Treatment of Childhood Sleep Disorders: Generalization Across Disorders and Effects on Family Members

Investigated the treatment of bedtime problems and its generalizationto night wakings. Six children (M age = 35 months) and theirparents participated in this study. A multiple-baseline designacross subjects was employed and found that treatment institutedat bedtime was successful in relieving both bedtime disturbancesand night wakings. Furthermore, significant positive changesin parental Sleep and family satisfaction occurred followingamelioration of the children's sleep problems. Data supportrecent work suggesting that chronic sleep problems in childrenare amenable to behavioral interventions. In addition, thismethod appears to be more cost-effective and less stressfulfor parents to implement than behavioral interventions thatdirectly target night wakings.     

Sleep Disorders and their Association with Laboratory Pain Sensitivity in Temporomandibular Joint Disorder

Study Objectives:

We characterized sleep disorder rates in temporomandibular joint disorder (TMD) and evaluated possible associations between sleep disorders and laboratory measures of pain sensitivity.

Design:

Research diagnostic examinations were conducted, followed by two consecutive overnight polysomnographic studies with morning and evening assessments of pain threshold.

Setting:

Orofacial pain clinic and inpatient sleep research facility

Participants:

Fifty-three patients meeting research diagnostic criteria for myofascial TMD.

Interventions:

N/A

Measurements and Results:

We determined sleep disorder diagnostic rates and conducted algometric measures of pressure pain threshold on the masseter and forearm. Heat pain threshold was measured on the forearm; 75% met self-report criteria for sleep bruxism, but only 17% met PSG criteria for active sleep bruxism. Two or more sleep disorders were diagnosed in 43% of patients. Insomnia disorder (36%) and sleep apnea (28.4%) demonstrated the highest frequencies. Primary insomnia (PI) (26%) comprised the largest subcategory of insomnia. Even after controlling for multiple potential confounds, PI was associated with reduced mechanical and thermal pain thresholds at all sites (P < 0.05). Conversely, the respiratory disturbance index was associated with increased mechanical pain thresholds on the forearm (P < 0.05).

Conclusions:

High rates of PI and sleep apnea highlight the need to refer TMD patients complaining of sleep disturbance for polysomnographic evaluation. The association of PI and hyperalgesia at a non-orofacial site suggests that PI may be linked with central sensitivity and could play an etiologic role in idiopathic pain disorders. The association between sleep disordered breathing and hypoalgesia requires further study and may provide novel insight into the complex interactions between sleep and pain-regulatory processes.

Citation:

Smith MT; Wickwire EM; Grace EG; Edwards RR; Buenaver LF; Peterson S; Klick B; Haythornthwaite JA. Sleep disorders and their association with laboratory pain sensitivity in temporomandibular joint disorder. SLEEP 2009;32(6):779–790.     

Anxiety Disorders in Epilepsy

Neuroscience and Behavioral Physiology - This review addresses the place of anxiety disorders in the spectrum of mental comorbidities in patients with epilepsy. The general features of the...     

Sleep Disturbance in Bipolar Disorder Across the Lifespan

The aim of this article is to highlight the importance of the sleep–wake cycle in children, adolescents, and adults with bipolar disorder. After reviewing the evidence that has accrued to date on the nature and severity of the sleep disturbance experienced, we document the importance of sleep for quality of life, risk for relapse, affective functioning, cognitive functioning, health (sleep disturbance is implicated in obesity, poor diet, and inadequate exercise), impulsivity, and risk taking. We argue that sleep may be critically important in the complex multifactorial cause of interepisode dysfunction, adverse health outcomes, and relapse. An agenda for future research is presented that includes improving the quality of sleep measures and controlling for the impact of bipolar medications.     

Treating Disgust in Anxiety Disorders

There is now a significant body of work which indicates that excessive disgust responses play a crucial role in certain anxiety disorders. In addition, emerging evidence suggests that disgust may not be effectively reduced by exposure therapy. Because of this, there is a need to arm clinicians with additional therapeutic tools to target maladaptive disgust responses. This study reviews potential strategies that may be useful in reducing disgust in the context of anxiety disorders. This review is intended to provide a useful starting point to inform clinicians and suggest possible future research directions. Ultimately, by ameliorating dysfunctional and distressing emotions other than fear that are prominent in certain anxiety disorders, such as disgust, treatments for anxiety disorders may be improved.     

强迫症患者眼球运动异常研究

目的：研究强迫症患者探究性眼球运动及其与临床的关系。方法：对符合DSM—Ⅳ诊断标准的57例强迫症（其中27例无用药史，30例有用药史）和50例在性别、年龄和受教育水平方面与之相匹配的正常人进行探究性眼球运动检查，并分析探究性眼球运动与临床的关系。结果：强迫症患者的探究性眼球运动多数指标均低于正常人（P〈0．05或者P〈0．01）；强迫症患者差别分析值正分者占37％，而正常对照组为8％，两者差异具有统计学显著性（x^2=12．27，P〈0．001）、以眼球运动指标为因变量并以临床变量为自变量进行多元逐步回归分析，在α=0．05水平，被选人反应性探究分回归方程者有思维形式障碍（如赘述）；选人认知性探究分回归方程者为强迫症状诱发因素、病程、精神运动迟缓分、Mausley强迫症状总分。结论：强迫症患者探究性眼球运动异常，支持强迫症额叶皮层-基底节异常学说，强迫症与精神分裂症存生物学上存在某些关联或者重叠。     

Assessing Anxiety Sensitivity in Inner-City African American Children: Psychometric Properties of the Childhood Anxiety Sensitivity Index

This study examined the psychometric properties of the Childhood Anxiety Sensitivity Index (CASI; Silverman et al., 1991) in a sample of urban African American elementary school children. One hundred forty-four 4th- and 5th-grade children completed the CASI as part of a larger project. In contrast to prior research with community samples, CASI total scores were higher and means did not differ by sex. Internal consistency (α = .82), 2-week test–retest reliability (r = .80), and convergent and divergent validity were good and consistent with prior research. The factor structure of the CASI differed from the structure found with White children. Results of exploratory factor analyses suggest two factors: physical concerns and mental incapacitation concerns. Implications for assessing anxiety and anxiety sensitivity among African American children are discussed.     

Systematic Trends Across the Night in Human Sleep Cycles

The durations of successive sleep cycles, defined according to NREM (stage 2) or REM onsets, were objected to trend analysis in three groups of normal subjects and in a group of elderly patients with chronic brain syndrome (CBS). NREM sleep cycles showed consistent curvilinear trends for all groups except that the trend in children was distinguished by a lengthy first NREM cycle. REM steep cycles showed quite similar curvilinear trends for the three normal age groups with the middle two cycles being longer than the first and fourth. In the CBS patients, REM sleep cycles did not show a significant trend across the night. Real-time cycles (i.e., with time awake included) manifested trends quite similar to those excluding waking. The trends in sleep cycle durations are normative characteristics of sleep which may not be apparent on a single night. A more constant cycle was found in the CBS elderly and may indicate brain pathology. Sleep cycle trends, along with such other temporal characteristics as the decline in stage 4, may provide clues to the metabolic processes which underlie the sleep EEG. They also provide a more exact basis for investigation of hypothesized biorhythm correlates of NREM-REM cycles.     

睡眠障碍的个案研究

睡眠障碍（sleep disorders）在大学生中很常见。既往研究表明,睡眠障碍与个体的身体健康状况、学习压力、情绪状态、生活环境和作息习惯等因素有关。我们在咨询中发现,很多案例都有着幼年期的创伤体验,而且病情与之有密切关系,因此,运用认知领悟疗法去干预此类案例便成为心理咨询的一条思路。本报告详细记录了其中1个案例的咨询过程。     

Sleep and Waking Disorders in Epilepsy

Neuroscience and Behavioral Physiology - Objective. To summarize existing published data on the prevalence, clinical features, and diagnostic criteria for sleep disturbances in epilepsy patients....     

Anxiety Treatment and Targeted Sleep Enhancement to Address Sleep Disturbance in Pre/Early Adolescents with Anxiety

Sleep disturbance is prevalent in anxious youth and prospectively predicts poor emotional adjustment in adolescence. Study 1 examined whether anxiety treatment improves subjective and objective sleep disturbance in anxious youth. Study 2 examined whether a sleep intervention called Sleeping TIGERS can further improve sleep following anxiety treatment. Study 1 examined 133 youth (ages 9–14; 56% female; 11% ethnic/racial minority) with generalized, social, or separation anxiety over the course of anxiety treatment (cognitive behavioral treatment or client-centered treatment). Sleep-related problems (parent-, child-report) and subjective (diary) and objective (actigraphy) sleep patterns were assessed across treatment in an open trial design. Study 2 included 50 youth (ages 9–14; 68% female; 10% ethnic/racial minority) who continued to report sleep-related problems after anxiety treatment and enrolled in an open trial of Sleeping TIGERS. Pre- and postassessments duplicated Study 1 and included the Focal Interview of Sleep to assess sleep disturbance. Study 1 demonstrated small reductions in sleep problems and improvements in subjective sleep patterns (diary) across anxiety treatment, but outcomes were not deemed clinically significant, and 75% of youth stayed above clinical cutoff. Study 2 showed clinically significant, large reductions in sleep problems and small changes in some subjective sleep patterns (diary). Anxiety treatment improves, but does not resolve, sleep disturbance in peri-pubertal youth, which may portend risk for poor emotional adjustment and mental health. The open trial provides preliminary support that Sleeping TIGERS can improve sleep in anxious youth to a clinically significant degree.     

Concurrent Validity of the Anxiety Disorders Section of the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent Versions

Evaluated the concurrent validity of the Anxiety Disorders Interview Schedule for the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV], American Psychiatric Association, 1994): Child and Parents Versions (ADIS for DSM-IV-C/P; Silverman & Albano, 1996) social phobia, separation anxiety disorder (SAD), generalized anxiety disorder (GAD), and panic disorder diagnoses. Children referred to an outpatient anxiety disorder clinic (N = 186; ages 8 to 17), and their parents completed the Multidimensional Anxiety Scale for Children (MASC; March, 1998) and the ADIS-C/P interview. There was no convergence between MASC scores and ADIS-C/P GAD diagnoses. However, there was strong correspondence between ADIS-C/P social phobia, SAD, and panic disorder diagnoses and the empirically derived MASC factor scores corresponding to these disorders. These results provide support for the concurrent validity of the anxiety disorders section of the ADIS-C/P.     

Emotion Regulation in Children With Anxiety Disorders

This study examined emotion management skills in addition to the role of emotional intensity and self-efficacy in emotion regulation in 26 children with anxiety disorders (ADs) ages 8 to 12 years and their counterparts without any form of psychopathology. Children completed the Children's Emotion Management Scales (CEMS) and Emotion Regulation Interview (ERI), and mothers reported on their children's emotion regulation using the Emotion Regulation Checklist (ERC). Results indicated that children who met Diagnostic and Statistical Manual for Mental Disorders (4th ed., American Psychiatric Association, 1994) criteria for an anxiety disorder had difficulty managing worried, sad, and anger experiences, potentially due to their report of experiencing emotions with high intensity and having little confidence in their ability to regulate this arousal. These findings indicate that emotion regulation needs to be considered centrally in research with anxious populations.