Prevalence of sleep problems in Smith-Lemli-Opitz syndrome

Smith-Lemli-Opitz syndrome (SLOS) is an autosomal recessive genetic disorder, characterized by multiple congenital anomalies, and intellectual disability. It is caused by a genetically inherited deficiency of the enzyme 7-dehydrocholesterol-delta-7-reductase, which results in increased serum levels of 7-dehydrocholesterol (7-DHC), and decreased levels of cholesterol. This study assesses the prevalence of sleep problems in patients with SLOS. The study group comprised 18 subjects with SLOS, ages 2-31 years (median 10.7 ± 8.5 years). Parents completed several questionnaires (Intake Demographic Form; Pediatric Sleep Questionnaire; Pediatric Daytime Sleepiness Scale). The SLOS subjects had symptoms of sleep-disordered breathing (50% snoring; 66.7% mouth breathing), problems with sleep onset [difficulty falling asleep (61.1%) sleep onset time >30 min (62%)], sleep maintenance [wake up screaming (61.1%), waking up more than twice (44.4%), having trouble falling back to sleep (66.7%), waking up early in the morning (61.1%), and restless sleep (50%)]. The subjects with SLOS needed parents in the room to fall asleep (50%), watch TV or listen to music to fall asleep (44.4%), and described bed sharing (33.3%), indicating sleep-anxiety and sleep-associations. Symptoms of excessive-daytime-sleepiness were frequently reported [un-refreshed in the morning (38.9%), daytime sleepiness (44.4%), and daytime naps (55.6%)]. Parents frequently observed difficulty of organizing tasks (66.7%), and easy distractibility (88.9%). Sleep problems such as sleep-disordered breathing, sleep-related anxiety and sleep associations, disturbed sleep patterns at night, and excessive daytime sleepiness are frequent in children with SLOS.     

Sleep‐disordered breathing in major depressive disorder

Individuals with major depressive disorder often experience obstructive sleep apnea. However, the relationship between depression and less severe sleep‐disordered breathing is unclear. This study examined the rate of sleep‐disordered breathing in depression after excluding those who had clinically significant sleep apnea (>5 apneas?h^?1). Archival data collected between 1991 and 2005 were used to assess the prevalence of sleep‐disordered breathing events in 60 (31 depressed; 29 healthy controls) unmedicated participants. Respiratory events were automatically detected using a program developed in‐house measuring thermal nasal air‐flow and chest pressure. Results show that even after excluding participants with clinically significant sleep‐disordered breathing, individuals with depression continue to exhibit higher rates of sleep‐disordered breathing compared with healthy controls (depressed group: apnea–hypopnea index mean = 0.524, SE = 0.105; healthy group: apnea–hypopnea index mean = 0.179, SE = 0.108). Exploratory analyses were also conducted to assess for rates of exclusion in depression studies due to sleep‐disordered breathing. Study exclusion of sleep‐disordered breathing was quantified based on self‐report during telephone screening, and via first night polysomnography. Results from phone screening data reveal that individuals reporting depression were 5.86 times more likely to report a diagnosis of obstructive sleep apnea than presumptive control participants. Furthermore, all of the participants excluded for severe sleep‐disordered breathing detected on the first night were participants with depression. These findings illustrate the importance of understanding the relationship between sleep‐disordered breathing and depression, and suggest that screening and quantification of sleep‐disordered breathing should be considered in depression research.     

Association between symptoms and subtypes of attention‐deficit hyperactivity disorder and sleep problems/disorders

This study aimed to investigate the association between attention‐deficit hyperactivity disorder (ADHD) symptoms and subtypes, and sleep schedules, daytime inadvertent napping, and sleep problems/disorders in children and adolescents with and without ADHD. The sample included 325 patients with ADHD, aged 10–17 years [male: 81.5%; combined type (ADHD‐C): 174; predominantly inattentive type (ADHD‐I): 130; predominantly hyperactive‐impulsive type (ADHD‐HI): 21], and 257 children and adolescents without lifetime ADHD (non‐ADHD). We conducted psychiatric interviews with the participants and their mothers before making the diagnoses of ADHD, other psychiatric disorders, and sleep problems or disorders. We also collected the medication treatment data and parent and teacher reports of ADHD symptoms. Multi‐level models were used for data analyses controlling for sex, age, psychiatric comorbidities, and treatment with methylphenidate. The ADHD‐C and ADHD‐I groups had more daytime inadvertent napping. In general, the three subtypes were associated with increased rates of sleep problems/disorders. Specifically, ADHD‐C rather than ADHD‐I was associated with circadian rhythm problems, sleep‐talking, nightmares (also ADHD‐HI), and ADHD‐I was associated with hypersomnia. The most‐related sleep schedules and problems for inattention and hyperactivity‐impulsivity were earlier bedtime, later rise time, longer nocturnal sleep, more frequent daytime napping, insomnia, sleep terrors, sleep‐talking, snoring, and bruxism across informants. The findings imply that in addition to the dichotomous approach of ADHD and considering the psychiatric comorbid conditions, ADHD subtypes and symptom dimensions need to be considered in clinical practice and in the research regarding the association between ADHD and sleep problems/disorders.     

The “Ins” and “Outs” of the Depressive Disorders Section of DSM‐5

In this article, we review and evaluate changes in the depressive disorders section from DSM‐IV to DSM‐5. We describe characteristics of three new depressive disorders: disruptive mood dysregulation disorder, premenstrual dysphoric disorder, and persistent depressive disorder. We also discuss the controversial decision in DSM‐5 to remove the bereavement exclusion from the criteria for major depressive disorder. Next, we review the decision to replace the diagnosis of depressive disorder not otherwise specified with two new diagnoses: other specified depressive disorder and unspecified depressive disorder. Finally, we discuss the inclusion of two novel specifiers in the DSM‐5 depressive disorders section: “with anxious distress” and “with mixed features.” For each of these changes, we examine the relevant research and discuss implications of the changes for research and clinical practice.     

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 quality and depression during pregnancy: a prospective study

For the first time, the relationship between depressive symptoms and sleep quality was explored prospectively during pregnancy. Participants (n = 273) completed the Pittsburgh Sleep Quality Index and Beck Depression Inventory at three 8-week intervals, starting from 15-23 weeks gestation. In addition to sleep quality and depression remaining relatively stable during pregnancy, findings revealed that sleep quality earlier in pregnancy predicted higher levels of depressive symptoms at later stage in pregnancy (after controlling for prior depression levels). In contrast, there was no evidence to suggest that depressive symptoms earlier in pregnancy impacted on sleep quality later on. Given that depressive symptomatology can lead to major depression and given the prevalence of pre- and postnatal depression, our findings suggest that screening for sleep problems during pregnancy may be of clinical significance.     

Relationships of sleep duration with sociodemographic and health‐related factors,psychiatric disorders and sleep disturbances in a community sample of Korean adults

The aim of this study is to examine relationships of sleep duration with sociodemographic and health‐related factors, psychiatric disorders and sleep disturbances in a nationwide sample in Korea. A total of 6510 subjects aged 18–64 years participated in this study. Logistic regression was used to calculate the odd ratios and 95% confidence intervals of the covariates, psychiatric disorders and sleep disturbances across the following sleep duration categories: 5 h or less, 6, 7, 8 and 9 h or more per day. Low levels of education, unemployment and physical illness were associated with sleeping for 5 h or less and 9 h or more. Being older and widowed/divorced/separated, high levels of physical activity, pain/discomfort, obesity and high scores on the General Health Questionnaires were associated with sleeping for 5 h or less. Female, being younger and underweight were associated with sleeping for 9 h or more. Alcohol dependence, anxiety disorder and social phobia were associated significantly with sleeping for 5 h or less and 9 h or more. Other psychiatric disorders were more common in subjects who slept for 5 h or less (e.g. alcohol use disorder, mood disorder, major depressive disorder, dysthymic disorder, obsessive‐compulsive disorder and specific phobia) or 9 h or more (e.g. post‐traumatic stress disorder). In addition, subjects who slept for 5 h or less reported more sleep disturbances than did subjects who slept for 7 h. Short or long sleep is associated with psychiatric disorders and/or sleep disturbance, therefore attention to the mental health of short or long sleepers is needed.     

Are malignant self‐regard and vulnerable narcissism different constructs?

In the clinical and empirical literature, vulnerable narcissism and malignant self‐regard (MSR) have been found to be highly interrelated and associated with theoretically related personality constructs, suggesting that the two constructs may be much more similar than different. The present study set out to test this hypothesis by examining the relationship of vulnerable narcissism and MSR to experiences and expressions of anger, the factor structure of grandiose and vulnerable narcissism with MSR, the associations of MSR and vulnerable narcissism to the five factor model of personality, and to global self‐esteem in self‐report measures within 1168 undergraduate students. A separate study of 158 undergraduates also assessed how MSR and vulnerable narcissism predicted state and trait anxiety and anger after receiving positive or negative feedback, and the extent to which negative feedback interacted with MSR and vulnerable narcissism. Overall, compared with grandiose narcissism, both MSR and vulnerable narcissism were more associated with experiencing anger internally, self‐reports of state and trait anger, high levels of neuroticism and openness, and lower levels of extraversion and global self‐esteem. Both vulnerable narcissism and MSR uniquely predicted trait levels of anger and anxiety and state levels of anger after receiving negative feedback. It is concluded that MSR and vulnerable narcissism are likely identical constructs.     

Association of sleep duration with weight and weight gain: a prospective follow-up study

The objective of this study was to examine the associations of sleep duration with subsequent weight and major weight gain in women and men during a follow-up period of 5-7years. The data were derived from the Helsinki Health Study cohort mail questionnaire surveys among 40-60-year-old employees of the City of Helsinki, Finland. At baseline in 2000-2002, 8960 people responded to the survey (80% women, response rate 67%). The follow-up survey was conducted in 2007 among all respondents to the baseline survey (n=7332, response rate 83%). Sleep duration (5h or less up to 10h or more) and weight and weight gain of at least 5kg were based on self-reports. Analyses of variance and logistic regression analyses were used to examine the associations between sleep duration and weight, as well as major weight gain. Short sleep duration was associated with major weight gain [odds ratio (OR) 1.52; 95% confidence interval (CI) 1.08, 2.14] during the follow-up. Adjusting for several covariates had only minor effects on that association. Long sleep duration was associated with major weight gain after adjusting for age (OR 1.35; 95% CI 1.00-1.81). No associations were found among men. Sleep duration was associated with major weight gain among middle-aged employed women. Short sleep may be a risk factor for subsequent weight gain.     

Vagal regulation and emotional intensity predict children's sleep problems

We examined the role of children's emotional intensity and vagal functioning in predicting sleep problems in healthy elementary school-aged children. Children's dispositional emotionality was examined via parent report, and their vagal regulation was assessed via respiratory sinus arrhythmia (RSA) during a baseline and a reaction time (RT) task. Sleep problems were examined through both child reports, and home monitoring with wrist actigraphs for four consecutive nights. Increased emotional intensity was predictive of a reduced amount of sleep and increased night activity. Less apt vagal regulation, characterized by lower levels of RSA suppression to the RT task, was predictive of increased sleep problems as assessed through both subjective and actigraphy-based measures of sleep. Results indicate that children's emotionality and regulation predict unique variance in the amount and quality of children's sleep, and suggest that they may underlie, at least in part, sleep disturbances in healthy children.     

Sleep problems in children with autism

Autism is a developmental disability characterized by severe deficits in social interaction and communication, and the presence of repetitive-ritualistic behaviors. Sleep problems are frequently reported by parents of children with autism with prevalence estimates of 44-83% for sleep disorders in this population. To better understand sleep in autism, we surveyed sleep problems in 210 children with autism using a Likert-based questionnaire for parent report. The most frequently reported sleep problems included difficulty in falling asleep, restless sleep, not falling asleep in own bed, and frequent wakenings. Least frequently reported sleep problems were sleep walking, morning headaches, crying during sleep, apnea, and nightmares. When surveys were divided into mental retardation (MR)/not MR categories, no significant differences were identified in frequencies of reported sleep problems except for waking at night which occurred much more frequently in the MR group. There was also no difference in sleep problems related to age of the child other than nocturnal enuresis. An association was noted between certain medical problems and sleep problems. Vision problems, upper respiratory problems, and runny nose were associated with decreased nighttime sleep. Vision problems, poor appetite, and poor growth were associated with increased nighttime waking. Poor appetite and poor growth were associated with decreased willingness to fall asleep. This study confirms a high prevalence of sleep problems reported by parents of children with autism and points to the need for more systematic research as an initial step in developing treatment strategies.