Sleep disturbances in autism spectrum disorder without intellectual impairment: relationship with executive function and psychiatric symptoms

The autism spectrum disorder (ASD) is a neurodevelopmental condition, frequently accompanied by medical and psychiatric pathology. One of the most commonly found problems associated with ASD is sleep disturbances, which are estimated to affect approximately 80% of the people with ASD, not only during childhood but also in the adolescence and adult stages. Nevertheless, the relationship of these sleep difficulties with autism severity, as well as other associated impairments such as executive functioning and psychiatric disorders (eg, depression), has not yet been widely studied. The main objective of the present study was to explore the relationship between sleep disturbances, subjective measures of executive function, and psychiatric pathology in the ASD population. To reach that goal, a group of 89 participants with ASD (44 children/adolescents and 45 adults) was recruited and evaluated with self-reported measures of executive function performance and psychiatric pathology tests. Multivariate analysis showed a significant association between sleep disturbances and psychiatric symptoms in both ASD groups, with greater sleep disturbances predicting more severe psychiatric pathology. No significant association was found with executive function in any group. Limitations included a small sample size and lack of objective measures. Sleep problems seem to be associated with the severity of psychiatric pathology throughout the lifespan, increasing the chance of developing psychiatric symptoms when they were present. Improving sleep quality in ASD at all ages may result in preventing and/or decreasing psychiatric pathology in this population.     

Psycho-cognitive behavioral problems in sleep disordered children

Sleep disturbances are common in childhood and adolescence. Sleep problems in early infants tend to be persistent and prominent in preschool and school-aged children. Chronic sleep disorders, especially in young children may lead to neurobehavioral problems and psycho-cognitive impairment. Sleep difficulties may be the result of underlying medical conditions, (breathing disorders) or psychological problems. Research studies have shown the association between sleep disorders and day time cognitive impairment, behavioral problems, poor school performance and inattention in children. Appropriate diagnosis and early management of sleep disorders in children lead to improvement of neurocognitive function and behavioral problems in these children.     

Sleep and headache

The relationship between sleep and headache has been known for over a century. Headache and sleeping problems are both some of the most commonly reported problems in clinical practice, and cause considerable social and family problems, as well as socio-economic impact and costs. There is a clear association between headache and sleep disturbances, especially headaches occurring during the night or early morning. The mechanism and causes are complex, multifactorial and poorly understood. Headache disorders like migraine, tension-type headache, cluster headache and hypnic headache all affect or are directly related to sleep disturbances and daytime functioning. Sleep fragmentation, insomnia and hypersomnia all show relations to headache. Primary sleep disorders like insomnia, hypersomnias including sleep disordered breathing are all associated with and may cause headache. Furthermore medical, psychiatric and rheumatic diseases are associated with sleep disturbances and headache. The current knowledge about headache and sleep is still sparse and further research is advocated.     

Psychiatric comorbidity of adolescents with sleep terrors or sleepwalking: a case-control study.

OBJECTIVE: This study investigated the psychiatric comorbidity, personality traits and family history of adolescents with sleep terrors and/or sleepwalking. METHOD: Thirty students with sleep terrors and/or sleepwalking and 30 classroom controls were selected on the basis of a sleep habit questionnaire. After completing the Junior Eysenck Personality Inventory (JEPI), the 60 subjects were interviewed by the first author with the Chinese-version Kiddie-SADS-E (Schedule for Affective Disorders and Schizophrenia for Children--Epidemiology Version). All subjects and their parents were interviewed for the subjects' sleep habits, sleep disorders, and personality characteristics in the previous year. The case and the control groups were divided based on whether the sleep terrors and/or sleepwalking had occurred in the previous year. There were 21 case and 30 control subjects in the final data analysis. RESULTS: The case group had more psychiatric diagnoses and problems; there were statistically significant differences in overanxious disorder, panic disorder, simple phobia and suicidal thoughts between the two groups. The case group had more sleeptalking and nightmares during the previous year as well as more enuresis in earlier years. From their parents' perspective, the case group was more nervous and pessimistic. The results of the JEPI showed a high neuroticism score in the case group. There was an increased familial occurrence of these two sleep disorders. CONCLUSIONS: Adolescents with sleep terrors and sleepwalking were found to have an increased prevalence of other sleep disorders, neurotic traits, and psychiatric disorders and problems. Whereas sleep terrors and sleepwalking in childhood are related primarily to genetic and developmental factors, their persistence and, especially, their onset in adolescence may be related to psychological factors.     

Pediatric sleep and epilepsy

Sleep disorders are common in childhood. The prevalence of childhood sleep disorders is higher in chronic neurologic disorders, specifically epilepsy. Sleep needs, requirements, and structure are different in children compared with adults. These variables are disrupted severely in patients with epilepsy. Electroencephalogram abnormalities, nocturnal seizures, and medications may contribute further to sleep problems and affect daytime functioning. These sleep disturbances may worsen seizure control and affect quality of life. This article offers an overview of the normal sleep patterns in children, describes the interaction of electroencephalogram, sleep, and commonly found sleep disorders, and reviews the current literature of the main sleep disturbances found in children with epilepsy.     

Sleep and youth suicidal behavior: a neglected field

PURPOSE OF REVIEW: Sleep undergoes substantial changes during adolescence and suicide risk begins to increase during this period as well. This review focuses on recent literature on the relationship between sleep and suicidal behavior and proposes directions for future research. RECENT FINDINGS: Adolescent sleep is characterized by widespread sleep restriction, irregular sleep schedules, daytime sleepiness, and elevated risk for sleep disturbances. More research on adolescent sleep and psychosocial impairment, psychiatric disorders, and suicidal behavior has been conducted. Suicidal psychiatric patients had more sleep disturbances including insomnia, hypersomnia, or nightmares than nonsuicidal patients. Shorter rapid eye movement latency and increased rapid eye movement activity have been noted to be a marker of suicidality in psychiatric patients. Epidemiological studies have demonstrated that insomnia, nightmares, and sleep insufficiency are associated with elevated risk for suicide. Although the link between insomnia and suicidal behavior appears to be mediated by depression, existing data suggest an independent predictive role of nightmares in future suicidal behavior. SUMMARY: Sleep loss or disturbances are likely to signal an increased risk of future suicidal action in adolescents. Large-scale prospective studies and neurobiological studies are needed for a better understanding of the complex relationship between sleep, psychopathology, and youth suicidal behavior.     

Developmental features of sleep.

In sum, sleep disorders are common problems for children and adolescents, with estimates indicating that approximately 20% to 25% of the pediatric population experiences some type of sleep disturbance. Furthermore, clinicians should be aware that sleep disturbances may not only exist in isolation, but can be related to psychiatric or medical issues. Although much appears to be known about sleep disorders in the pediatric population, our knowledge of this area is still in its infancy. Additional research is still needed to investigate differences in clinical presentation of specific sleep disturbances among different age groups (i.e., children, adolescents, adults, and elderly), to develop the most appropriate treatments for given populations, and to study the effects of sleep disturbances on functioning. Given the prevalence of these problems in the child and adolescent population and its likely impact on cognitive and behavioral functioning, health professionals need to become increasingly aware of and knowledgeable about sleep and sleep disorders. We all spend about one third of our lives sleeping, or trying to sleep; thus, we should understand as much as we can about it.     

EEG sleep in non-affective psychiatric disorders

Several sleep complaints and disturbances have been documented in psychiatric disorders. These modifications of sleep in anxiety disorders, alcoholism, schizophrenia, dementia and eating disorders are reviewed and discussed. At the present time, there is no evidence for any specific sleep pattern in non-affective psychiatric disorders. The co-morbidity of sleep disorders like sleep apnoea, periodic leg movements and parasomnia in psychiatric illness is not very well known at the present time.     

Is the developmental model accurate for all psychiatric disorders?

In the 1980's a neurodevelopmental hypothesis of schizophrenia was proposed. Since that time, the role of early developmental age as a risk period for action of etiological factors in psychosis was confirmed. Additionally, many disturbances of pre-schizophrenic persons in the developmental age were demonstrated. Recently published longitudinal cohort studies indicate that majority of the psychiatric disorders other than schizophrenia are preceded by occurrence of psychiatric disorders in childhood and early adolescence. Moreover, in numerous studies of adult anxiety and mood disorders, the role of early risk factors was observed and temperament, neurophysiological and psychopathological disturbances in early age were reported. The resulting developmental model of psychiatric disorders may help in the understanding of their pathogenesis. Subsequently, detection and treatment of early life disturbances may hypothetically prevent severe psychopathological symptoms in adulthood.     

Contribution of the electrophysiological study of sleep in psychiatry (author's transl)

The authors briefly remind us of physiological characteristics of normal sleep and its modifications in psychiatric disorders. They draw attention to the numerous possibilities in the clinic of using electrophysiological sleep research. This is of importance in an area where few biological markers are available for the diagnosis and the treatment. Furthermore, sleep studies support the hypothesis of disturbances in circadian rhythms in affective disorders.     

Interactive effects of BDNF Val66Met genotype and trauma on limbic brain anatomy in childhood

Childhood trauma is a major precipitating factor in psychiatric disease. Emerging data suggest that stress susceptibility is genetically determined, and that risk is mediated by changes in limbic brain circuitry. There is a need to identify markers of disease vulnerability, and it is critical that these markers be investigated in childhood and adolescence, a time when neural networks are particularly malleable and when psychiatric disorders frequently emerge. In this preliminary study, we evaluated whether a common variant in the brain-derived neurotrophic factor (BDNF) gene (Val66Met; rs6265) interacts with childhood trauma to predict limbic gray matter volume in a sample of 55 youth high in sociodemographic risk. We found trauma-by-BDNF interactions in the right subcallosal area and right hippocampus, wherein BDNF-related gray matter changes were evident in youth without histories of trauma. In youth without trauma exposure, lower hippocampal volume was related to higher symptoms of anxiety. These data provide preliminary evidence for a contribution of a common BDNF gene variant to the neural correlates of childhood trauma among high-risk urban youth. Altered limbic structure in early life may lay the foundation for longer term patterns of neural dysfunction, and hold implications for understanding the psychiatric and psychobiological consequences of traumatic stress on the developing brain.     

Adverse outcomes associated with personality disorder not otherwise specified in a community sample

OBJECTIVE: The authors investigated 1) whether adolescents and adults in the community diagnosed with personality disorder not otherwise specified are at elevated risk for adverse outcomes, and 2) whether this elevation in risk is comparable with that associated with the DSM-IV cluster A, B, and C personality disorders. METHOD: A community-based sample of 693 mothers and their offspring were interviewed during the offspring's childhood, adolescence, and early adulthood. Offspring psychopathology, aggressive behavior, educational and interpersonal difficulties, and suicidal behavior were assessed. RESULTS: Individuals who met DSM-IV criteria for personality disorder not otherwise specified were significantly more likely than those without personality disorders to have concurrent axis I disorders and behavioral, educational, or interpersonal problems during adolescence and early adulthood. In addition, adolescents with personality disorder not otherwise specified were at significantly elevated risk for subsequent educational failure, numerous interpersonal difficulties, psychiatric disorders, and serious acts of physical aggression by early adulthood. Adolescents with personality disorder not otherwise specified were as likely to have these adverse outcomes as those with cluster A, B, or C personality disorders or those with axis I disorders. CONCLUSIONS: Adolescents and young adults in the general population diagnosed with personality disorder not otherwise specified may be as likely as those with DSM-IV cluster A, B, or C personality disorders to have axis I psychopathology and to have behavioral, educational, or interpersonal problems that are not attributable to co-occurring psychiatric disorders. Individuals with personality disorder not otherwise specified and individuals with DSM-IV cluster A, B, or C personality disorders are likely to be at substantially elevated risk for a wide range of adverse outcomes.     

Transmission of Borna disease virus as etiopathogenetic factor in schizophrenia and affective disorders

Borna Disease Virus (BDV) is a negative single-stranded ribonucleic acid (RNA) virus, showing strong neurotropism. BDV may infect many different warm-blooded animal species, causing neurological and behavioral disorders. Seroepidemiological studies suggest the existence of human infections with BDV and their higher prevalence in psychiatric patients. Using different serological assays, anti-BDV antibodies were found in about 10%-20% of patients with schizophrenia, and in 1%-2% of the control group of healthy subjects. There are also reports on BDV antigens and BDV RNA in peripheral blood mononuclear cells of human subjects, and in the brain tissue examined during the autopsy in patients with psychiatric disorders. Higher prevalence of BDV infection markers was also found in the group of patients with affective illness. A hypothesis was put forward on the activation of BDV-infection in patients with affective illness during acute episode. There are also reports on higher BDV-seropositivity in various psychiatric disorders compared with healthy control subjects. It also would be purposeful to study a possibility of BDV infections in patients with psychiatric disturbances, having their onset in childhood or adolescence.     

Adolescents with insomnia and substance abuse: consequences and comorbidities

Adolescents have high rates of sleep disorders and substance abuse, both of which have been associated with deleterious effects on mood, attention, and behavior. This article reviews data on the prevalence of sleep disorders, substance abuse problems, and comorbid psychiatric conditions in the adolescent population. Studies have consistently demonstrated that the prevalence of sleep problems is under-reported in adolescents in both clinical and community samples. The bidirectional correlation between substance use and sleep disturbances is also discussed. Based on the findings presented here, the authors conclude that it is imperative to improve the detection and treatment of sleep problems in children and adolescents. By treating sleep disturbances and targeting poor sleepers with additional counseling and education regarding the risk of substance use, clinicians may be able to prevent or delay the adverse effects of addiction. At the very least, the presence of insomnia should alert clinicians to the need for further evaluation for drug and alcohol abuse.     

Maladaptative parenting and the association between parental and offspring psychiatric disorders

A longitudinal study was conducted to investigate the role of maladaptive parental behavior and the association between parent and offspring psychiatric disorders. Psychosocial and psychiatric interviews were carried out in a representative community sample of 593 biological parents and their offspring from two counties in the state of New York in 1975, 1983, 1985-86, and 1991-93. In 1975, the mean age of offspring was 6 years. Maladaptive parental behavior was assessed in 1975, 1983, and 1985-86. Parent and offspring psychiatric symptoms were assessed in 1983, 1985-86, and 1991-93. Maladaptive parental behavior substantially mediated a significant association between parental and offspring psychiatric symptoms. Parents with psychiatric disorders had higher levels of maladaptive behavior in the household than did parents without psychiatric disorders. Maladaptive parental behavior, in turn, was associated with increased offspring risk for psychiatric disorders during adolescence and early adulthood. Most of the youths that experienced high levels of maladaptive parental behavior during childhood had psychiatric disorders during adolescence or early adulthood, independent of whether or not their parents had psychiatric disorders. In contrast, the offspring of parents with psychiatric disorders were not at increased risk for psychiatric disorders unless there was a history of maladaptive parental behavior. Maladaptive parental behavior is associated with increased risk for the development of psychiatric disorders among the offspring of parents with and without psychiatric disorders. Maladaptive parental behavior appears to be an important mediator of the association between parental and offspring psychiatric symptoms.     

The affective storms of school children during night time: Do affective dysregulated school children show a specific pattern of sleep disturbances?

In many mentally ill children, a new phenotype of affective and behavioural dysregulation can be observed. Not much is known about development and maintenance of this phenotype. A possible risk factor that has been suggested is disturbed sleep. The co-occurrence of sleep disturbances and psychiatric symptoms is significant and it has been postulated that there are specific patterns of sleep disturbances for different psychiatric symptoms. The aim of this study, therefore, is to investigate the specific relation of sleep disturbances and affective dysregulation in school children and whether a specific pattern of sleep disturbances is associated with or of predictive value for affective dysfunctions. 4,774 school children took part in the Cologne Sleep Study and emotional disturbances and sleep abnormalities were assessed by parent reports. Of the sample, 206 children were identified as showing signs of severe affective and behavioural dysregulation (DP), 276 children were reported as showing a subclinical form (SUB-DP). Both groups reported significantly more sleep disturbances than healthy controls with moderate to large effect sizes. Differences between SUB-DP and DP exist, however, were not of clinical relevance (d?相似文献   

Insomnia and comorbid psychiatric disorders

Defining the relationship between sleep disturbances and psychiatric disorders is a thought-provoking task and is becoming even more challenging because it is apparent that insomnia is not simply a typical symptom of a psychiatric disorder but may actually be a predictor (or independent risk factor) for the development of such a condition. Studies have shown that depressed patients not only have disturbances in sleep continuity but have reduced slow wave sleep and disinhibited REM sleep. In particular, REM sleep regulation is characterized by shortened REM latency and increased REM density. It has been suggested that the reciprocal interaction between REM and nonREM sleep, driven by inhibitory aminergic and excitatory cholinergic activity, becomes unbalanced in depression. Exposure to cholinergic stimulants reduces REM latency, particularly in major depressive disorder. In fact, it has been shown that healthy individuals at high risk for developing depression have greater sensitivity to cholinergic stimulation than those not at high risk. While the causality of the insomnia-depression relationship is debated, epidemiological studies have indicated that insomnia is an independent risk factor for depression and other psychiatric disorders. As we learn more about the interplay between these pathophysiologies, we will be able to make better treatment decisions for our patients.     

Sleep-wake function in children with neurodevelopmental and psychiatric disorders

Sleep disturbance is commonly described in children with developmental problems of a primarily physical or psychiatric nature. Its persistence is likely to adversely affect cognition, mood, behavior, and family functioning. Therefore, accurate diagnosis of the underlying sleep disorder, with prompt and effective treatment, can be considered essential for overall care. Reports of sleep disturbance in various neurodevelopmental and psychiatric disorders of childhood are outlined. The origins of the disturbance in each condition may lie in the disorder itself, the child's circumstances, or reflect comorbidity. Each contributory factor has implications for treatment strategies and outcome. Much remains to be discovered about childhood sleep disorders. However, sufficient information is already known to significantly improve their recognition and management if professional education in such matters improves.     

Mental health services and young people with intellectual disability: is it time to do better?

Background There is evidence that the mental health needs of children with disabilities are inadequate. The aim of the present study was to determine the extent of specialist health service use during adolescence by a group of individuals with intellectual disability (ID) and mental health problems. Method The study population consisted of 80 young people with ID, who were examined in childhood and adolescence for psychiatric and behaviour disorder. These young people were interviewed again in early adult life for the presence of psychiatric and behaviour disorder. Evaluation questionnaires were used during the follow‐up study to assess service use from adolescence. Results The key finding was that the great majority (64%) of subjects with persistent challenging behaviour from childhood into adult life and those with an established childhood psychiatric disorder received no specialist mental health care. Conclusions The development of mental health services for this vulnerable group with complex psychiatric and behaviour disorders has been poor for a number of reasons, including lack of recognition at the primary care level and insufficient numbers of trained professionals within specialist services.     

Sleep and psychiatry

Psychiatric disorders constitute 15.4% of the disease burden in established market economies. Many psychiatric disorders are associated with sleep disturbances, and the relationship is often bidirectional. This paper reviews the prevalence of various psychiatric disorders, their clinical presentation, and their association with sleep disorders. Among the psychiatric disorders reviewed are affective disorders, psychosis, anxiety disorders (including posttraumatic stress disorder), substance abuse disorders, eating disorders, and attention deficit/hyperactivity disorders. The spectrum of associated sleep disorders includes insomnia, hypersomnia, nocturnal panic, sleep paralysis, hypnagogic hallucinations, restless legs/periodic limb movements of sleep, obstructive sleep apnea, and parasomnias. The effects on sleep of various psychotropic medications utilized to treat the above psychiatric disorders are summarized.