for the longitudinal associations between risk factors and persistent poor sleep health domains.

RESULTS

We obtained four trajectories for each of the three sleep domains. In particular, we identified a trajectory characterized by persistent shorter sleep, a trajectory of persistent later bedtime and a trajectory of persistent later MPS. Two risk factors were associated with the three poor sleep health domains: higher FAI with increased risk of persistent shorter sleep (OR = 1.20, 95% CI = 1.11-1.30, p < .001), persistent later bedtime (OR = 1.28, 95% CI = 1.19-1.39, p < .001) and persistent later MPS (OR = 1.30, 95% CI = 1.22-1.38, p < .001); and higher maternal socioeconomic status with reduced risk of persistent shorter sleep (OR = 0.99, 95% CI = 0.98-1.00, p = .048), persistent later bedtime (OR = 0.98, 95% CI = 0.97-0.99, p < .001) and persistent later MPS (OR = 0.99, 95% CI = 0.98-0.99, p < .001).

CONCLUSIONS

We detected trajectories of persistent poor sleep health (i.e. shorter sleep duration, later bedtime and later MPS) from infancy to adolescence, and specific perinatal risk factors linked to persistent poor sleep health domains.

Associations of chronotype with anxiety, depression and insomnia among general adult population: A cross-sectional study in Hubei, China

BACKGROUND

The relationship between chronotype and anxiety, depression, and insomnia was inconsistent. We aimed to assess the association between chronotype and mental health and the potential moderating effect of age and socioeconomic status (SES).

METHODS

A multi-stage sampling cross-sectional study with 12,544 adults was conducted. Chronotype, anxiety, depression, and insomnia were investigated by 5-item Morning and Evening, 7-item Generalized Anxiety Disorder, 9-item Patient Health, and the 7-item Insomnia Severity Index Questionnaires. Logistic regression was conducted.

RESULTS

The predominant chronotype was morning chronotype (69.2 %), followed by 27.6 % intermediate and 3.2 % evening chronotype. The prevalence of anxiety, depression, and insomnia was 0.7 %, 1.9 %, and 9.6 %, respectively. Compared with intermediate chronotype, morning chronotype participants had a lower risk of anxiety (OR = 0.28,95%CI:0.18-0.44), depression (OR = 0.54,95%CI:0.41-0.72) and insomnia (OR = 0.67,95%CI:0.58-0.77), while evening chronotype participants had a higher risk of depression (OR = 1.98,95%CI:1.06-3.71) but not anxiety or insomnia. Interactions between chronotype with age and SES on insomnia (Pinteraction < 0.05) were found. A more profound association between morning chronotype and insomnia was observed in <65 years participants (OR = 0.59,95%CI:0.50-0.71) and those with monthly household income ≥10,000yuan (OR = 0.21,95%CI:0.12-0.35), compared with their counterparts.

LIMITATIONS

The cross-sectional design limited causal conclusions. Only adults were included; the findings could not be generalized to children.

CONCLUSIONS

The morning chronotype might be protective for anxiety, depression, and insomnia, while the evening chronotype might be a risk factor for depression. Future studies are needed to assess the efficacy of chronotype-focused intervention for mental health. Insomnia prevention efforts should pay more attention to the elderly and those with lower incomes.

Urbanisation negatively impacts sleep health and mood in adolescents: a comparative study of female students from city and rural schools of North India

This study investigated the impact of social settings on sleep, physical and mental health in female adolescents of North India (latitude 29.5 oN; longitude 77.5 oE). Using a battery of questionnaires, we compared the chronotype, sleep-wake pattern, sleep health (e.g. sleep quality, daytime sleepiness and fatigue) and mood (via depression, anxiety and stress symptoms) in female students (age 14-18 years) from rural (N = 719) and urban (N = 1033) schools separated by about 35 km, but families had almost similar socio-demographic details. The morning type was prevalent amongst rural, whilst the evening type was prevalent amongst urban students who also had access to smart phones, suggesting a possible greater use of the internet. There were greater negative sleep effects, daytime sleepiness, overall poor sleep quality, higher fatigue and anxiety levels in urban than the rural cohort. Interestingly, these measures also differed between school days and free days, suggesting an impact of the conflict between internal biological and social timings (= social jet lag). We also found a significant relationship between chronotype, internet addiction, mood-related parameters and measures of sleep health. Overall, these results suggest a possible impact of social settings on sleep health and mood-related behaviours in female adolescents.

Parasomnias During the COVID-19 Pandemic

COVID-19 had a massive impact on sleep, resulting in overall increase of sleep disturbances. During lockdown many factors contributed to sleep disturbances, in particular changes in sleep-wake habits and stress. This article will describe the frequency and features of the principal parasomnias and the impact of the pandemic and the government restriction measures on sleep. Among different pathophysiological hypotheses, we will discuss the role of stress, considered as an expression of the allostatic load. Finally, during the pandemic, parasomnias were mainly investigated by questionnaires, with controversial results; video-polysomnographic studies are crucial to obtain a definitive diagnosis, even in critical conditions.

Nonlinear associations between insomnia symptoms and circadian preferences in the general population: Symptom-specific and lifespan differences in men and women

OBJECTIVES

This study investigated (non)linear associations between different eveningness characteristics (bedtime, wake time, morning affect, and peak performance time) and insomnia symptoms (difficulties initiating sleep, difficulties maintaining sleep, and nonrestorative sleep) in a large general population sample.

METHODS

The data came from digital surveys about insomnia (Minimal Insomnia Scale) and circadian preferences (Children's Chronotype Questionnaire/Composite Scale of Morningness) completed by the Dutch general population (37,389 participants aged 4-91years, 42.4% men) in the Lifelines cohort substudy Comorbid Conditions of ADHD.

RESULTS

Using generalized additive modeling, we found that different characteristics of eveningness related to insomnia either exponentially (later wake time/peak performance time, worse morning affect) or quadratically (early and late bedtime/midpoint of sleep). While difficulties initiating sleep and nonrestorative sleep were strongly associated with all eveningness characteristics, difficulties maintaining sleep related only to earlier bedtimes. These relationships were similar for men and women but varied partly in shapes and strengths across the lifespan. Additional analyses showed that bedtime and wake time were associated with insomnia symptoms only when their combination would result in an unusually long or short preferred time in bed.

CONCLUSION

The association between eveningness and insomnia symptoms highly depends on whether eveningness is reflected by daytime performance or sleep-wake time. The pattern and strength of these associations also vary depending on age and insomnia symptom, but less so on sex. Future sleep-related research and policies relying on circadian preferences should account for the nonlinearity, dimension/symptom-related specificity and age-related differences in the association between eveningness and insomnia symptoms.

The prevalence of temporomandibular disorder and temporomandibular morphology among diverse chronotype profiles

This study investigates the influence of chronotype on the prevalence of temporomandibular joint disorders (TMD) and the morphology of temporomandibular joint (TMJ). According to the Morningness-Eveningness Questionnaire-Self-Assessment, the participants were divided into morning group (n = 30), intermediate group (n = 83), and evening group (n = 30). Thirty participants were randomly selected from the intermediate group for subsequent examination and measurements. The morphology of TMJs was investigated using questionnaire and clinical examination form in Diagnostic Criteria for Temporomandibular Disorder. Meanwhile, the morphological results of TMJs were measured from cone-beam computed tomography images. The prevalence rate of TMD in the morning group (23%) was significantly lower than that in the intermediate group (56.7%), while there was no difference between the evening (53.4%) and intermediate groups. As to morphological measurements, there was no significant difference among three groups in mediolateral width of condylar process, anteroposterior width of condylar process, radius of condyle, medial joint space, lateral joint space, condylar stress angle, horizontal condylar inclination, width of glenoid fossa, depth of glenoid fossa, and posterior joint space, while there was a significant difference in horizontal condylar angle (p = 0.00490), articular eminence inclination (p < .0001), anterior joint space (p = 0.0163), and superior joint space (p = 0.0004). The morphology of TMJ in the morning group was better than that in the evening and intermediate groups. An association was found between TMD prevalence, temporomandibular morphology, and chronotype.

The effect of circadian preference and sleep disturbances on depression in children 6 to 12 years of age

Circadian rhythm and sleep disruption have been associated with depressive symptoms in children. This study was conducted to determine sleep disturbances and circadian preferences and their possible associations with depression in healthy children 6 to 12 years of age. A total of 111 healthy children (mean age 7.5 years; 62.2% male) were included. Sleep disturbances and depression were determined by the Sleep Disturbance Scale for Children (SDSC) and the Children's Depression Inventory (CDI), respectively. Circadian preference was evaluated by the Morningness - Eveningness Stability Scale improved (MESSi). SDSC was correlated with CDI (r = 0.396, p < 0.001). Morning affect was inversely correlated with CDI (r = -0.405, p < 0.001), SDSC (r = -0.348, p < 0.001), and three subdimensions of SDSC, i.e. disorders of initiating and maintaining sleep (DIMS, r = -0.317, p = 0.001), disorders of arousal (DA, r = -0.375, p < 0.001) and disorders of excessive somnolence (DOES, r = -0.303, p = 0.001). Distinctness was inversely correlated with CDI (r = -0.402, p < 0.001) and SDSC (r = -0.274, p < 0.001). Increased use of electronic devices was associated with higher CDI (p = 0.003), while decreased duration of physical activity with higher SDSC (p = 0.017). Our findings support the recommendations addressing sleep and circadian preferences as lifestyle modifications in reducing depression in children.

Obesogenic sleep patterns among Chinese preschool children: A latent profile and transition analysis of the association sleep patterns and obesity risk

OBJECTIVE

This paper utilized a person-centered approach to examine whether sleep patterns on school and free days are associated with obesity risk in preschool children aged 3-6 years.

METHODS

The cross-sectional analysis included 204 children from the Wuhan Healthy Start Project with valid sleep data in at least four consecutive days gathered via Actigraph GT3X+. Based on three domains of sleep duration, sleep onset, and sleep offset, we used latent profile analysis to identify distinct sleep patterns on school and free days separately. Additionally, we conducted latent transition analysis to explore the probabilities of sleep patterns transitions between school and free days. The multivariate logistic regression model investigated the associations of sleep patterns with overweight/obesity (OWO) (BMI ≥ age- and sex-specific 85th percentile) and abdominal obesity (AO) (WC ≥ age- and sex-specific 75th percentile).

RESULTS

Two sleep patterns were identified for school days: "EL-sc" (early-to-sleep/longer-duration) (n = 119; 58.3%) and "LS-sc" (late-to-sleep/shorter-duration) (n = 85; 41.7%). Similarly, "LES-fr" (late-to-sleep/early-to-wake/shorter-duration) (n = 118; 57.8%) and "ELL-fr" (early-to-sleep/late-to-wake/longer-duration) (n = 86; 42.2%) patterns were identified for free days. LTA categorized the participants into four distinct transition groups, i.e., "EL-sc→ELL-fr" (32.9%), "EL-sc→LES-fr" (24.0%), "LS-sc→LES-fr" (33.8%), and "LS-sc→ELL-fr" (9.3%). Compared with the "ELsc→ELL-fr", the "LS-sc→LES-fr" had a higher risk of OWO (AOR 4.76; 95% CI: 1.39-20.33) and AO (AOR, 2.78; 95% CI, 1.21-6.62), respectively. Neither "EL-sc→LES-fr" (AOR, 1.11; 95% CI, 0.14-6.67) nor "LS-sc→ELL-fr" (AOR, 0.74; 95% CI, 0.03-6.14) was significantly associated with OWO. Likewise, no significant association was observed for "EL-sc→LES-fr" (AOR, 0.96; 95% CI, 0.35-2.62) and "LS-sc→ELL-fr" (AOR, 0.56; 95% CI, 0.11-2.18) with AO.

CONCLUSIONS

"LS-sc→LES-fr" pattern is significantly associated with an increased risk of general and abdominal obesity, indicating its obesogenic nature. Furthermore, although not statistically associated with obesity outcomes, "LS-sc→ELL-fr" and "EL-sc→LES-fr" patterns exhibit a semi-obesogenic characteristic. In addition, we identified a concerning trend that preschool children are at risk of transitioning to and persisting in sleep patterns characterized by delayed and shorter sleep. These findings underscore the importance of implementing interventions and strategies to address sleep patterns as a crucial step to minimize the risk of obesity.

Impact of chronotype, insomnia symptoms, sleep duration, and electronic devices on nonrestorative sleep and daytime sleepiness among Japanese adolescents

OBJECTIVES

Nonrestorative sleep (NRS) and excessive daytime sleepiness (EDS) are important indicators of daytime dysfunction. Electronic media use before bedtime greatly affects adolescent sleep quality. However, few studies have examined factors associated with these symptoms. Therefore, we aimed to investigate the impact of chronotype, electronic device use before bedtime, and insomnia symptoms on NRS and EDS in Japanese adolescents.

METHODS

A web-based cross-sectional survey of 2067 adolescents was conducted in 2022 to mainly assess sleep-related issues (sleep duration, chronotype, insomnia symptoms, NRS, and EDS), time spent using electronic devices, physical activity, and mental health.

RESULTS

We analyzed data of 1880 adolescents (age, 16.4 ± 0.8 years; males, 56.7%). NRS and EDS prevalence rates were 54.9% and 39.4%, respectively. In multivariate analysis, evening chronotype [odds ratio (OR): 2.14, 95% confidence interval (CI): 1.58-2.89], difficulty initiating sleep (OR: 1.94, 95% CI: 1.43-2.64), <5 h sleep (OR: 1.77, 95% CI: 1.24-2.54), 5-6 h sleep (OR: 1.52, 95% CI: 1.20-1.93), and using electronic devices just before bedtime (OR: 1.48, 95% CI: 1.08-2.04) were associated with NRS. Evening chronotype (OR: 1.40, 95% CI: 1.07-1.82), early morning awakening (OR: 1.60, 95% CI: 1.02-2.50), using electronic devices just before bedtime (OR: 2.08, 95% CI: 1.48-2.93), and using electronic devices 30 min before bedtime (OR: 1.57, 95% CI: 1.07-2.29) were associated with EDS.

CONCLUSION

Chronotype may be an important factor influencing NRS and EDS. Discontinuing electronic device use at least 30 min before bedtime could benefit affected adolescents.

Screen time and sleep among medical students in Germany

Medical students are a vulnerable group for harmful health behaviours due to academic stress. Increased screen time is associated with adverse health behaviour, particularly delayed bedtime, shorter sleep duration and poorer sleep quality. This possible relationship has not yet been examined among medical students in Europe. Medical students at the Technical University of Dresden were invited to participate in an online questionnaire based cross-sectional study. To analyse correlations between screen time and sleep parameters, correlation coefficients, linear regression and mixed-model analysis were calculated. 415 students (average age 24 years, 70% female) were included in the analysis. The students reported an average of 7 h screen time per day and 7.25 h sleep duration per night. Approximately 23% (n = 97) reported sleeping less than 7 h per night and 25% (n = 105) reported fairly to very poor sleep quality. Students who reported more screen time for leisure went to bed significantly later (r = 0.213, p < 0.001). Students who spent more screen time for study/work tended to sleep shorter (r = - 0.108, p < 0.015). There was no significant association between screen time and sleep quality (p = 0.103). The results show a need for educational interventions to promote healthy sleep behaviour and to limit screen time.

Associations between sleep characteristics and glycemic variability in youth with type 1 diabetes

OBJECTIVE

This study aimed to determine sleep characteristics and their associations with glycemic variability in youth with type 1 diabetes (T1D).

MATERIAL AND METHODS

This cross-sectional study conducted at two pediatric diabetes centers in Istanbul, Turkey, included 84 children with T1D (mean age 10.5 years). Sleep characteristics and glycemic variability were determined by actigraphy, DSM-5 Level 2-Sleep Disturbance Scale Short Form and continuous glucose monitoring. Circadian preference was evaluated by the Children's Chronotype Questionnaire. Sleep disturbances were assessed by the. The sleep quality was determined by actigraphy-derived sleep measures.

RESULTS

Eighty-eight percent of participants had insufficient age-appropriate total sleep time (TST) (<9 h for 6-13-year-olds and <8 h for 14-17-year-olds). Chronotype was classified as intermediate in 50%, evening in 45.2%, and morning in 4.8%. A higher chronotype score indicating a stronger eveningness preference was associated with more time spent in hypoglycemia (β = 0.433, p = 0.002). On nights when participants had lower sleep efficiency and longer sleep onset latency, they had significantly higher overnight glycemic variability (β = -0.343, p = 0.016, β = 0.129, p = 0.017, respectively). Prolonged nocturnal wake duration was significantly associated with more time spent in daytime hypoglycemia (β = 0.037, p = 0.046) and higher overnight glycemic variability (J index, β = 0.300, p = 0.015). The associations between TST and glycemic variability indices were not significant.

CONCLUSIONS

Sleep quality rather than TST was significantly associated with glycemic variability in children with T1D. Eveningness preference might contribute to an increased risk of hypoglycemia. Addressing sleep patterns and chronotypes can be crucial in management plans for youth with T1D.

The association between various dimensions of sleep parameters and mental health: A large cross-sectional study of 13554 Chinese students

OBJECTIVES

We aimed to investigate the association between multiple sleep variables and mental health among Chinese students aged 9-22.

METHOD

We stratified the included 13,554 students by educational levels. Sleep parameters contained sleep duration on school days and weekends, napping time, chronotype and social jetlag (SJL), which were calculated via questionnaires. Individual psychological well-being and distress were assessed by Warwick-Edinburgh mental Well-being scale and the Kessler Psychological Distress Scale 10 respectively. The multiple linear and binary logistic regression were applied to analyze the association of sleep with mental health.

RESULTS

Short sleep on school days showed significantly positive association with psychological problems. While among senior high school students, we found reverse result that sleeping less might negatively associated with more severe distress (7-8 h: aOR = 0.67, 95% CI: 0.46, 0.97). The association of sleep duration with mental health was attenuated a lot on weekends. The chronotype was significantly related with mental health in primary and junior high school: intermediate chronotype (vs late chronotype) was associated with greater wellbeing (β = 1.03, 95% CI: 0.09, 1.96; β = 1.89, 95% CI: 0.81, 2.97) and less distress (aOR = 0.78, 95% CI: 0.60, 1.00; aOR = 0.73, 95% CI: 0.58, 0.91). The relationship between SJL, napping duration and psychological health problems were also observed in some educational levels.

CONCLUSION

Sleep deprivation on school days, late chronotype and SJL were positively associated with worse mental health in our study, which differed among various educational stages.

Child Eveningness as a Predictor of Parental Sleep

Child eveningness has been associated with many adverse outcomes for children. The aim of this study was to assess whether child eveningness poses a risk to parental sleep quality in follow-up. A total of 146 children (57% adopted, 47% boys, mean age at follow-up 5.1 years [standard deviation 1.7]) completed a 1-week actigraph recording to analyze their sleep twice, 1 year apart. The parents completed the Child ChronoType Questionnaire for their child and a short version of the Morningness-Eveningness Questionnaire for themselves and the Jenkins Sleep Scale for their sleep quality. Linear regression analyses showed that subjective parental sleeping problems at baseline were associated with subjective parental sleeping problems at follow-up. A morning-type child decreased the risk of parental sleeping problems at the 1-year follow-up compared to the child evening chronotype. Additionally, the child intermediate chronotype decreased the risk of maternal sleeping problems at the 1-year follow-up compared to the evening chronotype of the child. Parents of evening-type children experienced more sleeping problems in the follow-up, compared to parents of morning-type children. This finding encourages parents and professionals to steer the diurnal rhythm of evening-type children toward an earlier daily routine.

Role of chronotype in dietary intake, meal timing, and obesity: a systematic review

CONTEXT

Recent studies show that dietary habits and obesity seem to be influenced by chronotype, which reflects an individual's preference for the timing of sleeping, eating, and activity in a 24-hour period.

OBJECTIVE

This review aimed to analyze the association of chronotype with dietary habits, namely energy and macronutrient intakes, meal timing, and eating patterns, as well as with obesity.

DATA SOURCES

PubMed/MEDLINE, LILACS, and Google Scholar databases were searched between 2004 and 2020. Study selection was performed by 2 authors independently; disagreements on eligibility of articles were resolved by a third author. After assessment of 12 060 abstracts, 43 studies (21 articles on obesity; 13 on food consumption, meal timing, and eating patterns; and 9 that addressed both obesity and dietary behavior) were included.

DATA EXTRACTION

A standard form was used to extract study design, country, number of participants, method of chronotype determination, and main findings.

DATA ANALYSIS

Approximately 95% of included studies showed an association between eveningness and at least 1 unhealthy eating habit. Morningness was associated with regular consumption of fresh and minimally processed foods. In addition, about 47% of studies showed a higher association between late types and obesity.

CONCLUSION

Late types are more likely to present unhealthy eating habits, such as eating late at night, skipping breakfast often, and eating processed/ultraprocessed foods, while early types are more likely to have healthy and protective habits, such as eating early and eating predominantly fresh/minimally processed foods. Intermediate types tend to have a pattern of health and eating more similar to early types than to late types. Late types are also more likely to present higher weight and body mass index than early or intermediate types.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42021256078.

Effects of multiple exposures to general anesthesia on the sleep quality of children after plastic surgery in Beijing, China: a cohort study

To assess the effects of the number and duration of general anesthesia exposure on the sleep quality of 6-15-year-old school children who underwent plastic surgery. The study was conducted on 688 children who underwent plastic surgery between the ages of 6 and 15 years using the Sleep Disorder Scale for Children (SDSC). The children were divided into two groups according to their exposure to general anesthesia: No General Anesthesia (NGA) and General Anesthesia (GA) groups. The GA group was further divided into three subgroups according to the number of exposures: Single-exposure, Double-exposure, and Multiple-exposure groups. The GA group was also subdivided into two groups according to the cumulative total time of anesthesia exposure: < 3 h and ≥ 3 h groups. Multivariate logistic regression analysis was used to confirm the potential factors that affect children with sleep disturbance (SDSC scores > 39) after general anesthesia exposure. Linear regression was used to analyze the correlation of the factors with the SDSC scores. The SDSC scores were higher in the GA group [35.4 ± 4.3 vs. 34.0 ± 3.6, P < 0.0001] as compared to the NGA group. The number of children with SDSC scores > 39 was also higher in the GA group [80 (17.5%) vs. 17 (7.4%), P < 0.0001]. More anesthesia exposure was correlated with higher total SDSC scores [34.5 ± 4.3 for single exposure vs 35.1 ± 3.9 for double exposure vs 37.5 ± 4.5 for multiple exposures, P < 0.0001] and a higher proportion of SDSC scores > 39 [24 (12.0%) for single exposure vs 24 (15.5%) for double exposure vs 32 (31.1%) for multiple exposures, P < 0.0001]. Longer anesthesia exposure was also correlated with higher total SDSC scores [34.4 ± 4.5 for < 3 h vs. 35.8 ± 4.2 for ≥ 3 h, P = 0.002]. The number of exposures to general anesthesia was a potential factor in sleep disturbance among children, determined based on logistic regression. Children who underwent plastic surgery between the ages of 6 and 15 years with general anesthesia exposure might have worse sleep quality and a higher incidence of sleep disorders. More frequent anesthesia exposure leads to worsened sleep quality and a higher incidence of sleep disorders. This study also confirmed that a longer duration of cumulative anesthesia exposure also leads to worse sleep quality.

Chronotype, circadian rhythm, and psychiatric disorders: Recent evidence and potential mechanisms

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.

Relationships between Sleep Duration, Timing, Consistency, and Chronotype with Myopia among School-Aged Children

Background

The role of sleep in childhood myopia has been a research focus; however, the existing evidence is conflicting on sleep duration and timing, and as yet, no studies involve sleep consistency and chronotype. This study is done to make multiple-perspective analyses on the associations between sleep variables and myopia.

Methods

A population-based cross-sectional study was conducted in Shanghai, China, which included 10,142 school-aged children (7–12 years old, 53.2% boys). The Chinese version of the Children's Sleep Habits Questionnaire (CSHQ) was used to assess sleep variables. Propensity score matching was adopted to balance the difference of covariates between nonmyopic and myopic groups. Logistic regression models were implemented to examine the associations between sleep variables and myopia.

Results

Sleep duration and timing, mainly during weekdays, were correlated with myopia in a dose-dependent pattern, in which longer sleep duration was associated with decreased risk of myopia (9-10 hours/day: odds ratio (OR) = 0.87; ≥10 hours/day: OR = 0.77; by comparison with <9 hours/day); later bedtime (9 pm to 9:30 pm: OR = 1.46; 9:30 pm to 10 pm: OR = 1.51; 10 pm and after: OR = 2.08; by comparison with before 9 pm) and later wake-up time (7 am and after: OR = 1.36; by comparison with before 6:30 am) increased the risk (all P < 0.05). Moreover, longer weekend catch-up sleep duration and intermediate and evening chronotype were positively correlated with myopia, while social jetlag was associated with a lower odds of myopia. All these findings were also similarly observed in the matching sample.

Conclusions

Multiple dimensions of sleep were involved in childhood myopia. In addition to sleep duration and timing, sleep consistency and chronotype were also strictly related to myopia. More studies are needed to enrich the current evidence, thus further clarifying the association between sleep and childhood myopia.

Understanding Sleep-Wake Behavior in Late Chronotype Adolescents: The Role of Circadian Phase, Sleep Timing, and Sleep Propensity

BACKGROUND

Adolescents with a late chronotype are at greater risk for mood disorders, risk-taking behaviors, school absenteeism, and lower academic achievement. As there are multiple causes for late chronotype, the field lacks studies on the relationship between mood, circadian phase, and phase angle of entrainment in late chronotype adolescents. Three objectives guide this explorative study: (1) to describe sleep, circadian phase, and phase angle of entrainment in late chronotype adolescents, (2) to explore how different levels of lateness are associated with sleep quality, sleep propensity, and mood, and (3) to investigate the influence of circadian phase on bedtime choice and sleep duration.

METHODS

Baseline data from 19 male adolescents (M = 16.4 ± 1.0 yrs), who were part of a larger intervention trial, were analyzed. Chronotype was measured with the Munich Chronotype Questionnaire, circadian timing via dim light melatonin onset (DLMO), and sleep habits with a 7-day sleep log. Further questionnaires assessed daytime sleepiness, sleep quality, and mood. Evening sleepiness and sustained attention were used as a proxy for evening sleep propensity.

RESULTS

On school nights, sleep duration averaged 7.78 h (±1.65), and 9.00 h (±1.42) on weekend nights. Mean DLMO was observed at 23.13 h (± 1.65), with a weekend phase angle of entrainment of 2.48 h. Regression fittings revealed a tendency for shorter phase angles with delayed DLMOs. Further analysis with chronotype subgroups revealed that this was only true for light and moderate late types, whereas extreme late types showed wide phase angles. Even though daytime sleepiness and sleep duration did not differ between subgroups, mood and sleep quality declined as lateness increased. Extreme late chronotypes experienced higher evening sleepiness, while slight late chronotypes showed higher evening attention. Chronotype but not DLMO predicted bedtime on school- and particularly weekend-nights.

CONCLUSIONS

Our findings suggest that with increasing lateness, the likelihood of experiencing poor sleep quality and mood disorders increases. As DLMO did not predict bedtime, our data indicate that the factors contributing to a late chronotype are versatile and complex, particularly for extreme late types. Further studies involving a larger and gender-balanced sample are needed to confirm findings.

Sleep habits and sleep problems associated with depressive symptoms in school-age children

PROBLEM

Sleep disturbance is a characteristic symptom of depression, but it is also a problem in itself related to the severity of this illness. Hence, the objective of this study was to examine sleep habits and sleep problems associated with increased depressive symptoms in children.

METHODS

The sample included 524 children equally distributed by gender (51.1% female), with an average age of 10.29 (SD = 1.34) years. The administered instruments were the Children's Depression Inventory (CDI; Cronbach α = 0.82) and a Sleep Habits and Sleep Problems Questionnaire (α = 0.91).

FINDINGS

The mean score for the CDI was 12.51 (SD = 6.74) and 20% presented symptoms of depression. The linear regression model showed that sleep habits associated with the increase in symptoms of depression were: little sleep, hours of sleep during the week, and wake-up time on weekdays. In the same model, the associated sleep problems were: nocturnal awakenings, nightmares, and difficulty waking up. The presence of these sleep habits and sleep problems increased the score from 2.07 to 13.50 points on the CDI scale.

CONCLUSIONS

Depressive symptoms increase with the presence of sleep habits related to sleep deprivation and sleep problems related to parasomnias in school-age children.

Review: Identification and Management of Circadian Rhythm Sleep Disorders as a Transdiagnostic Feature in Child and Adolescent Psychiatry

OBJECTIVE

Sleep disturbances are highly frequent features in a range of child and adolescent psychiatric conditions. However, it is commonly not clear if such sleep problems represent symptomatic features of, comorbidities of, or risk factors for these conditions. It is believed that underlying dysfunction in the daily biological (circadian) clock may play important roles in the etiology of many sleep disorders, and circadian rhythm changes are reported in a number of neuropsychiatric conditions. The aim of this review was to explore the key identifying features of circadian rhythm disorders (CRDs) in child and adolescent psychiatry and address how such disorders may be managed in the clinic.

METHOD

A narrative review was conducted of the extant literature of CRDs in children and adolescents with psychiatric conditions.

RESULTS

Key biological and social factors that contribute to CRDs in children and adolescents, and the cognitive and neurobehavioral consequences resulting from insufficient sleep were outlined. The roles of melatonin and other chronotherapeutic and behavioral interventions for the management of CRDs were also outlined. Further, the importance of careful investigation of circadian rhythm abnormalities in shaping the most effective treatment plan according to chronobiological principles was highlighted.

CONCLUSION

CRDs are common in children and adolescents with psychiatric conditions and arise out of complex interactions between biological and social factors. Careful clinical attention to and management of CRDs in child and adolescent psychiatry have the potential for significant benefit not only in the domain of sleep but also in a range of cognitive, affective, and behavioral outcomes.

How does the COVID-19 affect mental health and sleep among Chinese adolescents: a longitudinal follow-up study

OBJECTIVE

The Corona Virus Disease-19 (COVID-19) pandemic has evolved into the largest public health event in the world. Earlier COVID-19 studies have reported that the pandemic caused widespread impacts on mental health and sleep in the general population. However, it remains largely unknown how the prevalence of mental health problems and sleep disturbance developed and interacted in adolescents at different times in the epidemic.

METHODS

831 teenagers (aged 14-19) underwent a longitudinal follow-up study to evaluate the prevalence of mental health problems and sleep disturbance among adolescents before, during, and after the COVID-19 breakout in China and to explore the interaction between mental health and sleep across the three measurements. The chronotype, anxiety and depression level, sleep quality, and insomnia were investigated during each measurement.

RESULTS

The adolescents had delayed sleep onset and sleep offset time, longer sleep duration during the quarantine than before and after the epidemic, whereas their chronotype tended to morning type during the epidemic. Yet, the highest prevalence of anxiety, depression, poor sleeper, and insomnia symptoms were observed before but not during the COVID-19 breakout. The females and adolescents who were eveningness type showed significantly higher anxiety and depression levels, poorer sleep quality, and severe insomnia status than the males and the intermediate and morning types. Sleep disturbance was positively associated with mental problems among three measurements. Pre-measured depression level significantly predicted sleep disturbance level at follow-ups.

CONCLUSION

These findings suggested that adolescents' high prevalence of mental health and sleep problems occurred before the COVID breakout and decreased during and after the epidemic. Gender and chronotype were significant risk factors associated with affective and sleep disturbances. Depression positively predicted later sleep problems, but not vice versa.

Later sleep timing predicts accelerated summer weight gain among elementary school children: a prospective observational study

OBJECTIVES AND BACKGROUND

Social demands of the school-year and summer environment may affect children's sleep patterns and circadian rhythms during these periods. The current study examined differences in children's sleep and circadian-related behaviors during the school-year and summer and explored the association between sleep and circadian parameters and change in body mass index (BMI) during these time periods.

METHODS

This was a prospective observational study with 119 children ages 5 to 8 years with three sequential BMI assessments: early school-year (fall), late school-year (spring), and beginning of the following school-year in Houston, Texas, USA. Sleep midpoint, sleep duration, variability of sleep midpoint, physical activity, and light exposure were estimated using wrist-worn accelerometry during the school-year (fall) and summer. To examine the effect of sleep parameters, physical activity level, and light exposure on change in BMI, growth curve modeling was conducted controlling for age, race, sex, and chronotype.

RESULTS

Children's sleep midpoint shifted later by an average of 1.5 h during summer compared to the school-year. After controlling for covariates, later sleep midpoints predicted larger increases in BMI during summer, (γ = .0004, p = .03), but not during the school-year. Sleep duration, sleep midpoint variability, physical activity levels, and sedentary behavior were not associated with change in BMI during the school-year or summer. Females tended to increase their BMI at a faster rate during summer compared to males, γ = .06, p = .049. Greater amounts of outdoor light exposure (γ = -.01, p = .02) predicted smaller increases in school-year BMI.

CONCLUSIONS

Obesity prevention interventions may need to target different behaviors depending on whether children are in or out of school. Promotion of outdoor time during the school-year and earlier sleep times during the summer may be effective obesity prevention strategies during these respective times.

Biological Rhythm and Chronotype: New Perspectives in Health

The circadian rhythm plays a fundamental role in regulating biological functions, including sleep–wake preference, body temperature, hormonal secretion, food intake, and cognitive and physical performance. Alterations in circadian rhythm can lead to chronic disease and impaired sleep. The circadian rhythmicity in human beings is represented by a complex phenotype. Indeed, over a 24-h period, a person’s preferred time to be more active or to sleep can be expressed in the concept of morningness–eveningness. Three chronotypes are distinguished: Morning, Neither, and Evening-types. Interindividual differences in chronotypes need to be considered to reduce the negative effects of circadian disruptions on health. In the present review, we examine the bi-directional influences of the rest–activity circadian rhythm and sleep–wake cycle in chronic pathologies and disorders. We analyze the concept and the main characteristics of the three chronotypes.

Disorders of Arousal: A Chronobiological Perspective

Non-rapid eye movement (NREM) sleep parasomnias are characterized by motor and emotional behaviors emerging from incomplete arousals from NREM sleep and they are currently referred to as disorders of arousal (DoA). Three main clinical entities are recognized, namely confusional arousal, sleep terror and sleepwalking. DoA are largely present in pediatric populations, an age in which they are considered as transitory, unhabitual physiological events. The literature background in the last twenty years has extensively shown that DoA can persist in adulthood in predisposed individuals or even appear de novo in some cases. Even though some episodes may arise from stage 2 of sleep, most DoA occur during slow wave sleep (SWS), and particularly during the first two sleep cycles. The reasons for this timing are linked to the intrinsic structure of SWS and with the possible influence on this sleep phase of predisposing, priming and precipitating factors for DoA episodes. The objective of this paper is to review the intrinsic sleep-related features and chronobiological aspects affecting SWS, responsible for the occurrence of the majority of DoA episodes during the first part of the night.

Developmental Profile of Sleep and Its Potential Impact on Daytime Functioning from Childhood to Adulthood in Sickle Cell Anaemia

Young individuals with sickle cell anaemia (SCA) experience sleep disturbances and often experience daytime tiredness, which in turn may impact on their daytime functioning and academic attainment, but there are few longitudinal data.

METHODS

Data on sleep habits and behaviour were taken on the same day as an in-hospital polysomnography. This study assesses the developmental sleep profiles of children and young adults aged 4-23 years old with SCA. We examined retrospective polysomnography (PSG) and questionnaire data.

RESULTS

A total of 256 children with a median age of 10.67 years (130 male) were recruited and 179 returned for PSG 1.80-6.72 years later. Later bedtimes and a decrease in total sleep time (TST) were observed. Sleep disturbances, e.g., parasomnias and night waking, were highest in preschool children and young adults at their first visit. Participants with lower sleep quality, more movement during the night and increased night waking experienced daytime sleepiness, potentially an indicator of lower daytime functioning. Factors influencing sleep quantity included age, hydroxyurea prescription, mean overnight oxygen saturation, sleep onset latency, periodic limb movement, socioeconomic status and night waking.

CONCLUSION

Sleep serves an important role for daytime functioning in SCA; hence, quantitative (i.e., PSG for clinical symptoms, e.g., sleep-disordered breathing, nocturnal limb movement) and qualitative (i.e., questionnaires for habitual sleep behaviour) assessments of sleep should be mutually considered to guide interventions.