Mental health antecedents of early midlife insomnia: evidence from a four-decade longitudinal study

The multifaceted consequences and economic costs of child anxiety problems: A systematic review and meta-analysis

Background

Over a quarter of people have an anxiety disorder at some point in their life, with many first experiencing difficulties during childhood or adolescence. Despite this, gaps still exist in the current evidence base of the multiple consequences of childhood anxiety problems and their costs.

Methods

A systematic review of Medline, PsycINFO, EconLit and the National Health Service Economic Evaluation Database was conducted for longitudinal and economic studies reporting on the association between childhood anxiety problems and at least one individual-, family- or societal-level outcome or cost. All studies were synthesised narratively. For longitudinal studies, 'effect direction' was used as a common metric, with random effects meta-analysis undertaken where possible.

Results

Eighty-three studies met inclusion criteria and were synthesised narratively. We identified 788 separate analyses from the longitudinal studies, which we grouped into 15 overarching outcome domains. Thirteen of the studies were incorporated into 13 meta-analyses, which indicated that childhood anxiety disorders were associated with future anxiety, mood, behaviour and substance disorders. Narrative synthesis also suggested associations between anxiety problems and worse physical health, behaviour, self-harm, eating, relationship, educational, health care, employment, and financial outcomes. 'Effect direction' was conflicting in some domains due to a sparse evidence base. Higher economic costs were identified for the child, their families, healthcare providers and wider society, although evidence was limited and only covered short follow-up periods, up to a maximum of 2 years. Total annual societal costs per anxious child were up to £4040 (2021 GBP).

Conclusions

Childhood anxiety problems are associated with impaired outcomes in numerous domains, and considerable economic costs, which highlight the need for cost-effective interventions and policies to tackle them. More economic evidence is needed to inform models of the long-term, economic-related, consequences of childhood anxiety problems.

Association between discrimination in the workplace and insomnia symptoms

Background

In Korea, little research has focused on the relationship between discrimination in the workplace and sleep health. Thus, this study aims to investigate the association between such discriminatory experiences and insomnia, a common sleep disorder, using Korean employees' data.

Methods

This study used data from the 6th Korea Working Conditions Survey. Discrimination experiences due to age, ethnic background, nationality, race, sex, religion, disability, sexual orientation, educational level, hometown, and employment status were investigated. The Minimal Insomnia Symptom Scale estimated insomnia symptoms. The association between discrimination experience and insomnia symptoms were analyzed using survey-weighted logistic regression analysis.

Results

Based on experiences of discrimination over the past 12 months, insomnia symptoms were associated with discrimination experience due to religion (odds ratio [OR]: 3.70; 95% confidential interval [CI]: 1.58-8.69), sex (OR: 2.51; 95% CI: 1.87-3.37), age (OR: 2.30; 95% CI: 1.88-2.81), hometown (OR: 2.07; 95% CI: 1.44-2.97), employment status (OR: 1.69; 95% CI: 1.37-2.10), and educational level (OR: 1.67; 95% CI: 1.31-2.14). Furthermore, the prevalence of insomnia symptoms increased with the number of discrimination experiences.

Conclusions

In this study, discrimination experiences due to religion, sex, age, hometown, employment status, and educational level were significantly associated with insomnia symptoms. Furthermore, as the number of discrimination experiences increased, so did the prevalence of insomnia. Preventing workplace discrimination may improve workers' sleep health.

The Origins of the Dark—Hyperactivity and Negative Peer Relationships, an Objectively Lower Sleep Efficiency, and a Longer Sleep Onset Latency at Age Five Were Associated with Callous-Unemotional Traits and Low Empathy at Age 14

Background: Within the spectrum of emotional competencies, callous-unemotional traits are socially discouraged, while empathy is considered a socially much more accepted emotional trait. This holds particularly true for adolescents, who are still building up their social and emotional competencies. The aims of the present study were two-fold: First, longitudinally, to identify traits of behavioral problems and objective sleep dimensions at the age of 5 years to predict callous-unemotional traits and empathy at the age of 14 years. Second, cross-sectionally, to associate callous-unemotional traits and empathy with current insomnia, stress, and mental toughness. Methods: Preschoolers at the age of 5 years were contacted nine years later at the age of 14 years. At 5 years, parents rated their children’s behavior (Strength and Difficulties Questionnaire, SDQ); in parallel, children underwent a one-night sleep-EEG assessment. At the age of 14 years, adolescents completed a series of questionnaires covering callous-unemotional traits, insomnia, empathy, stress, and mental toughness. Results: A total of 77 adolescents (38.1% females) took part in the present study. Longitudinally, higher scores for hyperactivity at age 5 significantly predicted higher callous-unemotional traits at age 14. A higher score for negative peer relationships at age 5 significantly predicted lower scores for cognitive empathy at age 14. Further, objective sleep-EEG measures showed that a higher sleep efficiency and a shorter sleep latency was associated with lower scores for callousness. Cross-sectionally, higher scores for callous-unemotional traits were associated with higher insomnia and stress, while lower insomnia was associated with higher empathy. Mental toughness was unrelated to callous-unemotional traits and empathy. Conclusions: It appears that hyperactivity traits and negative peer relationships and more unfavorable objective sleep patterns at 5 years predicted socially discouraged callous-unemotional traits and low empathy during adolescence. Further, cross-sectionally at the age of 14, callous-unemotional traits, subjective poor sleep, and higher stress were associated.

Insomnia, sleep duration, and risk of anxiety: A two-sample Mendelian randomization study

BACKGROUND

The effect of insomnia and sleep duration on risk of anxiety has been assessed based on traditional epidemiological studies. However, the inconsistent conclusions do not establish causal associations. This study aimed to explore the causal associations of insomnia, short sleep, and long sleep with anxiety.

METHODS

We used summary statistics from three large-scale genome-wide association studies (GWAS) of European ancestry to perform a two-sample Mendelian randomization (MR) study. MR analyses were mainly conducted with the inverse-variance-weighted (IVW) method. To evaluate the robustness of our findings, we performed the weighted-median approach, the MR-Egger method, and the MR-robust adjusted profile score (MR-RAPS) method for sensitivity analyses.

RESULTS

There was a statistically significant association of genetically predicted insomnia with anxiety using the IVW method (OR = 1.36, 95% CI = 1.23-1.51, P < 0.001). Genetically predicted short sleep was potentially associated with anxiety using IVW method (OR = 1.67, 95% CI = 1.08-2.60, P = 0.022). However, sensitivity analyses did not find the causal association of short sleep with anxiety (all P > 0.053). We did not observe a statistically significant causal association of genetically predicted long sleep with anxiety (OR = 0.91, 95% CI = 0.48-1.74, P = 0.775).

CONCLUSIONS

We found strong evidence that insomnia but not short sleep and long sleep has a causal effect on anxiety. The characteristics of insomnia should be incorporated into anxiety prevention and intervention strategies, which have important public health significance.

University Students' Sleep and Mental Health Correlates in South Korea

Sleep closely relates to emotional instability. Recent studies report an increase in young adults’ poor sleep and associated mental health problems, including attention deficit hyperactivity disorder (ADHD), anxiety, depression, and so on. However, the information on related modifiable factors of these variables is still lacking. This cross-sectional study examined the association of sleep patterns and sleep quality with ADHD and depression in university students. A total of 290 participants aged 18−27 (Mean = 22.0, SD = 2.1) completed a structured questionnaire consisting of the Pittsburgh Sleep Quality Index (PSQI), the Adult ADHD, and the Center for Epidemiologic Studies Depression scales (CES-D). Of the participants, more than half (52.7%) slept 6 to 8 h per night, and 37% slept less than 6 h. Only 10% reported they went to bed before midnight; 40% went to sleep after 2 am. The mean PSQI score was 5.9 (SD = 2.9) for total participants and significantly correlated with ADHD scores and with depression scores. After adjusting for covariates, PSQI significantly aligned with increased risk for ADHD (β = 0.29, p = 0.036) and depression (β = 0.67; p < 0.001). Late bedtime was a significant factor for depression only. Sleep quality rather than sleep pattern significantly related to ADHD scores, whereas both sleep quality and bedtime aligned with depression scores. Additional studies are needed to develop strategic interventions for university students with ADHD and depression as well as underlying mechanisms.

The impact of insomnia disorder on adult attention-deficit/hyperactivity disorder severity: A six-month follow-up study

BACKGROUND AND OBJECTIVES

The longitudinal relationship between insomnia disorder and adult attention-deficit/hyperactivity disorder (ADHD) has been scarcely investigated. This study aimed to evaluate the relationship between the remission of insomnia disorder and adult ADHD clinical severity, psychiatric and medical comorbidities, and the health-related quality of life (HRQoL) in a 6-month follow-up.

METHODS

Ninety-two adult patients with ADHD and insomnia disorder (52.2% males; mean age 39.5 ± 11.0 years) were comprehensively assessed at baseline, 3 months, and 6 months of a follow-up period. The evaluation included semi-structured interviews (for ADHD and comorbidity assessment), the Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Epworth Sleepiness Scale. The diagnosis of ADHD and insomnia disorder was performed according to DSM-5 criteria. At baseline and follow-up, psychoeducation/sleep hygiene and, if necessary, pharmacological were prescribed for insomnia.

RESULTS

Eighty-seven patients completed the 6-month follow-up. Insomnia disorder remission was reported in 72.4% of cases and was related to a greater improvement in ADHD symptoms and severity throughout the follow-up period. Additionally, an improvement in psychiatric comorbidities and better HRQoL were associated with insomnia disorder remission.

CONCLUSION

The current study highlights that the treatment of insomnia disorder in ADHD adult patients may have an important role in the outcome of ADHD therapeutic approaches by reducing their severity.

The Long-Term Outcomes of Prepubertal Depression and Internalizing Problems: A Scoping Review

LEARNING OBJECTIVES

After participating in this activity, learners should be better able to:• Discuss whether prepubertal depression shows longitudinal continuity with depression in adulthood.• Summarize existing literature on adult emotional and functional outcomes of prepubertal depression and internalizing problems.

BACKGROUND

Adolescent- and young adult-onset depression are common, recurrent, and can cause significant distress and psychosocial impairment across the life span, but recognition of prepubertal internalizing problems and depression, along with their prevalence, clinical course, and long-term outcomes, remains elusive.

OBJECTIVE

To examine whether prepubertal depression, which can manifest differently from adult depression, shows longitudinal continuity with depression in adulthood, and to summarize existing literature on adult emotional and functional outcomes of prepubertal depression and internalizing problems.

METHODS

A scoping review was conducted for peer-reviewed cohort articles published between 2000 and 2020 using PubMed and PsycINFO. From 4309 identified references, 17 articles were included.

RESULTS

Prepubertal depression confers increased risk of recurrence of depression in adulthood, with similar findings for prepubertal internalizing problems. No studies found prepubertal depression or internalizing problems predicting adult substance abuse, and no studies asked about adult bipolar diagnoses. More research is needed to draw clear conclusions regarding their implications for other psychiatric, medical, or psychosocial outcomes.

CONCLUSION

The reviewed studies provide limited evidence that prepubertal depression onset predicts adult depression. The small evidence base and heterogeneous methodological assessments may limit, however, the ability to draw meaningful conclusions about the long-term course of prepubertal-onset depression. Well-designed studies with longer follow-up and multiple assessments in adulthood are needed to clarify and assess the potential effects of prepubertal depression on adult health and functioning. This information will eventually become available as the samples in recently initiated longitudinal cohort studies of children mature further.

Sexual orientation and sleep problem among Chinese college students: Mediating roles of interpersonal problems and depressive symptoms

BACKGROUND

This study aimed to investigate disparities in sleep quality between sexual minority and heterosexual college students, and to examine the serial multiple mediation effects of interpersonal relationships and depressive symptoms on sexual minority disparities in sleep quality. We also explored the sex differences in the mediating effects.

METHODS

Data were drawn from the 2019 School-based Chinese College Students Health Survey using a multi-stage, stratified-cluster, random-sampling method to examine the risk factors of sleep disparities and the mediation effects. Measures included sexual orientation, perceived interpersonal relationships (i.e., family, teachers, and peer relationship), depressive symptoms, sleep quality, and other covariates.

RESULTS

Of all the college students in the analysis, 95.8% were heterosexual, 4.2% were sexual minorities. In the adjusted model without mediation, sexual minority students were at a higher risk of poor sleep quality (P < 0.001). Serial multiple mediation analysis revealed that: both interpersonal relationships and depressive symptoms mediated the link between sexual orientation and sleep quality; a serial indirect pathway (i.e., sexual orientation → interpersonal relationships → depressive symptoms → sleep quality) existed. Moreover, the serial indirect pathway might be moderated by sex.

LIMITATIONS

Causal inference is limited due to the cross-sectional design.

CONCLUSIONS

Interventions to prevent or manage sleep disorders of sexual minority college students may yield better results if they consider the effects of improving interpersonal relationships and depression symptoms comprehensively than targeting sleep problems alone.

Treatment Implications of Sleep-Related Problems in Pediatric Anxiety Disorders: A Narrative Review of the Literature

Pediatric anxiety disorders and sleep-related problems (SRPs) are highly prevalent and are associated with serious health or psychopathological consequences. This narrative review aims to provide an overview of the current evidence of the associations between anxiety disorders and SRPs, to examine how this relationship may affect treatment, and to evaluate future directions for the field. Despite their strong bi-directional relationship, SRPs are often neglected in pediatric anxiety literature. There is little consensus on the conceptualization and related measurements of SRPs, which has led to methodological limitations and difficulties. Furthermore, available research suggests that anxiety treatment alone may be inadequate as clinically impairing SRPs were still present post-treatment, which may, in turn, diminish effects of therapy. Understanding the implications of the relationship between anxiety and SRPs on treatment outcomes may be helpful in recognizing opportunities for high impact and enduring interventions.

[Pandémie COVID-19, sommeil et séquelles psychologiques: au nom du Réseau canadien du sommeil et des rythmes circadiens* et de la Société canadienne du sommeil*]

Les données recueillies lors de crises et tragédies passées prouvent que les problèmes de sommeil survenant durant ou peu de temps après un événement traumatique sont reliés à une probabilité accrue de développer des symptômes psychiatriques durables. Or la pandémie COVID-19 et ses conséquences à moyen et long-terme combinent plusieurs facteurs de risque pour le sommeil, tant pour les intervenants de la santé que la population générale. Notre relevé mensuel des publications scientifiques qui combinent COVID-19 et sommeil/insomnie entre janvier et juillet 2020 révèle un taux de croissance comparable pour les articles qui portent plus précisément sur la santé mentale mais aucune ne porte sur les résultats d’une intervention. Nous proposons qu’il faille agir rapidement sur les difficultés de sommeil en cette période de pandémie afin de protéger l’équilibre psychologique individuel à moyen et long terme, d’autant plus que les outils nécessaires à la prévention de l’insomnie, sa détection et son traitement sont à la portée de tous les professionnels de la santé mentale.

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.

Linking RDoC and HiTOP: A new interface for advancing psychiatric nosology and neuroscience

The Research Domain Criteria (RDoC) and the Hierarchical Taxonomy of Psychopathology (HiTOP) represent major dimensional frameworks proposing two alternative approaches to accelerate progress in the way psychopathology is studied, classified, and treated. RDoC is a research framework rooted in neuroscience aiming to further the understanding of transdiagnostic biobehavioral systems underlying psychopathology and ultimately inform future classifications. HiTOP is a dimensional classification system, derived from the observed covariation among symptoms of psychopathology and maladaptive traits, which seeks to provide more informative research and treatment targets (i.e., dimensional constructs and clinical assessments) than traditional diagnostic categories. This article argues that the complementary strengths of RDoC and HiTOP can be leveraged in order to achieve their respective goals. RDoC's biobehavioral framework may help elucidate the underpinnings of the clinical dimensions included in HiTOP, whereas HiTOP may provide psychometrically robust clinical targets for RDoC-informed research. We present a comprehensive mapping between dimensions included in RDoC (constructs and subconstructs) and HiTOP (spectra and subfactors) based on narrative review of the empirical literature. The resulting RDoC-HiTOP interface sheds light on the biobehavioral correlates of clinical dimensions and provides a broad set of dimensional clinical targets for etiological and neuroscientific research. We conclude with future directions and practical recommendations for using this interface to advance clinical neuroscience and psychiatric nosology. Ultimately, we envision that this RDoC-HiTOP interface has the potential to inform the development of a unified, dimensional, and biobehaviorally-grounded psychiatric nosology.

Who are the individuals with the worst perceived quality of sleep? A population-based survey in southern Brazil

This study aimed to investigate the factors associated with poorer sleep quality. It consisted of a population-based cross-sectional study conducted in Southern Brazil with individuals aged 18 years or older. Participants were selected through a two-stage random sampling strategy and data collection was conducted in 2016. The outcome was self-perceived quality of sleep. Questions regarding the number of hours of sleep and the use of medicines to sleep each week were also asked. Demographic, socioeconomic, behavioral and health conditions were collected through questionnaire. The study sample was composed of 1,300 individuals whose mean age was 46.1 years (SD = 17.3). The prevalence of poor sleep quality was 10.7% (95% CI 9.3% to 12.1%). The poorer the quality of sleep was, the higher the prevalence of the use of medicines to sleep (22.3% versus 10.0% in the overall sample; p < 0.001) and the lower the average amount of daily sleep (6.0 h/day versus 7.3 h/day in the overall sample; p < 0.001). Groups with the worst quality of sleep, in the adjusted analyses, were female (p = 0.012), younger (18 to 39 years versus 60 years or more) (p = 0.048), with poorer perceived diet (p < 0.001), most stressed (p < 0.001), with chronic back pain (p = 0.002), with chronic respiratory disease (p = 0.012), with worse quality of life (p = 0.018) and depression (p = 0.034). Concluding, one out of ten individuals reported poor sleep quality. The results suggest that lifestyle changes could improve the quality of sleep.

Effect of a Multi-Layer, Extended-Release Methylphenidate Formulation (PRC-063) on Sleep in Adults with ADHD: A Randomized, Double-Blind, Forced-Dose, Placebo-Controlled Trial Followed by a 6-month Open-Label Extension

BACKGROUND

The effects of stimulant treatment on sleep in adults with attention-deficit/hyperactivity disorder (ADHD) are complex and varied, with some individuals experiencing worsening of sleep but others experiencing improvement.

METHODS

Data from previously reported trials of the clinical efficacy and safety of the long-acting methylphenidate formulation PRC-063 (Adhansia XR^® in the USA; Foquest^® in Canada) in adults with ADHD were used to evaluate patient-reported sleep outcomes, as captured using the Pittsburgh Sleep Quality Index (PSQI) and adverse events of insomnia. The trials comprised 4 weeks of randomized, forced-dose PRC-063 treatment at a dose of 0 (placebo), 25, 45, 70, or 100 mg/day followed by an optional 6 months of open-label PRC-063 treatment at an individually optimized dose of 25-100 mg/day.

RESULTS

At the end of double-blind treatment, PRC-063 (all doses combined; N = 297) showed no significant difference versus placebo (N = 78) in least squares mean change in global PSQI score from baseline (- 0.7 vs. - 1.3; P = 0.0972) or in scores for each of the seven subscales of the PSQI. For patients enrolled in the open-label extension (N = 184), mean ± standard deviation global PSQI score improved from 7.8 ± 3.55 at the end of double-blind treatment to 5.8 ± 3.11 at 1 month and 5.4 ± 3.21 at 6 months (P < 0.0001). A greater proportion of patients were good sleepers (global PSQI score ≤ 5) at the end of the open-label extension (57.3%) than at baseline (20.9%) or at the end of double-blind treatment (26.0%). In a logistic regression analysis, baseline global PSQI score (odds ratio 1.491; P < 0.0001), but not randomized study treatment (P = 0.1428), was a significant predictor of poor sleep (global PSQI score > 5) at the end of double-blind treatment. Adverse event rates for insomnia (15.8 vs. 3.8%) and initial insomnia (6.1 vs. 1.3%) during double-blind treatment were higher for PRC-063 (all doses combined) than for placebo. Two patients receiving PRC-063 in the double-blind study and one patient in the open-label study were withdrawn because of insomnia adverse events.

CONCLUSIONS

Our findings indicate that, on average, PRC-063 had no significant impact on overall sleep quality in adults with ADHD. Although insomnia was observed as an adverse event, when sleep was measured over time as an outcome in its own right for patients receiving dose-optimized PRC-063 open-label, more patients showed improvement in sleep than deterioration. CLINICALTRIALS.

GOV IDENTIFER

NCT02139124 and NCT02168127.

Genetic Associations Between Childhood Psychopathology and Adult Depression and Associated Traits in 42 998 Individuals: A Meta-analysis

Importance

Adult mood disorders are often preceded by behavioral and emotional problems in childhood. It is yet unclear what explains the associations between childhood psychopathology and adult traits.

Objective

To investigate whether genetic risk for adult mood disorders and associated traits is associated with childhood disorders.

Design, Setting, and Participants

This meta-analysis examined data from 7 ongoing longitudinal birth and childhood cohorts from the UK, the Netherlands, Sweden, Norway, and Finland. Starting points of data collection ranged from July 1985 to April 2002. Participants were repeatedly assessed for childhood psychopathology from ages 6 to 17 years. Data analysis occurred from September 2017 to May 2019.

Exposures

Individual polygenic scores (PGS) were constructed in children based on genome-wide association studies of adult major depression, bipolar disorder, subjective well-being, neuroticism, insomnia, educational attainment, and body mass index (BMI).

Main Outcomes and Measures

Regression meta-analyses were used to test associations between PGS and attention-deficit/hyperactivity disorder (ADHD) symptoms and internalizing and social problems measured repeatedly across childhood and adolescence and whether these associations depended on childhood phenotype, age, and rater.

Results

The sample included 42 998 participants aged 6 to 17 years. Male participants varied from 43.0% (1040 of 2417 participants) to 53.1% (2434 of 4583 participants) by age and across all cohorts. The PGS of adult major depression, neuroticism, BMI, and insomnia were positively associated with childhood psychopathology (β estimate range, 0.023-0.042 [95% CI, 0.017-0.049]), while associations with PGS of subjective well-being and educational attainment were negative (β, -0.026 to -0.046 [95% CI, -0.020 to -0.057]). There was no moderation of age, type of childhood phenotype, or rater with the associations. The exceptions were stronger associations between educational attainment PGS and ADHD compared with internalizing problems (Δβ, 0.0561 [Δ95% CI, 0.0318-0.0804]; ΔSE, 0.0124) and social problems (Δβ, 0.0528 [Δ95% CI, 0.0282-0.0775]; ΔSE, 0.0126), and between BMI PGS and ADHD and social problems (Δβ, -0.0001 [Δ95% CI, -0.0102 to 0.0100]; ΔSE, 0.0052), compared with internalizing problems (Δβ, -0.0310 [Δ95% CI, -0.0456 to -0.0164]; ΔSE, 0.0074). Furthermore, the association between educational attainment PGS and ADHD increased with age (Δβ, -0.0032 [Δ 95% CI, -0.0048 to -0.0017]; ΔSE, 0.0008).

Conclusions and Relevance

Results from this study suggest the existence of a set of genetic factors influencing a range of traits across the life span with stable associations present throughout childhood. Knowledge of underlying mechanisms may affect treatment and long-term outcomes of individuals with psychopathology.

Effects of perceived stress and resilience on suicidal behaviors in early adolescents

Suicidal behaviors are significant public health issues. The aim of the current study is to examine the effects of perceived stress and resilience on suicidal ideation (SI), plan (SP), and attempt (SA) among early adolescents. A longitudinal study was conducted with data collected from 1035 junior high-school students at baseline and 1-year follow-up. Participants were assessed for suicidal behaviors, resilience, and perceived stress. Logistic regression was performed to analyze for the associations between independent variables and suicidal behaviors. 210 (20.3%) of the participants reported to have SI, 59 (5.7%) had SP, and 49 (4.7%) had SA at baseline. Perceived stress was a strong risk factor (p < 0.001) for SI (OR 1.16-1.18), SP (OR 1.20-1.21), and SA (OR 1.12-1.16) while accounting for different dimensions of resilience. Students with persistent high stress during the 1-year follow-up period had significantly increased risk of SI (OR 7.14-9.64), SP (OR 3.92-6.37), and SA (OR 3.76-3.84) than the persistent low-stress group (p < 0.01). Increased perceived stress scale (PSS) (OR 2.89-3.15) and decreased PSS (OR 2.47) also had a higher risk for SI than persistent low PSS group. Moreover, students with high perceived stress who reported to have higher hope and optimism were less likely to show SI (OR 0.90, p = 0.001) and SP (OR 0.87, p = 0.002) at baseline, and the problem-solving and cognitive maturity mature dimension of resilience showed a significant protective effect on SP longitudinally (OR 0.25, p = 0.003). Perceived stress substantially increased the risk for suicidal behaviors, and moderates the protective effect of resilience on suicide. Considering both risk and protective factors of suicidal behaviors is essential in designing future suicide prevention and intervention programs.

Therapeutic Approaches for the Management of Sleep Disorders in Geriatric Population

OBJECTIVE

Aging is a natural biological phenomenon that occurs in human beings. With increasing of age, there is an appearance of deleterious changes related to progression onto pathological conditions, including hypertension, heart disease, diabetes, hearing and vision impairments, as well as sleep disorders. It is important to recognize that some sleep disturbances reported by aged subjects include insomnia, obstructive sleep apnea, restless legs syndrome, among others. Moreover, accumulating evidence indicates that coexistence of medical issues with sleep disorders constitutes clinical challenges for treatment of comorbidities in elderly. Here, we have attempted to review and summarize the available literature that assesses the sleep disturbances in aging. In addition, we highlight the management of sleep disorders associated with aging. Due to the particular health condition of aged adults, the development of effective pharmacological interventions for sleep disorders treatment in aging is warranted.

METHODS

Review of studies retrieved from the PubMed.

RESULTS

The sleep-wake cycle includes abnormalities classified as sleep disorders. Comorbidity between sleep disturbances and aging-related health issues will represent a public health challenge to be addressed in the near future. Moreover, this scenario will suggest an area that requires further drug investigation and design of new pharmacological and pharmaceutical strategies to treat sleep disorders in the elderly population.

CONCLUSION

The review highlights the sleep disturbances in aging. We focus on current knowledge in medicinal chemistry and further design of new treatments tools for managing sleep disturbances in the aged population.

Impaired emotional memory and decision-making following primary insomnia

Previous studies have indicated that sleep plays an important role in emotional memory and decision-making. However, very little attention has been given to emotional memory and decision-making in patients with primary insomnia (PI). We investigated whether PI influences the accuracy of emotional memory and social decision-making.We examined 25 patients with PI and 20 healthy controls (HC) using an emotional picture memory task and the Iowa Gambling Task (IGT). In the emotional picture memory task, participants completed two testing sessions: an emotional picture evaluation and a delayed recognition phase. During the emotional picture evaluation phase, participants were presented with 48 pictures with different valence (16 positive, 16 neutral, and 16 negative), which they had to evaluate for emotional valence and arousal. During the recognition phase, participants were asked to make a yes/no memory assessment of a set of pictures, which contained the 48 target pictures intermingled with 48 non-target pictures.The performance of the participants with PI was the same as that of the HC in the emotional picture evaluation task. However, the PI group showed worse recognition of the positive and neutral pictures than did the HC group, although recognition of negative pictures was similar in the 2 groups. In the IGT, participants in the PI group more frequently selected cards from the risky decks as the game progressed and selected more disadvantageous cards than did participants in the HC group after the first block.Our findings suggest that insomnia had different effects on memory, depending on the valence of the memory. Specifically, memory performance was impaired for positive and neutral items, but the recognition of negative stimuli seemed to be more resistant to the effects of insomnia. Our results also suggest that decision-making, which is known to be mediated by the ventromedial prefrontal cortex, including decision-making under conditions of uncertainty, may be vulnerable in PI.

Impact of Sleep Disorders and Other Factors on the Quality of Life in General Population: A Cross-Sectional Study

The study objective was to assess if insomnia, along with other factors, can impact the physical and mental quality of life (QOL) of the Lebanese general population. This cross-sectional study, conducted between November 2017 and March 2018, enrolled 756 community-dwelling participants. A first linear regression, using the SF-12 PCS score as the dependent variable, showed that having a family history of insomnia problems (β = 1.107, p = 0.026) was significantly associated with higher physical QOL (higher SF-12 PCS score), whereas increased stress (β = 0.048, p = 0.015) was significantly associated with lower physical QOL. A second linear regression, using the SF-12 MCS score as dependent variable, showed that having increased age (β = -0.079, p < 0.001) was significantly associated with lower mental QOL. Despite its cross-sectional design and the modest sample size, this study adds to the evidence that insomnia, along with other factors (including sociodemographic and psychological factors), can have a detrimental impact on both physical and mental QOL of participants.

Psychometric Analysis Of The Sleep Hygiene Index And Correlation With Stress And Anxiety Among Saudi University Students

AIMS

This study aimed to assess the psychometric properties of the Sleep Hygiene Index (SHI) instrument in screening poor sleep hygiene practices among Saudi university students. As a secondary goal, the association of sleep hygiene practices with stress and anxiety scores were assessed.

METHODS

Two-hundred and four healthy college and university students aged 18 to 25 years participated in this cross-sectional questionnaire-based survey. Participants were asked to complete the English version of the SHI instrument, the Perceived Stress Scale (PSS-10), the Generalized Anxiety Disorder (GAD-7) scale, and to provide demographic details.

RESULTS

The average scores for the SHI, the GAD-7, and the PSS-10 were 6.6, 5.3, and 16.2, respectively. The internal consistency of the SHI was adequate (McDonald's Omega 0.76). The corrected item-total correlations for all the items were fair (range, 0.31-0.50). A statistically significant positive correlation/association of the SHI scores with the PSS score, GAD-7, and self-reported poor sleep were obtained in this sample of Saudi university students. Factor analysis favored a 4-factor model of the SHI in the study sample.

CONCLUSION

The SHI scale demonstrated an adequate level of internal consistency as a self-reported instrument in the assessment of sleep hygiene among Saudi university students. In addition, poor sleep hygiene was correlated with stress and anxiety scores.

Bullying involvement, psychological distress, and short sleep duration among adolescents

PURPOSE

Previous research has found links between involvement in bullying and sleep duration in adolescents. However, little is known about the factors that might mediate these relationships. This study examined the associations between cyberbullying victimization and school bullying involvement (bully, victim, bully-victim) with short sleep duration in a large sample of middle and high school students and tested whether psychological distress mediates these relationships.

METHODS

Data on 5061 students (49% females; mean age = 15.1 years) from the 2015 Ontario Student Drug Use and Health Survey were used. Participants self-reported their sleep duration and their levels of bullying involvement over the past year. Psychological distress was assessed using the Kessler 6 (K6) scale. Covariates in multiple linear regression analyses included age, sex, racial background, socioeconomic status, and substance use.

RESULTS

Being a victim of cyberbullying (β = - 1.179; 95% CI - 0.238; - 0.120) or school bullying (β = - 0.119; 95% CI - 0.190; - 0.049) was associated with short sleep duration. Mediation analyses suggested that psychological distress fully mediates the relationships between being cyberbullied, a school bullying victim or bully-victim with short sleep duration. There was a complementary mediation by psychological distress on the relationship between being a bully at school and short sleep duration.

CONCLUSIONS

These results suggest that higher levels of bullying involvement place adolescents at risk of developing higher psychological distress which, in turn, can lead to short sleep duration. Longitudinal research is necessary to confirm the mediating role of psychological distress on the relationship between bullying involvement and short sleep duration among adolescents.

Relationship between the presence of insomnia and walking physical activity and diet quality: A cross-sectional study in a sample of Spanish adults

INTRODUCTION AND OBJECTIVES

Certain lifestyle habits may influence aspects of sleep quality, such as insomnia. The main objective of the present study was to analyze the relationship of the presence of insomnia, with walking physical activity and diet quality in an adult population.

PATIENTS AND METHODS

A cross-sectional descriptive study was performed (subanalysis of the TRIPLE A study) between January of 2014 to June of 2015. A total of 454 subjects were selected by consecutive sampling. Insomnia was evaluated with the Atenas scale, diet quality using the diet quality index (DQI) questionnaire, and physical activity using pedometers for seven days, evaluating the total number of steps, aerobic steps, and energy expended.

RESULTS

Of all patients, 26.8% presented with insomnia (33.8% in women and 17.5% in men). In a adjusted model, the mean differences of total steps/day, aerobic steps/day, and kilocalories/day spent in performing physical activity, between no insomnia group and insomnia group were: 1022.5 (95% CI: 177.9-1867.0), 743.9 (95% CI: 68.3-1419.4) and 39.8 (95% CI: 5.7-73.9), respectively. We did not find an association between the diet quality index (DQI) and insomnia.

CONCLUSIONS

The findings suggest that completing daily a greater total number of steps, aerobic steps, and energy expended by walking, could be correlated with less insomnia, independent of age, sex, and other confounding variables. However, no relationship was observed between diet quality and insomnia.

Review: Schlafprobleme und psychische Störungen im Kindes- und Jugendalter

Zusammenfassung. Schlafprobleme und -störungen sind in Kindheit und Jugendalter weitverbreitet. Dieser Review beleuchtet den Zusammenhang zwischen Schlafproblemen und psychischen Störungen im Kindes- und Jugendalter. Schlafprobleme und -störungen gelten zum einen als Risikofaktoren für die Entwicklung psychischer Störungen, aber auch als Symptom und Auswirkung psychischer Störungen. Oft stehen Schlafverhalten und Psychopathologie in einer Wechselwirkung, sodass Schlafprobleme zur Intensität und Aufrechterhaltung psychischer Störungen beitragen. Dieser bidirektionale Zusammenhang ist sowohl in der frühen Kindheit als auch im Schulalter und bei Jugendlichen zu beobachten. Viele Studien konnten zeigen, dass es einen langfristigen Zusammenhang über die kindliche Entwicklung hinweg gibt. Sowohl Umweltfaktoren als auch genetische Faktoren scheinen bei der Entwicklung und Aufrechterhaltung dieses Zusammenhangs eine Rolle zu spielen. Diverse Forschungsergebnisse zeigen, dass die Behandlung von psychischen Störungen und die Behandlung von Schlafproblemen sich wechselseitig positiv beeinflussen. Daher ist die Berücksichtigung von Schlafproblemen in der Diagnostik und Behandlung, aber auch in der Prävention von psychischen Störungen dringend anzuraten.

The Association Between Insomnia and Sleep Duration in Adults With Attention-Deficit Hyperactivity Disorder: Results From a General Population Study

STUDY OBJECTIVES

Insomnia and short or long sleep duration are important comorbid conditions in adults with attention-deficit hyperactivity disorder (ADHD), but reports of the association vary. In a general population study, we evaluated the relationship between ADHD symptom severity, insomnia symptoms, and sleep duration in adults.

METHODS

Data were from the third wave of the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2; n = 4,618). ADHD symptom severity and symptom dimensions (hyperactivity and inattention) were assessed using the Adult ADHD Self-Report Scale screener. Self-reported insomnia symptoms (Insomnia Rating Scale; IRS) were defined as clinically relevant if IRS ≥ 9. Self-reported short sleep duration was defined as ≤ 6 hours, and long sleep duration as ≥ 10 hours.

RESULTS

Within the group with clinically relevant ADHD symptoms, 43% reported significant insomnia symptoms (odds ratio [OR] = 2.66, 95% confidence interval [CI] 1.74-4.07); 41% short sleep duration (relative risk ratio [RRR] = 1.94, 95% CI 1.31-2.85) and 6% long sleep (RRR = 5.87, 95% CI 1.97-17.45). Increased inattention symptoms were associated with IRS ≥ 9, short and long sleep duration in fully adjusted models (OR = 1.10, 95% CI 1.06-1.14; RRR = 1.06, 95% CI 1.02-1.09; RRR = 1.16, 95% CI 1.05-1.28, respectively). Increased hyperactivity symptoms were associated with IRS ≥ 9 (OR = 1.17, 95% CI 1.11-1.23) and short sleep duration (RRR = 1.12, 95% CI 1.05-1.19).

CONCLUSIONS

Both clinically significant ADHD symptoms and inattention and hyperactivity symptom dimensions were consistently associated with insomnia symptoms and altered sleep duration. These associations confirm that sleep disturbances should be assessed and given appropriate clinical attention in adults with ADHD.

Psychosocial Adjustment Throughout University: A Longitudinal Investigation of the Roles of Sleep Quality and Emotion Dysregulation

Sleep problems and emotion dysregulation are associated with depressive symptoms and alcohol use but little research has examined the long-term associations and the direction of effects between these factors. We examined these relationships with 1132 undergraduates (70.5% female) over 5 years. Sleep problems and emotion dysregulation, sleep problems and depressive symptoms, and emotion dysregulation and depressive symptoms were all related bidirectionally. Tests of indirect effects indicated that sleep problems predicted depressive symptoms over time (and vice versa) via emotion dysregulation and emotion dysregulation predicted depressive symptoms over time (and vice versa) via sleep problems. The results highlight the need to assess direction of effects, given that many factors that are typically seen as "predictors" also can be framed as "outcomes".

Adult Attention-Deficit/Hyperactivity Disorder (ADHD) and Insomnia: an Update of the Literature

PURPOSE OF REVIEW

Insomnia is diagnosed when there is dissatisfaction with sleep quantity or quality. It has a prevalence in the general population ranging from 31 to 56%. Insomnia has previously been associated with adult attention-deficit/hyperactivity disorder (ADHD). In this review, we address three topics: (1) the cross-sectional relationship between ADHD and insomnia in adulthood, (2) the longitudinal relationship between ADHD and insomnia, and (3) insomnia as a side effect of pharmacological treatments for adult ADHD.

RECENT FINDINGS

Three cross-sectional, clinical, and population studies report a prevalence of insomnia in ADHD adults ranging from 43 to 80%. Longitudinal evidence for a link between childhood-onset ADHD and insomnia at later age is mixed, with one study confirming and another study not supporting such a longitudinal association. In randomized, placebo-controlled trials, insomnia is reported significantly more often in the treatment arm than in the placebo arm. In varying percentages of trial participants, insomnia is a treatment-emergent adverse effect in triple-bead mixed amphetamine salts (40-45%), dasotraline (35-45%), lisdexamfetamine (10-19%), and extended-release methylphenidate (11%). Ten to seventeen percent of subjects in placebo-controlled trials of atomoxetine report insomnia, possibly related to poor metabolizer status. The mechanisms explaining the relationship between ADHD and sleep problems are incompletely understood, but both genetic and non-shared environmental influences may be involved. Adults with ADHD should be assessed for insomnia, which is frequently comorbid, and both conditions should be treated.

Externalizing Behaviors and Callous-Unemotional Traits: Different Associations With Sleep Quality

Study Objectives

Sleep quality is associated with different aspects of psychopathology, but relatively little research has examined links between sleep quality and externalizing behaviors or callous-unemotional traits. We examined: (1) whether an association exists between sleep quality and externalizing behaviors; (2) whether anxiety mediates this association; (3) whether callous-unemotional traits are associated with sleep quality.

Methods

Data from two studies were used. Study 1 involved 1556 participants of the G1219 study aged 18-27 years (62% female). Questionnaire measures assessed sleep quality, anxiety, externalizing behaviors, and callous-unemotional traits. Study 2 involved 338 participants aged 18-66 years (65% female). Questionnaires measured sleep quality, externalizing behaviors, and callous-unemotional traits. In order to assess objective sleep quality, actigraphic data were also recorded for a week from a subsample of study 2 participants (n = 43).

Results

In study 1, poorer sleep quality was associated with greater externalizing behaviors. This association was partially mediated by anxiety and moderated by levels of callous-unemotional traits. There was no significant relationship between sleep quality and callous-unemotional traits. In study 2, poorer sleep quality, as assessed via self-reported but not objective measures, was associated with higher levels of externalizing behaviors. Furthermore, in study 2, better sleep quality (indicated in both questionnaires and actigraphy measures: lower mean activity, and greater sleep efficiency) was associated with higher levels of callous-unemotional traits.

Conclusions

Self-reports of poorer sleep quality are associated with externalizing behaviors, and this association is partially mediated by anxiety. Callous-unemotional traits are not associated with poor sleep and may even be related to better sleep quality. This is an exceptional finding given that poor sleep quality appears to be a characteristic of most psychopathology.

Efficacy and safety of acupuncture treatment on primary insomnia: a randomized controlled trial

OBJECTIVE

The objective of this study was to evaluate the efficacy and safety of acupuncture treatment for primary insomnia.

METHODS

We conducted a single-center, single-blinded, and randomized controlled clinical trial. Seventy-two patients with primary insomnia were randomly assigned into two groups - the acupuncture group, who received acupuncture treatment, and the control group, who received sham acupuncture treatment. The treatment was given three times a week for four weeks. Patients were asked to wear sleep monitors and complete questionnaires every two weeks for a total of eight weeks. The primary outcome was the Insomnia Severity Index (ISI). The secondary outcomes were sleep parameters including sleep efficiency (SE), sleep awakenings (SA) and total sleep time (TST) recorded by the Actigraphy, as well as scores of the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS).

RESULTS

Compared with pretreatment baseline, patients in both groups had varying degrees of improvements in their sleep conditions. Paired t-test showed that there was a significant difference in all indicators in the acupuncture group before and after acupuncture treatment. One-way analysis of covariance adjusted for baseline scores indicated that the ISI improved dramatically in the acupuncture group at two weeks post-treatment (F = 11.3, p = 0.001), four weeks post-treatment (F = 33.6, p < 0.001), 2 weeks follow-up (F = 39.4, p < 0.001) and four weeks follow-up (F = 34.1, p < 0.001). Similar significant improvements can also be observed in the SE, TST and SDS scores. Although no differences in SA and SAS were shown between the two groups until the end of the treatment, remarkable decrements in SA and SAS were found in the acupuncture treatment group after the two-week and four-week follow-ups.

CONCLUSION

Acupuncture treatment is more effective than sham acupuncture treatment in increasing insomnia patients' sleep quality and improving their psychological health.

TRIAL REGISTRATION

Chinese Clinical Trial Registry: Chi CTR-TRC-14004859.

ADHD and Sleep Quality: Longitudinal Analyses From Childhood to Early Adulthood in a Twin Cohort

Attention-deficit/hyperactivity disorder (ADHD) is associated with poor sleep quality, but there is more to learn about the longitudinal association and aetiology of this association. We investigated the following: (a) Is there an association between childhood ADHD and poor sleep quality in young adulthood? (b) Is this driven by the long-term effects of childhood ADHD or concurrent associations with ADHD in young adulthood? (c) To what extent do genetic and environmental influences explain the overlap between symptoms of ADHD and poor sleep quality? Participants were from the Environmental Risk Longitudinal Twin Study of 2,232 twin children born in the United Kingdom in 1994-1995. We ascertained ADHD diagnoses at ages 5, 7, 10, 12, and 18. We assessed sleep quality using the Pittsburgh Sleep Quality Index at age 18. We used regression models to examine longitudinal associations and bivariate twin modelling to test genetic and environmental influences. Children with ADHD had poorer sleep quality in young adulthood, but only if their ADHD persisted. Adults with ADHD had more sleep problems than those without ADHD, over and above psychiatric comorbidity and maternal insomnia. ADHD and sleep problems in young adulthood were associated because of genetic (55%) and nonshared environmental influences (45%). Should ADHD remit, children with ADHD do not appear to have an increased risk of later sleep problems. Good quality sleep is important for multiple areas of functioning, and a better understanding of why adults with ADHD have poorer sleep quality will further the goal of improving treatments.

Dad's Snoring May Have Left Molecular Scars in Your DNA: the Emerging Role of Epigenetics in Sleep Disorders

The sleep-wake cycle is a biological phenomena under the orchestration of neurophysiological, neurochemical, neuroanatomical, and genetical mechanisms. Moreover, homeostatic and circadian processes participate in the regulation of sleep across the light-dark period. Further complexity of the understanding of the genesis of sleep engages disturbances which have been characterized and classified in a variety of sleep-wake cycle disorders. The most prominent sleep alterations include insomnia as well as excessive daytime sleepiness. On the other side, several human diseases have been linked with direct changes in DNA, such as chromatin configuration, genomic imprinting, DNA methylation, histone modifications (acetylation, methylation, ubiquitylation or sumoylation, etc.), and activating RNA molecules that are transcribed from DNA but not translated into proteins. Epigenetic theories primarily emphasize the interaction between the environment and gene expression. According to these approaches, the environment to which mammals are exposed has a significant role in determining the epigenetic modifications occurring in chromosomes that ultimately would influence not only development but also the descendants' physiology and behavior. Thus, what makes epigenetics intriguing is that, unlike genetic variation, modifications in DNA are altered directly by the environment and, in some cases, these epigenetic changes may be inherited by future generations. Thus, it is likely that epigenetic phenomena might contribute to the homeostatic and/or circadian control of sleep and, possibly, have an undescribed link with sleep disorders. An exciting new horizon of research is arising between sleep and epigenetics since it represents the relevance of the study of how the genome learns from its experiences and modulates behavior, including sleep.

Exploring Gender Difference in Sleep Quality of Young Adults: Findings from a Large Population Study

OBJECTIVES

To explore if gender difference in sleep quality is due to higher prevalence of depression in females, and whether socio-demographic and lifestyle factors have a differential effect on sleep quality in males and females.

METHODS

Youth self-reports and the Pittsburgh Sleep Quality Index were used to assess sleep quality and associated risk factors. Logistic regression analyses were used to analyze the association between various risk factors and poor sleep quality.

RESULTS

Reports from 3,778 young adults (20.6±0.86 years) indicate a higher prevalence of poor sleep quality in females than males (65.1% vs. 49.8%). It seems that gender difference in poor sleep is independent of depression, socio-demographics, and lifestyle factors, since the higher odds of poor sleep quality in females was robust to adjust for depression, socio-demographics, and lifestyle factors (OR: 1.53, 95% CI: 1.23-1.90). Lifestyle factors (eg, smoking) (OR 1.91; 95% CI 1.05-3.46) were associated with sleep quality in only males.

CONCLUSION

Our findings indicate that female vulnerability to poor sleep quality should be explored beyond psycho-social disparities. Perhaps, exploring if the female predisposition to poor sleep quality originates at the biological level could lead to the answer.

Self-referral to group cognitive behavioural therapy: Is it effective for treating chronic insomnia?

OBJECTIVES

To evaluate the effectiveness of a short (3 session) programme of group cognitive behavioural therapy (CBT) on insomnia, sleepiness and symptoms of anxiety and depression.

METHODS

Prospective observational study of group CBT with follow-up at 3 months. Participants were self-referred patients with chronic insomnia. Outcome measures were the insomnia severity scale (ISI), the Epworth sleepiness scale (ESS), depression (Pichot scale), and the number of anxiety symptoms.

RESULTS

Participation in CBT was offered to 489 patients of whom 474 completed the programme and 154 were followed up at 3 months. Significant improvements in insomnia were seen: ISI score (17.74-14.27, P<0.0001) after CBT and at follow-up (13.78, P<0.0001). At the end of CBT, 76% (59/78) with initial severe insomnia and 52% (132/255) with moderate insomnia were improved, maintained at 3 months in 71% (15/21) with severe insomnia and 56% (50/90) with moderate insomnia. Depression and anxiety symptoms were significantly improved: mean depression symptoms (4.15-3.35, P<0.0001) and anxiety symptoms (4.52-3.95, P<0.0001), maintained at 3 months with mean depression symptoms (3.17, P<0.0001) and mean anxiety symptoms (3.62, P<0.0001). Sleepiness increased between baseline and the end of the group (6.67-7.24, P=0.015) followed by a reduction at 3 months (7.19-6.34 at 3 months, P=0.001). Initial ISI score but neither sex nor age were predictive of outcome.

CONCLUSIONS

A short programme of CBT can improve sleep, depression and anxiety symptoms in self-referred patients suffering from chronic insomnia with good adherence and maximum benefit in patients with severe insomnia.

Longitudinal Stability of Genetic and Environmental Influences on the Association between Diurnal Preference and Sleep Quality in Young Adult Twins and Siblings

Overlapping genetic influences have been implicated in diurnal preference and subjective sleep quality. Our overall aim was to examine overlapping concurrent and longitudinal genetic and environmental effects on diurnal preference and sleep quality over ~5 years. Behavioral genetic analyses were performed on data from the longitudinal British G1219 study of young adult twins and nontwin siblings. A total of 1556 twins and siblings provided data on diurnal preference (Morningness-Eveningness Questionnaire) and sleep quality (Pittsburgh Sleep Quality Index) at time 1 (mean age = 20.30 years, SD = 1.76; 62% female), and 862 participated at time 2 (mean age = 25.30 years, SD = 1.81; 66% female). Preference for eveningness was associated with poorer sleep quality at both time points ( r = 0.25 [95% confidence intervals {CIs} = 0.20-0.30] and r = 0.21 [CI = 0.15-0.28]). There was substantial overlap in the genetic influences on diurnal preference and sleep quality individually, across time (genetic correlations [rAs]: 0.64 [95% CI = 0.59-0.67] and 0.48 [95% CI = 0.42-.053]). There were moderate genetic correlations between diurnal preference and sleep quality concurrently and longitudinally (rAs = 0.29-0.60). Nonshared environmental overlap was substantially smaller for all cross-phenotype associations (nonshared environmental correlations (rEs) = -0.02 to 0.08). All concurrent and longitudinal associations within and between phenotypes were largely accounted for by genetic factors (explaining between 60% and 100% of the associations). All shared environmental effects were nonsignificant. Nonshared environmental influences played a smaller role on the associations between phenotypes (explaining between -0.06% and 40% of the associations). These results suggest that to some extent, similar genes contribute to the stability of diurnal preference and sleep quality throughout young adulthood but also that different genes play a part over this relatively short time frame. While there was evidence of genetic overlap between phenotypes concurrently and longitudinally, the possible emergence of new genetic factors (or decline of previously associated factors) suggests that molecular genetic studies focusing on young adults should consider more tightly specified age groups, given that genetic effects may be time specific.

[Factors associated with poor sleep quality in the Brazilian population ≥ 40 years of age: VIGICARDIO Study]

OBJECTIVE

The prevalence of poor sleep quality in men and women ≥ 40 years old from the VIGICARDIO Study was determined, and sociodemographic, health, lifestyle and social capital factors associated with poor sleep quality were identified.

METHODS

A population-based study conducted in 2011 among 1,058 non-institutionalised individuals randomly selected from Cambé, Paraná State, Brazil. Logistic regression was used to evaluate the association between sleep quality and sociodemographic, health, lifestyle and social capital factors in men and women.

RESULTS

The prevalence of poor sleep quality was 34% in men and 44% in women. Having bad/regular self-rated health status was a factor associated with poor sleep quality in men (OR: 1.79; 95% CI: 1.17-2.72) and women (OR: 2.43; 95% CI: 1.68-3.53). Being obese (OR: 1.67; 95% CI: 1.13-2.46), having depression (OR: 2.09; 95% CI: 1.41-3.13) and presenting temporal orientation difficulties (OR: 1.95; 95% CI: 1.08-3.52) were associated factors in women. Difficulty to understand what is explained (OR: 2.18; 95% CI: 1.16-4.09) and alcohol abuse (OR: 1.85; 95% CI: 1.21-2.83) were associated factors in men.

CONCLUSION

Factors affecting sleep quality are different for men and for women. These factors should be taken into consideration when devising activities that promote good sleep quality, with a view to improving their effectiveness.

Sleep state misperception in schizophrenia: Are negative symptoms at work?

OBJECTIVE

This study investigates subjective and objective sleep quality to ascertain whether there is a sleep state misperception in schizophrenia patients, as well as analyze potential effect factors.

METHODS

A total of 148 inpatients with schizophrenia admitted to Beijing HuiLongGuan Hospital were enrolled in this study. The quality of objective sleep was assessed by polysomnography (PSG). On the second day after the successful completion of the PSG evaluation, an interview was arranged to collect patients' recorded subjective evaluation on sleep time, sleep latency, and wake times. Demographic information was collected from an interview, medical records were reviewed, and psychiatric symptoms were assessed using the Positive And Negative Symptom Scale (PANSS).

RESULTS

The main finding of this study was that schizophrenic patients exhibited sleep state misperception with a pattern of overestimation of total sleep time (TST) as well as sleep efficiency (SE), and an underestimation of sleep onset latency (SOL). Regarding the ±standard deviation of the differences between subjective and objective TST as a clinical acceptable range, the patients were divided into three groups: the overestimate group, the normal group, and the underestimate group. The differences of total PANSS score, especially the PANSS-N score in the overestimate group, the normal group and the underestimate group were significant, and there were significant differences between the overestimate group and the other groups.

CONCLUSION

A comprehensive evaluation of the subjective and objective sleep quality in patients with schizophrenia is needed, especially when negative symptoms are severe.

Is there an association between short sleep duration and adolescent anxiety disorders?

OBJECTIVE

The purpose of this study is to provide the first data on the prospective, reciprocal association between short sleep duration and DSM-IV anxiety disorders among adolescents.

METHODS

A community-based two-wave cohort study included 4175 youths aged 11-17 years at baseline, with 3134 of these followed up a year later, drawn from a metropolitan area with a population of over 4 million. Anxiety is defined as any DSM-IV anxiety disorder in the past year generalized anxiety: panic disorder, agoraphobia without panic, social phobia, and post-traumatic stress disorder. Short sleep duration is defined as ≤6 h of sleep per night.

RESULTS/CONCLUSIONS

In multivariate analyses, short sleep duration every night at baseline predicted anxiety disorders at follow-up, controlling for anxiety at baseline. Examining the reciprocal association, anxiety disorders at baseline did not predict short sleep duration at follow-up. We are the first to examine the reciprocal effects for anxiety disorders and sleep duration among adolescents using prospective data. The data suggest that reduced quantity of sleep may increase risk for anxiety, but anxiety does not increase risk for decreased sleep duration.

Annual Research Review: Sleep problems in childhood psychiatric disorders--a review of the latest science

BACKGROUND

Hippocrates flagged the value of sleep for good health. Nonetheless, historically, researchers with an interest in developmental psychopathology have largely ignored a possible role for atypical sleep. Recently, however, there has been a surge of interest in this area, perhaps reflecting increased evidence that disturbed or insufficient sleep can result in poor functioning in numerous domains. This review outlines what is known about sleep in the psychiatric diagnoses most relevant to children and for which associations with sleep are beginning to be understood. While based on a comprehensive survey of the literature, the focus of the current review is on the latest science (largely from 2010). There is a description of both concurrent and longitudinal links as well as possible mechanisms underlying associations. Preliminary treatment research is also considered which suggests that treating sleep difficulties may result in improvements in behavioural areas beyond sleep quality.

FINDINGS

To maximise progress in this field, there now needs to be: (a) greater attention to the assessment of sleep in children; (b) sleep research on a wider range of psychiatric disorders; (c) a greater focus on and examination of mechanisms underlying associations; (d) a clearer consideration of developmental questions and (e) large-scale well-designed treatment studies.

CONCLUSIONS

While sleep problems may sometimes be missed by parents and healthcare providers; hence constituting a hidden risk for other psychopathologies - knowing about these difficulties creates unique opportunities. The current excitement in this field from experts in diverse areas including developmental psychology, clinical psychology, genetics and neuropsychology should make these opportunities a reality.

Insomnia and Relationship with Anxiety in University Students: A Cross-Sectional Designed Study

Purpose

Sleep disorders (SDs) are now recognized as a public health concern with considerable psychiatric and societal consequences specifically on the academic life of students. The aims of this study were to assess SDs in a group of university students in Lebanon and to examine the relationship between SDs and anxiety.

Methods

An observational cross-sectional study was conducted at Saint-Joseph University, Lebanon, during the academic year 2013–2014. Four questionnaires were face-to-face administered to 462 students after obtaining their written consent: Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Generalized Anxiety Disorder 7-item scale (GAD-7).

Results

The prevalence of clinically significant insomnia was 10.6% (95% CI: 7.8–13.4%), more frequent in first year students. ISI mean score was 10.06 (SD = 3.76). 37.1% of the participants were poor sleepers. Excessive daytime sleepiness (EDS) and poor sleep were significantly more frequent among participants with clinical insomnia (p = 0.031 and 0.001 respectively). Clinically significant anxiety was more frequent in students suffering from clinical insomnia (p = 0.006) and in poor sleepers (p = 0.003). 50.8% of the participants with clinically significant anxiety presented EDS versus 30.9% of those with no clinically significant anxiety (p<0.0001).

Conclusions

The magnitude of SDs in this sample of Lebanese university students demonstrate the importance of examining sleep health in this population. Moreover, the link between SD and anxiety reminds us of the importance of treating anxiety as soon as detected and not simply targeting the reduction of sleep problems.

Subjective Sleep Quality Deteriorates Before Development of Painful Temporomandibular Disorder

There is good evidence that poor sleep quality increases risk of painful temporomandibular disorder (TMD). However, little is known about the course of sleep quality in the months preceding TMD onset, and whether the relationship is mediated by heightened sensitivity to pain. The Pittsburgh Sleep Quality Index was administered at enrollment into the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) prospective cohort study. Thereafter the Sleep Quality Numeric Rating Scale was administered every 3 months to 2,453 participants. Sensitivity to experimental pressure pain and pinprick pain stimuli was measured at baseline and repeated during follow-up of incident TMD cases (n = 220) and matched TMD-free controls (n = 193). Subjective sleep quality deteriorated progressively, but only in those who subsequently developed TMD. A Cox proportional hazards model showed that risk of TMD was greater among participants whose sleep quality worsened during follow-up (adjusted hazard ratio = 1.73, 95% confidence limits = 1.29, 2.32). This association was independent of baseline measures of sleep quality, psychological stress, somatic awareness, comorbid conditions, nonpain facial symptoms, and demographic characteristics. Poor baseline sleep quality was not significantly associated with baseline pain sensitivity or with subsequent change in pain sensitivity. Furthermore the relationship between sleep quality and TMD incidence was not mediated via baseline pain sensitivity or change in pain sensitivity.

PERSPECTIVE

Subjective sleep quality deteriorates progressively before the onset of painful TMD, but sensitivity to experimental pain does not mediate this relationship. Furthermore, the relationship is independent of potential confounders such as psychological stress, somatic awareness, comorbid conditions, nonpain facial symptoms, and various demographic factors.

Self-reported sleep quality, weight status and depression in young adult twins and siblings

Background

Research supporting relationships between sleep quality, weight, depression and anxiety has typically examined the relationships separately rather than simultaneously, potentially hampering insights into the characteristics of reported links. This study aimed to fill this gap in the research to provide further insight into the factors associated with sleep.

Methods

Data from wave 4 of the G1219 cohort were used in cross-sectional analyses. The sample comprised 1392 adult twins and siblings aged 18–27 years. Participants completed a self-report questionnaire which included the Pittsburgh Sleep Quality Index as a measure of sleep quality, the Short Mood and Feelings Questionnaire as a measure of depression symptoms and the Revised Symptoms of Anxiety Scale as a measure of anxiety symptoms. Participants were asked to self-report general health and weight and height so researchers could derive weight status from measures of body mass index.

Results

An analysis of covariance including weight status, depression, anxiety and general health as predictors and sleep quality as the outcome revealed main effects of depression (F(3,1163) = 10.93, p < 0.001) and general health (F(4,1163) = 5.72, p < 0.001) only.

Conclusions

A direct relationship between weight and sleep should not be assumed as it is possible that the relationship is at least in part accounted for by depression symptoms or general health. Depression symptoms and general health may also account for the association between sleep quality and anxiety symptoms in young adults.

Sleep and anxiety in late childhood and early adolescence

PURPOSE OF REVIEW

Adolescence is a period of dynamic change in both sleep and emotional systems, with related increases in problems controlling emotion and behavior. Youth with anxiety enter adolescence with pre-existing vulnerabilities in systems of sleep and emotion that may place them at heightened risk. This review summarizes recent research on sleep and anxiety during the transition to adolescence, and highlights emerging themes.

RECENT FINDINGS

Prospective studies support that sleep predicts anxiety symptoms in early adolescence. Notably, robust evidence for subjective sleep problems in anxious youth is not well corroborated by objective assessments. Longitudinal designs and methodology that carefully examine dimensions of anxiety and sleep may clarify inconsistencies. Preliminary evidence suggests that late childhood to early adolescence may be a sensitive period for escalating problems with sleep and anxiety. Recent advances in the neuroscience of sleep can further refine integrative mechanistic models of developmental psychopathology - the role of sleep in emotional learning and memory is provided as an example.

SUMMARY

Sleep problems are common and prospectively predict escalating anxiety symptoms. Precision is needed regarding the nature of sleep disruption, and how and when sleep affects various aspects of developmental trajectories. This precision, along with advances in the neuroscience of sleep, may lead to developmentally informed translational interventions.

Referral Practices for Cognitive Behavioral Therapy for Insomnia: A Survey Study

This study examined referring practices for cognitive behavioral therapy for insomnia (CBTI) by physicians at University of Michigan Hospitals and Weill Cornell Medical College of Cornell University. A five-item questionnaire was sent via email that inquired about the physician's patient load, number of patients complaining of insomnia, percent referred for CBTI, and impressions of what is the most effective method for improving sleep quality in their patients with insomnia. The questionnaire was completed by 239 physicians. More physicians believed a treatment other than CBTI and/or medication was most effective (N = 83). “Sleep hygiene” was recommended by a third of the sample. The smallest number of physicians felt that CBTI alone was the most effective treatment (N = 22). Additional physician education is needed.

Is insomnia associated with deficits in neuropsychological functioning? Evidence from a population-based study

STUDY OBJECTIVES

People with insomnia complain of cognitive deficits in daily life. Results from empirical studies examining associations between insomnia and cognitive impairment, however, are mixed. Research is needed that compares treatment-seeking and community-based insomnia study samples, measures subjective as well as objective cognitive functioning, and considers participants' pre-insomnia cognitive function.

DESIGN AND PARTICIPANTS

We used data from the Dunedin Study, a representative birth cohort of 1,037 individuals, to examine whether insomnia in early midlife was associated with subjective and objective cognitive functioning. We also tested whether individuals with insomnia who reported seeking treatment for their sleep problems (treatment-seekers) showed greater impairment than other individuals with insomnia (non-treatment-seekers). The role of key confounders, including childhood cognitive ability and comorbid health conditions, was evaluated.

MEASUREMENTS

Insomnia was diagnosed at age 38 according to DSM-IV criteria. Objective neuropsychological assessments at age 38 included the WAIS-IV IQ test, the Wechsler Memory Scale, and the Trail-Making Test. Childhood cognitive functioning was assessed using the Wechsler Intelligence Scale for Children-Revised (WISC-R).

RESULTS

A total of 949 cohort members were assessed for insomnia symptoms and other study measures at age 38. Although cohort members with insomnia (n = 186, 19.6%) had greater subjective cognitive impairment than their peers at age 38, they did not exhibit greater objective impairment on formal testing. Treatment-seekers, however, exhibited significant objective impairment compared to non-treatment-seekers. Controlling for comorbidity, daytime impairment, and medications slightly decreased this association. Childhood cognitive deficits antedated the adult cognitive deficits of treatment-seekers.

CONCLUSIONS

Links between insomnia and cognitive impairment may be strongest among individuals who seek clinical treatment. Clinicians should take into account the presence of complex health problems and lower premorbid cognitive function when planning treatment for insomnia patients.

Anxiety Disorders and Sleep in Children and Adolescents

Sleep problems are common in children and adolescents. A growing body of research has explored the relationship between sleep problems and anxiety in youth. When reviewing the literature, methodologic inconsistencies need to be considered, such as variation in conceptualization of sleep problems, measurement of sleep, and the classification of anxiety. Despite this, there seems to be good evidence of concurrent and longitudinal associations between sleep difficulties and anxiety in community and clinical samples of young people. Potential mechanisms are proposed. There is a need for further exploration of these relationships, with the hope of aiding preventive capability and developing useful treatments.

Coping mediates the effects of depressive symptoms on sleep problems

OBJECTIVES

To explore the relationships of perceived stress and depressive symptoms to sleep problems, testing for mediation by adaptive and maladaptive coping strategies.

METHODS

Alternative high school students (N = 1676) completed self-report surveys. Cross-sectional data were analyzed via Preacher and Hayes' procedures for multiple mediation.

RESULTS

The positive relationship between depressive symptoms and sleep problems was mediated partially by anger coping (positively related to sleep problems). The positive relationship between perceived stress and sleep problems was not mediated by coping strategies.

CONCLUSIONS

Findings provide information on psychological factors that may lead to poor sleep outcomes, and are useful for developing health promotion interventions to impact lifelong health behaviors.