A community-based study of insomnia in Hong Kong Chinese children: Prevalence, risk factors and familial aggregation

ObjectivesThere has been limited data on familial aggregation of insomnia. We aimed to explore the prevalence, risk factors and familial aggregation of childhood insomnia with a large community-based sample.MethodsA community-based epidemiologic study of sleep disorders was conducted among primary school children. Those children with at least one reported biological parent were recruited. A total of 5695 children (mean age 9.2; SD 1.8), 4939 of their reported biological mothers (mean age 38.9; SD 4.6) and 4289 of their reported biological fathers (mean age 43.3; SD 5.5) were studied.ResultsThe rates of insomnia ?3 times/week in the past 12 months were 4.0%, 12.8% and 9.7% for children, mothers and fathers, respectively. A robust familial aggregation of insomnia was found even after adjustment of the shared environmental and socio-demographic factors. There was a significant dose–response relationship among the children across their parental status from neither, fathers, mothers to both parents with insomnia [3.0%, 7.1%, 9.5% and 11.9%; with ORs (95% CIs) = 2.48 (1.82–4.37) for fathers, 3.42 (2.55–4.59) for mothers and 4.42 (2.42–8.10) for both parents, respectively]. In addition, the frequency of insomniac symptoms of the parents also had a dose–response effect on the rate of insomnia of their children.ConclusionsInsomnia is a common problem in both children and their parents. A significant familial aggregation of childhood onset insomnia was seen in this study even after adjustment of the co-risk factors. There was a dose–response effect of parental insomnia on the rate of insomnia of their children with a slight predilection of maternal influences.     

Cytokine polymorphisms and plasma levels are associated with sleep onset insomnia in adults living with HIV/AIDS

Sleep disturbance has been associated with inflammation and cytokine activity, and we previously described genetic associations between cytokine polymorphisms and sleep maintenance and duration among adults with HIV/AIDS. Although sleep onset insomnia (SOI) is also a commonly reported sleep problem, associations between cytokine biomarkers and SOI have not been adequately studied. The purpose of this study was to describe SOI in relation to cytokine plasma concentrations and gene polymorphisms in a convenience sample of 307 adults (212 men, 72 women, and 23 transgender) living with HIV/AIDS. Based on the Pittsburgh Sleep Quality Index item that asks the time it usually took to fall asleep in the past month, participants were categorized as either >30 min to fall asleep (n = 70, 23%) or 30 min or less to fall asleep (n = 237). Plasma cytokines were analyzed, and genotyping was conducted for 15 candidate genes involved in cytokine signaling: interferon-gamma (IFNG), IFNG receptor 1 (IFNGR1), interleukins (IL1R2, IL2, IL4, IL6, IL8, IL10, IL13, IL17A), nuclear factor of kappa light polypeptide gene enhancer in B cells (NFKB1 and NFKB2), and tumor necrosis factor alpha (TNFA). Demographic and clinical variables were evaluated as potential covariates. After adjusting for genomic estimates of ancestry, self-reported race/ethnicity and viral load, SOI was associated with higher IL-13 plasma levels and with six single nucleotide polymorphisms (SNPs): IL1B rs1143642 and rs1143623, IL6 rs4719714, IL13 rs1295686, NFKB1 rs4648110, and TNFA rs2857602. In addition, the IL1B rs1143642 polymorphism was associated with plasma levels of IL-1β in adjusted analyses. This study strengthens the evidence for an association between inflammation and sleep disturbance, particularly self-report of habitual SOI. In this chronic illness population, the cytokine polymorphisms associated with SOI provide direction for future personalized medicine intervention research.     

Spectral analysis of the sleep onset period in primary insomnia

ObjectiveTo compare the EEG power spectra characteristics of the sleep onset period (SOP) in patients with sleep onset insomnia (SOI), sleep maintenance insomnia (SMI) and good sleepers (GS).MethodsThe time course of EEG power density (1–40 Hz) during the SOP was examined in thirty subjects (SOI patients: N = 10, SMI patients: N = 10, GS: N = 10).ResultsThe EEG power of the beta2 frequency band (18–29.75 Hz) was significantly lower in SOI than in SMI in the period preceding sleep onset. The alpha power was significantly higher for the SMI group compared to GS before sleep onset. Despite the lack of statistical significance, several differences in EEG dynamics were observed in SOI compared to two other groups: delta power increased slower after sleep onset; beta2 and 3 (18–29.75 and 30–39.75 Hz) power decrease less abruptly before sleep onset; beta1 (15–17.75 Hz) power increase through the whole SOP.ConclusionsThe lower level of beta2 frequency band in SOI and the differences in dynamics in delta and beta bands may suggest that a mechanism other than hyperarousal participates in etiology of SOI.SignificanceSOI and SMI patients have different spectral characteristics in SOP, thus future studies should avoid the inclusion of mixed insomnia samples.     

Demographic and clinical characteristics of familial and sporadic multiple sclerosis: A single center exploratory study from Abu Dhabi

Demographic and clinical characteristics of Familial Multiple Sclerosis (FMS) have not been fully investigated yet in Abu Dhabi. The aim of this single center exploratory study was to investigate demographic and clinical characteristics of FMS compared to sporadic MS (SMS) in Abu Dhabi.A chart review single center study was conducted in 98 patients with MS. Group comparisons were performed using Mann-Whitney and Chi-Square tests as appropriate. A p < 0.05 was considered statistically significant. 24.5% were patients with FMS and 83% were Emirates. No significant differences in demographic and clinical characteristics were found between patients with FMS and SMS in overall all MS patients and in the Emirati group analyzed alone.Patients with FMS did not differ in demographic and clinical characteristics compared to patients with SMS. Further prospective studies are needed to elucidate environmental and genetic risk factors contributing to FMS in the Emirati population.     

精神分裂症患者发病年龄与临床特征的相关性研究

目的 探讨精神分裂症发病年龄与临床特征的关系。方法 对符合DSM-IV精神分裂症诊断标准的294例住院患者进行BPRS评估和BEAM检查，并收集其人口学资料和病史资料。结果 BPRS总分和迟滞因子分与发病年龄呈负相关，而BPRS总分、迟滞因子分和敌对猜疑因子分与未治疗期的长短呈正相关。发病年龄在性别和遗传因素中的差异无显著性，而在发病诱因、BEAM检查结果和诊断类型间的差别有统计学意义。结论 精神分裂症的临床特征与发病年龄明显相关，发病年龄越小病情越严重，阴性症状也越突出，提示在制定治疗康复方案方面，应有所区别。     

Comparing clinical features of young onset,middle onset and late onset Parkinson's disease

BackgroundParkinson's disease (PD) affects 1–2% of the population over 65 years. There is evidence that the clinical features differ with age at symptom onset, but published information is scarce.MethodsWe reviewed the charts of 593 PD patients and divided them into young onset (≤49 years), middle onset (50–69 years) and late onset (≥70 years) groups. Data collected included age at symptom onset, year of onset, family history of Parkinson's disease in first and second degree relatives, predominant first symptom, first anti parkinsonian medication prescribed, frequency of levodopa-induced dyskinesia, therapy related dystonia, therapy related gastrointestinal side effects, hallucination, dementia, depression and apathy.ResultsThe middle onset was the largest group (51%), followed by the late onset (39%) and the young onset (10%) groups. Young onset patients had a more frequent family history of Parkinson's disease and a longer survival. Symptoms other than tremor were more frequent as the initial symptom of the young onset group, and the frequency of tremor as the first symptom increased with advancing age at onset. Depression was more frequent in the young onset group. The frequency of treatment related dyskinesia or dystonia decreased with advancing age at onset.ConclusionWe have identified specific clinical differences in Parkinson's disease related to the patient's age at onset and added to the existing knowledge of the variability of disease presentation. We suggest an age of onset of 49 years or less for the definition of young onset PD.     

失眠症患者的心理特征与家庭功能关系的初步分析

目的探讨失眠症患者的心理特征、家庭功能及其对睡眠质量的影响。方法采用匹兹堡睡眠质量指数（PSQI）、自我和谐量表（SCCS）、家庭亲密度与适应性量表（FACES—Ⅱ）,对51例失眠症患者进行测评,并与正常对照组46例进行比较。结果（1）失眠组的家庭亲密度和适应性因子分显著低于对照组,不满意度A显著高于对照组（P〈0．01）;（2）SCCS总分及不和谐度因子分显著高于正常组,灵活性因子分显著低于正常组（P〈0．01）;（3）失眠组的家庭亲密度与PSQI各因子呈显著负相关,不满意度A及SCCS总分、不和谐度与PSQI各因子呈显著正相关。结论失眠症患者多有自我内部和谐度低,灵活性差的心理特征,且家庭亲密度及适应性差、满意度低,可能是其睡眠质量不满意及症状慢性化的重要影响因素。     

Gender differences in age at onset of Schizophrenia

Summary We present the results of a review of the literature concerning gender differences in age at the onset of schizophrenia. In view of the very consistent finding that the first admission to hospital for schizophrenia occurs on average earlier in men than in women we examined the question whether this is due to the fact that the psychosis manifests itself earlier in men or that the period between first manifestation and admission to hospital is shorter than in women. By means of a metaanalytic approach we then looked for evidence for the existence of local or temporal variations in the degree of gender difference. Lastly, we dealt with the question whether gender differences in age of onset can be observed in other functional psychoses.     

Co-occurring insomnia and obstructive sleep apnea

Study objectivesPrior research investigating co-occurring insomnia/obstructive sleep apnea (CIO) has mainly focused on comparing comorbid patients, obstructive sleep apnea (OSA), and insomnia (INS) to those with OSA alone. This approach is informative but omits the potentially interesting comparison of comorbid patients to those with INS alone. Our study used an incomplete factorial design, crossing OSA (present or absent) with INS (present or absent) to more clearly focus on the question, is comorbid INS an epiphenomenon of OSA or an independent disorder?MethodsOur study was an archival analysis from the database of a sleep center comparing consecutively diagnosed patients characterized as OSA or INS. A third group, CIO, was derived from the OSA group. Our study was conducted at an American Academy of Sleep Medicine–accredited sleep disorders center. We studied 299 patients, including 94 OSA, 97 INS, and 108 CIO. Patients ranged from ages 15 to 86 years.ResultsGroups were compared on polysomnography (PSG), sleep pattern, sleep stages, sleep pathology, self-reported sleep concerns, and self-reported daytime functioning. From a consecutive group of OSA patients, we estimate the prevalence of CIO at 67.4%. Based mainly on multivariate analysis of covariance (MANCOVA) controlling for demographic differences between groups, we found few if any significant differences between CIO and INS alone or between CIO and OSA alone.ConclusionsThe clinical presentation of CIO is indistinguishable from INS alone, both with respect to PSG findings and to self-reported sleep onset and sleep maintenance disturbance. We observed a weak relation between OSA severity and co-occurring INS. These data are consistent with the view that INS with co-occurring OSA is an independent, self-sustaining disorder. We hypothesized that in some unknown proportion of cases, OSA initially instigated the INS, but the INS was then perpetuated and reshaped by sleep concerns and self-defeating compensatory behaviors.     

Clinical features of familial moyamoya disease

Objects This study aims to clarify the genetic background of moyamoya disease by comparing clinical features between familial and sporadic cases to reveal the responsible genes for familial moyamoya disease.Methods This study included 155 Japanese patients with moyamoya disease, which included 24 familial cases (10 family pedigrees) and 131 sporadic cases. Clinical features were compared between the familial and sporadic cases.Results and conclusion A female preponderance was significantly more prominent in the familial than in the sporadic group (P=0.0421). Mean age at onset was significantly lower in familial than in sporadic cases (P=0.004). In eight parent–offspring pairs, mean age at onset was significantly lower in the second than in the first generation (P<0.0001). These results suggest that familial moyamoya disease is associated with genetic anticipation and female predominance and that a genetic analysis study focused on expanded triplet repeats may clarify the pathogenesis of the disease.     

Examining determinants of early and late age at onset in panic disorder: An admixture analysis

Past research demonstrated that age at onset might account for different clinical and etiological characteristics in panic disorder (PD). However, prior research relied on arbitrary choices of age cut-offs. Using a data-driven validated method, this study aimed to examine differences between early and late onset PD in various determinants. Admixture analysis was used to determine the best fitting model of age at onset distribution in PD. Data was collected from 511 individuals (ages 18–65) with PD diagnoses, who participated in the Netherlands Study of Depression and Anxiety (NESDA). DSM-IV comorbidities and various measures of childhood adversities, suicidal behavior, anxiety and depressive symptoms were assessed. The best fitting cut-off score between early and late age at onset groups was 27 years (early age at onset ≤ 27 years). Univariate tests showed that participants with early onset PD were younger and more likely to be female. Early onset PD was associated with agoraphobia, higher frequency of childhood trauma and life events, and higher rates of suicide attempts as compared to late onset PD. Multivariate logistic regression analysis demonstrated that only current age, childhood trauma and agoraphobia remained significantly associated with early onset PD. Findings suggest that 27 years marks two onset groups in PD, which are slightly distinct. Early onset PD is independently associated with exposure to childhood trauma and increased avoidance. This highlights the importance of subtyping age of onset in PD. Clinical implications are further discussed.     

Sleep bruxism and its associations with insomnia and OSA in the general population of Sao Paulo

Sleep bruxism (SB) is characterized by recurrent masticatory muscle activity during sleep with occasional tooth grinding. SB can be concomitant with sleep apnea although its association with insomnia is understudied.Study objectiveAssess the strength of the associations between SB, insomnia and sleep apnea in a general population.MethodsData from the 2007 EPISONO general population study (n = 1042; Sao Paulo, Brazil) were reused for the present analyses. The data was collected from polysomnography (PSG) and from a questionnaire. SB could only be assessed as “possible” with self-report questionnaires, but as “definitive” with both self-reports and PSG. Logistic regression and decision tree analyses were performed.ResultsLogistic regression analyses revealed that being male, overweight, obese, having an apnea/hypopnea index (AHI) above 30 and insomnia syndrome are among risk factors for SB (prevalence ratio (PR): 1.5–3.3). A high AHI and insomnia syndrome had similar PRs, 2.7 and 2.8, respectively. Decision tree analysis showed that insomnia syndrome contributed to the predictive accuracy of SB self-report (88%). A similar estimate (91%) was observed with SB PSG data. Correspondence analysis illustrated three age profiles in participants: (1) good sleepers aged 20–35 years, (2) females aged 35–50 years with SB and concomitant insomnia syndrome, and (3) participants aged ≥ 50 years with obesity and sleep apnea.ConclusionsInsomnia is likely a condition associated with SB, especially in middle-age females, while sleep apnea seems age and gender dependent. Such overlap may influence the treatment decision to achieve best outcomes.Clinical trial registrationEPISONO study; Clinical trials.gov ID # NCT00596713.     

Admixture analysis of age at first suicide attempt

Objective

Clinical and familial studies have suggested that age at first suicide attempt (SA) is a marker for different subtypes of suicidal behaviors. However, none of the various thresholds used to define subgroups according to the age at first suicide attempt have been validated. The aim of this study was to try to define different subgroups according to age at first SA subtypes using admixture analysis.

Method

In a sample of 368 consecutively recruited patients from Sept. 2001 to Sept. 2005 with a personal history of suicide attempt, admixture analysis was used to determine the best-fitting model for the observed distribution of age at first SA.

Results

The theoretical model that best explains the observed distribution of age at first SA was a mixture of two Gaussian distributions with mean ages (±SD) of 19.5 ± 4.3 and 38.5 ± 12.4 years with a cut-off point of 26 years for the two subgroups. In multivariate analyses, the early onset subgroup was characterized by more frequent comorbid anxiety disorders, cannabis misuse and personal history of emotional and sexual abuse. Patients belonging to the late onset subgroup were more likely to suffer from major depressive disorders (single or recurrent).

Conclusion

This study provides a mathematical modelisation suggesting the existence of two age at onset subgroups in suicidal behaviors with different clinical picture and history of childhood trauma. Given the heterogeneity of suicidal behavior, these results suggest that the age at first SA may represent a valid ‘candidate symptom’ for future investigations of vulnerability factors.     

Task switching in older adults with and without insomnia

BackgroundTask-switching deficits are common in older adults and in those with insomnia. Such deficits may be driven by difficulties with sleep continuity and dampened homeostatic sleep drive.ObjectiveTo identify the aspects of task switching affected by insomnia and its treatment, and to determine whether such effects are associated with sleep continuity and homeostatic sleep drive.MethodsPolysomnographic sleep and task switching were tested in healthy older adults aged 60–93 years with insomnia (n = 48) and normal sleeping controls (n = 51). Assessments were repeated in the insomnia group after eight weeks of cognitive behavioral treatment for insomnia. Sleep measures included wake after sleep onset (WASO) and quantitative indices of homeostatic sleep drive (delta power during nonrapid eye movement [NREM] sleep and the ratio of delta power during the first and second NREM periods). A cued task-switching paradigm instructed participants to perform one of two tasks with varying preparatory cue-target intervals, manipulating task alternation, task repetition, and task preparation.ResultsThe effect of preparatory cues on accuracy was diminished in the insomnia group compared with that in controls. Across the two groups, a stronger effect of preparatory cues was associated with a higher delta sleep ratio. Following insomnia treatment, task-repetition accuracy significantly improved. This improvement was associated with improvements in WASO. There were no group or treatment effects on response time or task alternation accuracy.ConclusionsEffects of insomnia diagnosis and treatment apply to conditions that depend on the maintenance of a task set, rather than a domain general effect across task switching. Such effects are associated with homeostatic sleep drive and sleep continuity.     

Later age at onset in Parkinson's disease over twenty years in an Italian tertiary clinic

BackgroundAge is considered an important risk factor for Parkinson's disease (PD). However, although life-expectancy has increased considerably, incidence rates of PD appeared to be stable over the last two decades. Accordingly, an increase in mean age at onset over time could be expected. We investigated the changes in age at onset in PD over the last two decades.MethodsAll consecutive PD patients assessed over a 18-year period (1995–2013) in a single tertiary outpatient clinic were included in the present retrospective cohort study.ResultsAfter adjusting for several confounders (gender, positive family history for PD, education, smoking at onset and past exposure to environmental/occupational pollutants), 5-year cohorts of year of disease onset were associated with increasing age at onset in both prevalent (N = 6996) and incident (N = 4172) cases (for trend, P < 0.001). From 1995–2000 to 2010–2013 there was an increase in predicted age of 4.1 years (95% CI, 3.0–5.2) and 3.9 years (95% CI, 2.7–5.1) in prevalent and incident cases, respectively. However, the change in predicted age at PD onset, across cohorts of year at onset, showed a steeper increase than the corresponding sex and cohort-matched mean age from the official Italian statistics.ConclusionsOver the last two decades, age at onset of PD appeared to shift progressively towards more advanced age. However, sequential, high-quality population-based incidence studies are required. To establish whether there is a trend towards increase in age at onset over and above general population ageing and to assess whether the increase is associated with improved medical and socio-economic conditions.     

Admixture analysis of age at onset in schizophrenia: evidence of three subgroups in a first-episode sample

Objective

The objective was to assess the presence of different subgroups, via age-at-onset (AAO) analysis, in a schizophrenia population consecutively recruited through an Early Psychosis Service in London, Canada.

Method

Admixture analysis was applied in order to identify a model of separate normal distribution of AAO characterized by different means, variances and population proportions to allow for evaluation of different subgroups in a sample of 187 unrelated patients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of schizophrenia.

Results

The best-fitting model suggested three subgroups with means and standard deviations of 16.8±1.9, 22.3±2.1 and 32.7±5.9 years comprising 41%, 30% and 29% of the schizophrenia sample, respectively. These three subgroups were categorized as early, intermediate and late onset with cutoffs determined by admixture analysis to be 19 and 26 years of age, respectively. In our investigation, the definition of early-onset schizophrenia is the main outcome. We considered the clinical variables mainly related to the heritability and neurobiology of schizophrenia. Single status was strongly associated with early onset (P< .001). The male gender (P= .023), as well as a history of drug abuse (P= .004), was significantly associated with early onset. Interestingly, lower academic achievement was also associated with early-onset schizophrenia (P< .001).

Conclusion

Overall, our study showed that a typical early-onset schizophrenia patient is more likely to be a single male, with a history of drug abuse and birth complications, and lower academic achievement as compared to the late-onset subgroup.     

The development of intellectual abilities in pediatric temporal lobe epilepsy

PURPOSE: The aim of this study was to examine the impact of clinical variables, particularly age at onset of epilepsy, on intellectual function in a group of children with temporal lobe epilepsy (TLE). METHODS: We reviewed the preoperative neuropsychological test results of 79 children with unilateral TLE who subsequently underwent surgical resection. The impact of age at onset and duration of epilepsy, pathology type, and side of resection on full-scale intelligence quotient (IQ) scores was examined. RESULTS: Intellectual dysfunction (defined as IQ < 79) was present in 57% of children, and age at onset of epilepsy was the best predictor of intellectual function. Children with epilepsy onset in the first year of life had a particularly high incidence of intellectual impairment (82.4%). CONCLUSION: These data suggest a critical period during the first year of life for the subsequent development of intellectual abilities and highlight the importance of early treatment in this population.     

Evidence of a genetic marker associated with early onset in Friedreich's ataxia

We evaluated the association between age at onset of Friedreich's ataxia and alleles of two restriction fragment length polymorphisms (RFLP) at D9S15 and D9S5 in the 9gl3–9g21.1 region. We studied 65 Italian patients from 49 families. Age at onset was not normally distributed in our patients, suggesting allelic heterogeneity. Patients homozygous for allele 1 ofMspI RFLP detected by probe MCT112 at D9S15 (M1) had an earlier onset (mean 9.3, SD 3.4 years) than patients homozygous for allele 2 (M2; mean 12.1, SD 4.3). Heterozygotes had an onset age similar to that of the M2 homozygotes. These findings suggest that the M1 allele might be a marker of one allelic early-onset Friedreich's ataxia mutation.