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Feder MA, Baroni A. Just Let Me Sleep in: Identifying and Treating Delayed Sleep Phase Disorder in Adolescents. Psychiatr Clin North Am 2024; 47:163-178. [PMID: 38302205 DOI: 10.1016/j.psc.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Individuals with delayed sleep phase disorder (DSPD) are unable to naturally fall asleep and awake at conventional times; for this reason, DSPD is often mistaken for insomnia. However, unlike many patients with insomnia, those with DSPD struggle to get up at appropriate times. DSPD is associated with school refusal, academic difficulties, and lower employment rate. DSPD in youth has prevalence as high as 16%, and is often comorbid with other psychiatric disorders. Treatments include appropriate light exposure during the day, melatonin use, developing an evening routine that minimizes arousal-increasing activities, and gradually shifting sleep-wake times toward more functional ones.
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Affiliation(s)
- Michael A Feder
- Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at NYU Langone, NYC H+H/Bellevue, New York, NY, USA; Child Study Center, One Park Avenue, 7th Floor, New York, NY 10016, USA
| | - Argelinda Baroni
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 7th Floor, New York, NY 10016, USA.
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Segalàs C, Labad J, Salvat-Pujol N, Real E, Alonso P, Bertolín S, Jiménez-Murcia S, Soriano-Mas C, Monasterio C, Menchón JM, Soria V. Sleep disturbances in obsessive-compulsive disorder: influence of depression symptoms and trait anxiety. BMC Psychiatry 2021; 21:42. [PMID: 33446149 PMCID: PMC7809865 DOI: 10.1186/s12888-021-03038-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/28/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Sleep disturbances have been reported in obsessive-compulsive disorder (OCD) patients, with heterogeneous results. The aim of our study was to assess sleep function in OCD and to investigate the relationship between sleep and the severity of obsessive-compulsive (OC) symptoms, depressive symptoms and trait anxiety. METHODS Sleep quality was measured in 61 OCD patients and 100 healthy controls (HCs) using the Pittsburgh Sleep Quality Index (PSQI). Multiple linear regression was conducted to explore the association between sleep and psychopathological measures; a mediation analysis was also performed. RESULTS OCD patients showed poor sleep quality and more sleep disturbances compared to HCs. The severity of depression, trait anxiety and OC symptomatology were correlated with poor sleep quality. Multiple linear regression analyses controlling for potential confounders revealed that the severity of depression and trait anxiety were independently related to poor sleep quality in OCD. A mediation analysis showed that both the severity of trait anxiety and depression mediate the relationship between the severity of OC symptoms and poor sleep quality among patients with OCD. CONCLUSIONS Our findings support the existence of sleep disturbances in OCD. Trait anxiety and depression play a key role in sleep quality among OCD patients.
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Affiliation(s)
- Cinto Segalàs
- grid.411129.e0000 0000 8836 0780Department of Psychiatry, Bellvitge University Hospital. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Feixa Llarga s/n. 08907, L’Hospitalet de Llobregat, Barcelona, Spain ,grid.469673.90000 0004 5901 7501Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain ,grid.5841.80000 0004 1937 0247Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Javier Labad
- grid.469673.90000 0004 5901 7501Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain ,Department of Mental Health, Consorci Sanitari del Maresme. Institut d’Investigació i Innovació Parc Taulí(I3PT), Barcelona, Spain
| | - Neus Salvat-Pujol
- grid.411129.e0000 0000 8836 0780Department of Psychiatry, Bellvitge University Hospital. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Feixa Llarga s/n. 08907, L’Hospitalet de Llobregat, Barcelona, Spain ,grid.469673.90000 0004 5901 7501Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain ,grid.5841.80000 0004 1937 0247Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain ,Department of Mental Health, Consorci Sanitari del Maresme. Institut d’Investigació i Innovació Parc Taulí(I3PT), Barcelona, Spain
| | - Eva Real
- grid.411129.e0000 0000 8836 0780Department of Psychiatry, Bellvitge University Hospital. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Feixa Llarga s/n. 08907, L’Hospitalet de Llobregat, Barcelona, Spain ,grid.469673.90000 0004 5901 7501Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain
| | - Pino Alonso
- grid.411129.e0000 0000 8836 0780Department of Psychiatry, Bellvitge University Hospital. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Feixa Llarga s/n. 08907, L’Hospitalet de Llobregat, Barcelona, Spain ,grid.469673.90000 0004 5901 7501Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain ,grid.5841.80000 0004 1937 0247Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Sara Bertolín
- grid.411129.e0000 0000 8836 0780Department of Psychiatry, Bellvitge University Hospital. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Feixa Llarga s/n. 08907, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Susana Jiménez-Murcia
- grid.411129.e0000 0000 8836 0780Department of Psychiatry, Bellvitge University Hospital. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Feixa Llarga s/n. 08907, L’Hospitalet de Llobregat, Barcelona, Spain ,grid.5841.80000 0004 1937 0247Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain ,grid.413448.e0000 0000 9314 1427Centro de Investigación Biomédica en Red de Fisiopatología Obesidad y Nutrición (CIBEROBN), Carlos III Health Institute, Madrid, Spain
| | - Carles Soriano-Mas
- grid.411129.e0000 0000 8836 0780Department of Psychiatry, Bellvitge University Hospital. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Feixa Llarga s/n. 08907, L’Hospitalet de Llobregat, Barcelona, Spain ,grid.469673.90000 0004 5901 7501Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain ,grid.7080.fDepartment of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Carmen Monasterio
- grid.417656.7Multidisciplinary Sleep Unit, Department of Respiratory Medicine, Bellvitge University Hospital. Bellvitge Biomedical Research Institute (IDIBELL), Section of Respiratory Medicine, L’Hospitalet de Llobregat, Barcelona, Spain ,grid.413448.e0000 0000 9314 1427Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Carlos III Health Institute, Madrid, Spain
| | - José M. Menchón
- grid.411129.e0000 0000 8836 0780Department of Psychiatry, Bellvitge University Hospital. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Feixa Llarga s/n. 08907, L’Hospitalet de Llobregat, Barcelona, Spain ,grid.469673.90000 0004 5901 7501Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain ,grid.5841.80000 0004 1937 0247Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Virginia Soria
- Department of Psychiatry, Bellvitge University Hospital. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Feixa Llarga s/n. 08907, L'Hospitalet de Llobregat, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain. .,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain.
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Abstract
Individuals with delayed sleep phase disorder (DSPD) are unable to naturally fall asleep and awake at conventional times; for this reason, DSPD is often mistaken for insomnia. However, unlike many patients with insomnia, those with DSPD struggle to get up at appropriate times. DSPD is associated with school refusal, academic difficulties, and lower employment rate. DSPD in youth has prevalence as high as 16%, and is often comorbid with other psychiatric disorders. Treatments include appropriate light exposure during the day, melatonin use, developing an evening routine that minimizes arousal-increasing activities, and gradually shifting sleep-wake times toward more functional ones.
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Affiliation(s)
- Michael A Feder
- Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at NYU Langone, NYC H+H/Bellevue, New York, NY, USA; Child Study Center, One Park Avenue, 7th Floor, New York, NY 10016, USA
| | - Argelinda Baroni
- Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at NYU Langone, NYC H+H/Bellevue, New York, NY, USA; Child Study Center, One Park Avenue, 7th Floor, New York, NY 10016, USA.
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Abstract
PURPOSE OF REVIEW Sleep timing, quantity, and quality are controlled by homeostatic and circadian systems. Circadian clock systems are present in all cells and organs and their timing is determined by a transcriptional-translational feedback loop of circadian genes. Individual cellular clocks are synchronized by the central body clock, situated in the suprachiasmatic nucleus, which communicates with them through humoral and neural signals including melatonin. The circadian system controls both the circadian period: (i.e., the length of the intrinsic clock), but also the circadian phase (i.e., the clock timing). An important determinant of the circadian system is light exposure. In most humans, the circadian period is slightly longer than 24 h and without regular resetting it tends to drift, leading to progressively later bedtimes and wake times and a tendency to cycle though periods of normal and abnormal sleep. Blind patients are thus at an increased risk of abnormal circadian function. The purpose of this article is to review recent research and clinical management of circadian rhythm disorders in blind patients. RECENT FINDINGS Blind patients can present delayed and advanced sleep phase disorders but the most common abnormality in totally blind patients without light perception is non-24-hour sleep-wake disorder (N24SWD). This is rare in the general population but may affect up to 50% of blind patients without light perception. The diagnosis of a circadian rhythm disorder in the blind is complex. New screening tools have been developed but actigraphy and repeated melatonin profiles over 24 h remain essential. Circadian disorders in the blind are frequent, especially in the patients without light perception. They require accurate diagnosis in order to target treatment. Determining the precise nature of a sleep disorder in blind patients with a suspected circadian rhythm abnormality is complex and requires a detailed clinical history with sleep diaries and the use of actigraphy and melatonin profiles.
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Richardson C, Cain N, Bartel K, Micic G, Maddock B, Gradisar M. A randomised controlled trial of bright light therapy and morning activity for adolescents and young adults with Delayed Sleep-Wake Phase Disorder. Sleep Med 2018; 45:114-23. [PMID: 29680419 DOI: 10.1016/j.sleep.2018.02.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/16/2018] [Accepted: 02/01/2018] [Indexed: 12/17/2022]
Abstract
A randomised controlled trial evaluated bright light therapy and morning activity for the treatment of Delayed Sleep-Wake Phase Disorder (DSWPD) in young people. 60 adolescents and young adults (range = 13-24 years, mean = 15.9 ± 2.2 y, 63% f) diagnosed with DSWPD were randomised to receive three weeks of post-awakening Green Bright Light Therapy (∼507 nm) and Sedentary Activity (sitting, watching TV), Green Bright Light Therapy and Morning Activity (standing, playing motion-sensing videogame), Red Light Therapy (∼643 nm) and Sedentary Activity or Red Light Therapy and Morning Activity. Sleep (ie sleep onset time, wake up time, sleep onset latency, total sleep time) and daytime functioning (ie morning alertness, daytime sleepiness, fatigue, functional impairment) were measured pre-treatment, post-treatment and at one and three month follow-up. Contrary to predictions, there were no significant differences in outcomes between treatment groups; and interaction effects between treatment group and time for all outcome variables were not statistically significant. However, adolescents and young adults in morning activity conditions did not meaningfully increase their objective activity (ie movement frequency). Overall, adolescents reported significantly improved sleep timing (d = 0.30-0.46), sleep onset latency (d = 0.32) and daytime functioning (d = 0.45-0.87) post-treatment. Improvements in sleep timing (d = 0.53-0.61), sleep onset latency (d = 0.57), total sleep time (d = 0.51), and daytime functioning (d = 0.52-1.02) were maintained, or improved upon, at the three month follow-up. However, relapse of symptomology was common and 38% of adolescents and young adults requested further treatment in addition to the three weeks of light therapy. Although there is convincing evidence for the short-term efficacy of chronobiological treatments for DSWPD, long-term treatment outcomes can be improved. To address this gap in our current knowledge, avenues for future research are discussed. CLINICAL TRIAL Australian & New Zealand Clinical Trials Registry, https://www.anzctr.org.au, ACTRN12614000308695.
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Lee J, Na G, Joo EY, Lee M, Lee J. Clinical and polysomnographic characteristics of excessive daytime sleepiness in children. Sleep Breath 2017; 21:967-74. [PMID: 28822033 DOI: 10.1007/s11325-017-1545-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/26/2017] [Accepted: 07/20/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE This study aimed to delineate the clinical and polysomnography (PSG) characteristics of sleep disorders in children with excessive daytime sleepiness (EDS). METHODS Between February 2002 and June 2015, 622 pediatric patients with EDS were evaluated with overnight PSG and the Multiple Sleep Latency Test at the Samsung Medical Center. The medical records; questionnaire responses about depression, sleepiness, sleep habits; and sleep study data of 133 patients without obstructive sleep apnea (OSA) were reviewed retrospectively. RESULTS The patients (63 girls, 70 boys) slept for an average of 7 h 30 min and 8 h 44 min on weekdays and weekends, respectively. The mean Epworth Sleepiness Scale score was 11.01 ± 4.09 and did not differ significantly among sleep disorders. Among the 102 patients who completed the depression questionnaire, 53 showed depressive feelings, which were moderate or severe in 39, with no significant differences among specific sleep disorders. Thirty-four patients exhibited normal PSG results. Seventeen of them were concluded as not having any sleep disorders, and the others as having delayed sleep phase disorder (DSPD). Narcolepsy (n = 78) was the most common disorder, followed by DSPD (n = 17) and idiopathic hypersomnia (n = 12). CONCLUSIONS Pediatric patients with EDS had various sleep disorders and some did not have any sleep disorder despite EDS. More than half the patients with EDS showed depressive feelings affecting their daily lives. For pediatric patients with EDS, a systematic diagnostic approach including questionnaires for sleep habits and emotion and PSG is essential for accurate diagnosis and treatment.
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Esaki Y, Kitajima T, Ito Y, Koike S, Nakao Y, Tsuchiya A, Hirose M, Iwata N. Wearing blue light-blocking glasses in the evening advances circadian rhythms in the patients with delayed sleep phase disorder: An open-label trial. Chronobiol Int 2016; 33:1037-44. [PMID: 27322730 DOI: 10.1080/07420528.2016.1194289] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
It has been recently discovered that blue wavelengths form the portion of the visible electromagnetic spectrum that most potently regulates circadian rhythm. We investigated the effect of blue light-blocking glasses in subjects with delayed sleep phase disorder (DSPD). This open-label trial was conducted over 4 consecutive weeks. The DSPD patients were instructed to wear blue light-blocking amber glasses from 21:00 p.m. to bedtime, every evening for 2 weeks. To ascertain the outcome of this intervention, we measured dim light melatonin onset (DLMO) and actigraphic sleep data at baseline and after the treatment. Nine consecutive DSPD patients participated in this study. Most subjects could complete the treatment with the exception of one patient who hoped for changing to drug therapy before the treatment was completed. The patients who used amber lens showed an advance of 78 min in DLMO value, although the change was not statistically significant (p = 0.145). Nevertheless, the sleep onset time measured by actigraph was advanced by 132 min after the treatment (p = 0.034). These data suggest that wearing amber lenses may be an effective and safe intervention for the patients with DSPD. These findings also warrant replication in a larger patient cohort with controlled observations.
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Affiliation(s)
- Yuichi Esaki
- a Department of Psychiatry , Fujita Health University School of Medicine , Aichi , Japan
| | - Tsuyoshi Kitajima
- a Department of Psychiatry , Fujita Health University School of Medicine , Aichi , Japan
| | - Yasuhiro Ito
- b Department of Physiology , Fujita Health University School of Health Sciences , Aichi , Japan
| | - Shigefumi Koike
- c Department of Sleep Medicine , Toyohashi Mates Sleep Disorders Center , Aichi , Japan
| | - Yasumi Nakao
- c Department of Sleep Medicine , Toyohashi Mates Sleep Disorders Center , Aichi , Japan
| | - Akiko Tsuchiya
- a Department of Psychiatry , Fujita Health University School of Medicine , Aichi , Japan
| | - Marina Hirose
- a Department of Psychiatry , Fujita Health University School of Medicine , Aichi , Japan
| | - Nakao Iwata
- a Department of Psychiatry , Fujita Health University School of Medicine , Aichi , Japan
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Hiller RM, Lovato N, Gradisar M, Oliver M, Slater A. Trying to fall asleep while catastrophising: what sleep-disordered adolescents think and feel. Sleep Med 2013; 15:96-103. [PMID: 24333224 DOI: 10.1016/j.sleep.2013.09.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 09/24/2013] [Accepted: 09/28/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Catastrophising is a repetitive cognitive process related to sleep disturbance in adult insomnia patients. More recently catastrophising has been associated with increased sleep disturbances in community samples of children and adolescents, with this association mediated by anxiety and depression. However, there currently is no evidence of these processes outside of community samples; impeding our ability to draw clinical conclusions. Knowledge on such dysfunctional cognitive processes in adolescents experiencing sleep disturbance would be clinically beneficial in aetiology and intervention. Our research examined the link between catastrophising, anxiety, depression and sleep latency in a sample of sleep-disordered adolescents. We also explored specific catastrophising themes which may impact the sleep latency of these adolescents. METHOD Forty adolescents (age=15.1±1.5 years, 53% boys) diagnosed with delayed sleep phase disorder completed a 7-day sleep diary, along with measures of anxiety and depression and a catastrophising interview with a trained sleep therapist. RESULTS Several catastrophisation themes were generated, the most common concerning interpersonal and performance aspects of school. Bootstrapping analyses showed depression did not mediate the relationship between catastrophising and sleep; however, an indirect relationship was found between catastrophising, anticipatory anxiety, and sleep latency. CONCLUSION These findings have implications for the role of dysfunctional thinking in prolonging sleep onset for adolescents and providing a clinical framework for health professionals when assessing and treating adolescents with delayed sleep timing.
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Affiliation(s)
- Rachel M Hiller
- Flinders University, School of Psychology, Adelaide, SA, Australia
| | - Nicole Lovato
- Flinders University, School of Psychology, Adelaide, SA, Australia
| | - Michael Gradisar
- Flinders University, School of Psychology, Adelaide, SA, Australia.
| | - Mike Oliver
- Flinders University, School of Psychology, Adelaide, SA, Australia
| | - Amy Slater
- Flinders University, School of Psychology, Adelaide, SA, Australia
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Paterson JL, Reynolds AC, Ferguson SA, Dawson D. Sleep and obsessive-compulsive disorder (OCD). Sleep Med Rev 2013; 17:465-74. [PMID: 23499210 DOI: 10.1016/j.smrv.2012.12.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 10/24/2012] [Accepted: 12/12/2012] [Indexed: 11/18/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a chronic mental illness that can have a debilitating effect on daily functioning. A body of research reveals altered sleep behaviour in OCD sufferers; however, findings are inconsistent and there is no consensus on the nature of this relationship. Understanding sleep disturbance in OCD is of critical importance given the known negative consequences of disturbed sleep for mood and emotional wellbeing. A systematic literature search was conducted of five databases for studies assessing sleep in adults diagnosed with OCD. Fourteen studies met inclusion criteria and qualitative data analysis methods were used to identify common themes. There was some evidence of reduced total sleep time and sleep efficiency in OCD patients. Many of the sleep disturbances noted were characteristic of depression. However, some OCD sufferers displayed delayed sleep onset and offset and an increased prevalence of delayed sleep phase disorder (DSPD). Severe OCD symptoms were consistently associated with greater sleep disturbance. While the sleep of OCD patients has not been a major focus to date, the existing literature suggests that addressing sleep disturbance in OCD patients may ensure a holistic approach to treatment, enhance treatment efficacy, mitigate relapse and protect against the onset of co-morbid psychiatric illnesses.
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Affiliation(s)
- Jessica L Paterson
- Central Queensland University, Appleton Institute, PO Box 42, Goodwood SA 5034, Australia.
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Rhee MK, Lee HJ, Rex KM, Kripke DF. Evaluation of two circadian rhythm questionnaires for screening for the delayed sleep phase disorder. Psychiatry Investig 2012; 9:236-44. [PMID: 22993522 PMCID: PMC3440472 DOI: 10.4306/pi.2012.9.3.236] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 06/07/2012] [Accepted: 06/07/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Delayed sleep phase disorder (DSPD) is a condition in which patients often fall asleep some hours after midnight and have difficulty waking up in the morning. Circadian chronotype questionnaires such as Horne-Östberg Morningness-Eveningness Questionnaire (MEQ) and Basic Language Morningness (BALM) scale have been used for screening for DSPD. This study was to evaluate these two chronotype questionnaires for screening of DSPD. METHODS The study samples were 444 DSPD and 438 controls. Cronbach's alpha coefficient was calculated to evaluate for internal consistency. An exploratory factor analysis was conducted using principal-axis factoring. The diagnostic performance of a test was evaluated using Receiver Operating Characteristic (ROC) curve analysis. A discriminant function analysis was also performed. RESULTS For internal consistency, Cronbach's alpha of 0.898 for BALM was higher than the 0.837 for MEQ, though both have acceptable internal consistency. BALM has better construct validity than the MEQ because some MEQ items measure different dimensions. However, when we evaluated the efficiency of two questionnaires for DSPD diagnosis by using the ROC curve, the BALM was similar to the MEQ. In a discriminant analysis with the BALM to classify the two groups (DSPD vs. normal), 6 items were identified that resulted in good classification accuracy. Upon examination of the classification procedure, 94.2% of the originally grouped cases were classified correctly. CONCLUSION These findings suggest that the BALM has better psychometric properties than the MEQ in screening and discriminating DSPS.
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Affiliation(s)
- Min Kyu Rhee
- Department of Psychology, Gyeongsang National University, Jinju, Republic of Korea
| | - Heon-Jeong Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Katharine M. Rex
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Daniel F. Kripke
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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Gradisar M, Dohnt H, Gardner G, Paine S, Starkey K, Menne A, Slater A, Wright H, Hudson JL, Weaver E, Trenowden S. A randomized controlled trial of cognitive-behavior therapy plus bright light therapy for adolescent delayed sleep phase disorder. Sleep 2011; 34:1671-80. [PMID: 22131604 DOI: 10.5665/sleep.1432] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate cognitive-behavior therapy plus bright light therapy (CBT plus BLT) for adolescents diagnosed with delayed sleep phase disorder (DSPD). DESIGN Randomized controlled trial of CBT plus BLT vs. waitlist (WL) control with comparisons at pre- and post-treatment. There was 6-month follow-up for the CBT plus BLT group only. SETTING Flinders University Child & Adolescent Sleep Clinic, Adelaide, South Australia. PATIENTS 49 adolescents (mean age 14.6 ± 1.0 y, 53% males) diagnosed with DSPD; mean chronicity 4 y 8 months; 16% not attending school. Eighteen percent of adolescents dropped out of the study (CBT plus BLT: N = 23 vs. WL: N = 17). INTERVENTIONS CBT plus BLT consisted of 6 individual sessions, including morning bright light therapy to advance adolescents' circadian rhythms, and cognitive restructuring and sleep education to target associated insomnia and sleep hygiene. MEASUREMENTS AND RESULTS DSPD diagnosis was performed via a clinical interview and 7-day sleep diary. Measurements at each time-point included online sleep diaries and scales measuring sleepiness, fatigue, and depression symptoms. Compared to WL, moderate-to-large improvements (d = 0.65-1.24) were found at post-treatment for CBT plus BLT adolescents, including reduced sleep latency, earlier sleep onset and rise times, total sleep time (school nights), wake after sleep onset, sleepiness, and fatigue. At 6-month follow-up (N = 15), small-to-large improvements (d = 0.24-1.53) continued for CBT plus BLT adolescents, with effects found for all measures. Significantly fewer adolescents receiving CBT plus BLT met DPSD criteria at post-treatment (WL = 82% vs. CBT plus BLT = 13%, P < 0.0001), yet 13% still met DSPD criteria at the 6-month follow-up. CONCLUSIONS CBT plus BLT for adolescent DSPD is effective for improving multiple sleep and daytime impairments in the immediate and long-term. Studies evaluating the treatment effectiveness of each treatment component are needed. CLINICAL TRIAL INFORMATION Australia-New Zealand Trials Registry Number: ACTRN12610001041044.
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Affiliation(s)
- Michael Gradisar
- Child & Adolescent Sleep Clinic, School of Psychology, Flinders University, Adelaide, SA, Australia.
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