汶川地震后18个月都江堰地区青少年睡眠问题共患PTSD、抑郁、焦虑状况

目的:考查汶川地震后18个月青少年睡眠问题共患PTSD、抑郁、焦虑状况及其影响因素。方法:采用便利取样,抽取都江堰地区青少年1287人,应用匹兹堡睡眠质量指数、创伤后应激障碍自评量表、儿童抑郁障碍自评量表、儿童焦虑性情绪障碍自评量表、青少年自评生活事件量表、儿童青少年社会支持评定量表等对其进行评估。结果:采用PSQI总分8作为划界分,震后18个月都江堰地区青少年睡眠问题的检出率为28.2%;睡眠问题共患PTSD、抑郁、焦虑的检出率分别为7.5%、15.6%、17.9%。睡眠质量总分与PTSD(r=0.397)、抑郁(r=0.504)、焦虑总分(r=0.463)显著正相关。在检出有睡眠问题的青少年中,有26.4%检出PTSD,有55.4%检出抑郁,有63.4%检出焦虑。多元Lo-gistic回归表明地震中有亲人伤亡、对支持的利用度低、震后较多负性生活事件是睡眠问题共患PTSD的危险性因素;女性、客观支持少、主观支持少、对支持的利用度低和震后较多负性生活事件是睡眠问题共患抑郁的危险性因素;女性、主观支持低、对支持的利用度低和震后较多继发负性生活事件是睡眠问题共患焦虑的危险性因素。结论:震后18个月睡眠问题共患PTSD、抑郁、焦虑较高,评估及干预青少年的睡眠问题对预防精神健康问题有重要意义。     

Sleep-Related Problems and the Effects of Anxiety Treatment in Children and Adolescents

This study examined (a) demographic and clinical characteristics associated with sleep-related problems (SRPs) among youth with anxiety disorders, and (b) the impact of anxiety treatment: cognitive-behavioral therapy (CBT; Coping Cat), medication (sertraline), their combination, and pill placebo on SRPs. Youth (N?=?488, ages 7–17, 50% female, 79% White) with a principal diagnosis of generalized anxiety disorder, separation anxiety disorder, or social phobia participated. SRPs were reported by parents and youth. Findings differed by informant and by type of SRP, with evidence that SRPs are associated with age, anxiety severity, externalizing problems, functional impairment, and family burden at pretreatment. Anxiety treatment reduced SRPs; effect sizes were small to medium. Reductions in parent-reported separation-related sleep difficulties were significantly greater in active treatment than in the placebo condition, with the greatest reductions reported by parents of youth whose active treatment was multimodal or included sertraline. Youth whose anxiety treatment involved CBT reported significantly greater decreases in dysregulated sleep (e.g., sleeplessness). Both CBT for anxiety and sertraline appear to be somewhat effective in reducing SRPs, and multimodal treatment may be preferable depending on the symptom presentation. To inform practice, future research should examine a broad range of SRPs, incorporate objective measures of sleep, and evaluate the impact of behavioral strategies that directly target SRPs in youth with anxiety disorders.     

Sleep and Risk-Taking Behavior in Adolescents

The primary purpose of this study was to examine the relationship between adolescents' sleep-wake patterns and risk-taking behavior. A second goal was to replicate the results obtained by Wolfson and Carskadon (1998) regarding adolescents' sleep habits. Three hundred eighty-eight adolescents (217 males, 171 females) completed the Sleep Habits Survey and the Youth Risk Behavior Survey. The results indicated that adolescents who reported longer weekend delay and higher levels of sleep problems also reported significantly higher levels of risk-taking behaviors, and students' weekend delay was also related to their academic performance in this sample. As in the sample studied by Wolfson and Carskadon (1998), the adolescents in this study exhibited changes in both weekday and weekend sleep habits across grade/age. However in the present study, only school-night total sleep time and weekend delay were related to adolescents' daytime functioning, with no significant relationships being found between weekend oversleep and daytime functioning. This provides partial support for the findings of Wolfson and Carskadon (1998). Overall, sleep-wake patterns were found to relate to risk-taking behavior during adolescence in this study.     

睡眠呼吸暂停低通气综合征患者的抑郁焦虑症状研究

目的:探讨睡眠呼吸暂停低通气综合征(SAHS)患者并发抑郁焦虑情况.方法:对50例SAHS患者和30例正常对照者进行整夜多导睡眠图(PSG)检查,分别对其进行抑郁、焦虑症状评定.结果:SAHS组SAS量表、SDS量表标准分均高于正常对照组(P<0.05).SAHS组抑郁和焦虑发生率分别为42.0%和32.0%.SAHS组抑郁焦虑情绪与夜间总睡眠时间、NREM和REM睡眠时间呈显著负相关(r>0.6),与觉醒次数及睡眠潜伏期呈正相关(r>0.3).结论:SAHS患者存在显著的抑郁焦虑症状.     

Screening for Trauma-Related Sleep Disturbance in Women Admitted for Specialized Inpatient Treatment

Abstract

The authors designed a Sleep Disturbance Screening questionnaire to assist clinicians in disentangling trauma-related factors that contribute to sleep disturbance from other common factors, such as depression. They administered the questionnaire to 129 female psychiatric inpatients, most of whom were treated in a specialty program for trauma-related disorders. Confirmatory and exploratory factor analyses distinguished four sleep disturbance scales, two pertaining to sleep disturbance generally (Insomnia, Hypersomnia) and two pertaining to sleep-related fear (Intrusive, Phobic). Correlations of the sleep disturbance scales with the Childhood Trauma Questionnaire (Bernstein et al., 1994), Impact of Event Scale-Revised (Weiss & Marmar, 1997), Dissociative Experiences Scale (Bernstein & Putnam, 1986), Beck Depression Inventory (Beck & Steer, 1993), and selected scales of the Millon Clinical Multiaxial Inventory (MCMI-III; Millon, 1994) show evidence of convergent and discriminant validity for the Sleep Disturbance Screening. The findings point to the potential diagnostic value of screening for trauma-related sleep disturbance, with the Sleep Disturbance Screening providing a small set of key questions that may be used in psychometric form or incorporated into routine diagnostic clinical interviews.     

Sleep Problems and Disorders among Adolescents with Persistent and Subthreshold Attention-deficit/Hyperactivity Disorders

Study Objectives:

To investigate the sleep schedules, problems, and disorders among adolescents with persistent attention-deficit/hyperactivity disorder (ADHD) and those with partially remitted ADHD symptoms.

Design:

A case-control study.

Setting:

National Taiwan University and schools in Taipei

Patients or Participants:

The sample included 281 adolescents (male, 85.4%; 145 with persistent ADHD, 136 with subthreshold ADHD), aged 11 to 17, who were diagnosed with ADHD, according to DSM-IV criteria, at the mean age of 6.7 years (SD = 3.0) and 185 unaffected control subjects.

Interventions:

N/A.

Measurements and Results:

We conducted psychiatric interviews of participants and their mothers using the Chinese Kiddie-Schedule for Affective Disorders and Schizophrenia-Epidemiology version for 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-related symptoms. Our results showed that adolescents with a childhood diagnosis of ADHD according to DSM-IV criteria, regardless of persistent ADHD, were more likely to have current and lifetime sleep problems and sleep disorders according to DSM-IV (insomnia, sleep terrors, nightmares, bruxism, and snoring). The presence of at least 1 psychiatric comorbid condition increased the risks for insomnia and nightmares. The use of methylphenidate was not associated with further increased risk of sleep problems, except bruxism.

Conclusions:

Our findings support a relationship between ADHD and sleep problems, which can be partially explained by the psychiatric comorbidities, but did not support a disturbed sleep schedule. Our study suggests that mental health professionals should screen for sleep problems and psychiatric comorbidities among adolescents with a childhood diagnosis of ADHD regardless of the severity of current ADHD symptoms.

Citation:

Gau SSF; Chiang HL. Sleep problems and disorders among adolescents with persistent and subthreshold attention-deficit/hyperactivity disorders. SLEEP 2009;32(5):671-679.     

Sleep Disturbance and Injury Risk in Young Children

The objective of this study was to investigate the relationship between sleep disturbance and both injury rates and injury-prone behaviors in preschool-age and early school-age children, using cross-sectional surveys of sleep disturbance (Children's Sleep Habits Questionnaire) and injury-related behaviors (Injury Behavior Checklist), and chart review of injuries. Participants were 71 patients enrolled in a pediatric clinic in a children's teaching hospital, ages 3 through 7 years, coming either for well-child care in a pediatric primary care clinic or for pediatric emergency room treatment of minor injuries. Results suggest that children with more frequent injuries had significantly more sleep problems overall, particularly anxiety around sleep, than did children with low injury rates. Children with more parent-reported injury-prone behaviors also had significantly more sleep disturbance. Daytime sleepiness-related items did not differ between injury history or injury behavior groups. Results of this study support an increased prevalence of sleep disturbances in young children with higher injury rates and more injury-prone behavior. Sleep disturbance may be a potential risk factor for increased injuries in this age group.     

Effectiveness Trial of Psychoanalytic Psychotherapy for Children and Adolescents with Severe Anxiety Symptoms in a Naturalistic Treatment Setting

Background The aim of the study was to look at symptom changes in naturalistic outpatient psychoanalytic child and adolescent psychotherapy for anxiety disorders in Germany. Methods (1) The first treatment period of the psychodynamic intervention group (<25 sessions) was compared with a minimal supportive treatment (waiting list) control group, and (2) the effects of long‐term psychoanalytical treatment (>25 sessions) were analysed using a longitudinal observational design. A total of 86 children and adolescents (4–21 years) were in the treatment group and 35 in the minimal supportive treatment control group. Questionnaires were administered at the beginning and end of treatment, as well as at 6‐ and 12‐month follow‐up (FU). Results When comparing the first treatment period with the minimal supportive treatment control group, both groups improved significantly with small effect sizes and no significant group differences. Both parents and patients reported moderate symptom improvements at the end of therapy (parent: d=0.58; patient: d=0.57), which were stable at FU and increased from the patient perspective (parent: d=0.37; patient: d=0.80). Conclusions The results suggest that anxiety symptoms significantly decreased during the treatment period and remained stable at FU. Due to the study design we could not rule out alternative explanations like regression to the mean.     

失眠症患者状态-特质焦虑与睡眠结构的关系

目的:探讨失眠症患者睡眠结构改变与状态焦虑和特质焦虑的关系.方法:对31例失眠症患者和20例正常对照者进行状态-特质焦虑问卷调查和整夜多导睡眠图描记,失眠症组于症状缓解出院后3~4月回访时重复检查.结果:(1)在睡眠结构上,与对照组相比,失眠症组呈现睡眠时间减少[(333.71±84.33)min vs.(403.65±19.29)min]、睡眠效率下降[(70.41±17.35) % vs.(83.45±4.42) %]、睡眠潜伏期[(39.48±24.24) min vs.(19.65±8.57) min]和快速眼动睡眠潜伏期延长[(106.60±42.89) min vs.(86.80±12.25) min],S_1睡眠时间比例增加[( 25.36±14.22) %vs.(8.86±1.77) %]、觉醒次数增多[(4.45±2.51) vs.(1.75±1.07)].S_(3+4)睡眠[(7.38±9.70)% vs.(13.78±4.24)%]和快速眼动睡眠时间比例[( 14.54±5.61) %vs.(19.18±2.14) %]减少 (Ps<0.05).(2)在状态-特质焦虑问卷评分上,失眠症组状态焦虑[(47.94 ±8.96) vs.(39.15±4.51)]和特质焦虑[(49.94 ±8.90) vs.(42.05±7.13)]得分均高于对照组(Ps<0.05).状态焦虑与睡眠潜伏期、快眼动睡眠潜伏期、觉醒次数和S_1睡眠时间比例均呈正相关(r=0.25~0.44,Ps<0.05),而与快眼动睡眠时间比例呈负相关(r=-0.41,P<0.01);特质焦虑与睡眠潜伏期和觉醒次数正相关(r=0.37,0.29;均Ps<0.05).(3)回访时患者睡眠结构改善,状态焦虑得分下降,特质焦虑无明显变化.结论:失眠症患者有明显的睡眠结构改变和较高的状态焦虑和特质焦虑,其睡眠结构改变与状态焦虑和特质焦虑相关.     

Depressive Symptoms and Sleep Disturbance in Adults with Histories of Childhood Abuse

Abstract

Depressive symptoms including sleep disturbance are clinically apparent in many patients with histories of childhood abuse. This study investigated the nature and severity of depressive symptoms, sleep disturbance, and trauma-related symptoms in a group of female participants with abuse histories, as compared to a non-abused group of female participants with major depression. Sixty (60) participants with a history of childhood abuse and 13 participants with major depression completed several self-report instruments which examine past life experiences, depressive symptoms, post-traumatic symptoms, dissociative symptoms, and sleep problems. To control for differences in background characteristics, a subset of participants with abuse histories were matched to and compared with the 13 depressed participants. Both the abused and depressed groups showed high levels of depressive symptoms, but there were no significant differences between the groups. The abused group had significantly more intrusive post-traumatic symptoms, more dissociative symptoms, and were more likely to be afraid of falling asleep and more anxious upon mid-sleep awakening. Severity of depressive symptoms in the abused group was correlated with severity of intrusive post-traumatic symptomatology. The investigators conclude that symptoms of major depression in some patients with abuse histories may have a post-traumatic etiology, especially since intrusive reexperi-encing of past trauma may produce severe dysphoria and hopelessness. The nature of sleep disturbance in patients with abuse histories may be a clinical tool to identify patients whose depressive symptoms may be post-traumatic in origin.     

Enhanced Early Posterior Negativity to Fearful Faces in Patients with Anxiety Disorder

Patients with anxiety disorders (AnDs) have distinct patterns of threat-related emotional processing compared to healthy controls (HCs). The current study investigated the temporal course of emotional processing in AnDs by examining Event-related potential (ERP) components. Twenty-three AnDs and twenty-four age- and gender-matched HCs viewed emotional (fearful, happy) and neutral faces while their electroencephalograms were recorded. Early (P100, N170), middle (early posterior negativity; EPN), and late ERP components late positive potential were analyzed. To localize ERP source activity, standardized low-resolution brain electromagnetic tomography (sLORETA) was used. AnDs displayed significantly enhanced mean amplitude of the EPN compared to HCs when fearful faces were presented. In addition, the EPN’s mean amplitude elicited by fearful faces was more pronounced than for happy and neutral faces in AnDs, whereas in HCs the EPN elicited by fearful faces was only augmented compared to neutral faces. Finally, sLORETA analysis revealed that the source activity of the EPN (fearful minus happy face condition) was increased in the cuneus and precuneus in AnDs compared to HCs. Our results indicate that the EPN is a distinct ERP component modulated by facial emotional processing in AnDs. Furthermore, the results show that anxiety symptoms enhance selective attention for fearful faces. Finally, it revealed that the cuneus and precuneus are involved in fearful face processing in AnDs.     

Facing Complaining Customer and Suppressed Emotion at Worksite Related to Sleep Disturbance in Korea

This study aimed to investigate the effect of facing complaining customer and suppressed emotion at worksite on sleep disturbance among working population. We enrolled 13,066 paid workers (male = 6,839, female = 6,227, age < 65 years) in the 3rd Korean Working Condition Survey (2011). The odds ratio (OR) and 95% confidence intervals (CI) for sleep disturbance occurrence were calculated using multiple logistic regression models. Among workers in working environments where they always engage complaining customers had a significantly higher risk for sleep disturbance than rarely group (The OR [95% CI]; 5.46 [3.43–8.68] in male, 5.59 [3.30–9.46] in female workers). The OR (95% CI) for sleep disturbance was 1.78 (1.16–2.73) and 1.63 (1.02–2.63), for the male and female groups always suppressing their emotions at the workplace compared with those rarely group. Compared to those who both rarely engaged complaining customers and rarely suppressed their emotions at work, the OR (CI) for sleep disturbance was 9.66 (4.34–20.80) and 10.17 (4.46–22.07), for men and women always exposed to both factors. Sleep disturbance was affected by interactions of both emotional demands (engaging complaining customers and suppressing emotions at the workplace). The level of emotional demand, including engaging complaining customers and suppressing emotions at the workplace is significantly associated with sleep disturbance among Korean working population.     

抑郁症患者睡眠障碍相关因素及对预后影响调查

目的调查抑郁症患者睡眠障碍的相关因素、以及睡眠障碍对患者预后的影响。方法选择60例抑郁症患者,采用匹兹堡睡眠质量指数量表（PSQI）评估患者的主观睡眠质量,并随访3个月。结果治疗前PSQI评分与性别（F=8.67,P＜0.01）、受教育年限（r=-0.33,P＜0.01）、躯体疾病（F=6.68,P＜0.01）、家族史（F=4.04,P＜0.05）、首发与否（F=20.43,P＜0.01）、积极应对分（r=-0.44,P＜0.01）、消极应对分（r=0.23,P＜0.01）、HAMD（r=0.22,P＜0.05）、HAMA（r=0.31,P＜0.01）、SIOSS（r=0.56,P＜0.01）明显相关,治疗后PSQI评分与HAMD、HAMA、SIOSS均显著正相关（P＜0.01）。结论抑郁症患者的睡眠障碍危险因素较多,对疾病结局有不良影响。     

Sleep and Sleep Disturbance in Children: Reliability and Validity of the Dutch Version of the Child Sleep Habits Questionnaire

Study Objectives:

The Child Sleep Habits Questionnaire (CSHQ) was developed in the US for measuring medical and behavioral sleep disorders in school-aged children. This study was conducted to assess the reliability and structural validity of the Dutch version of the CSHQ.

Design:

Population-based study

Setting:

Questionnaires (n = 2385) were distributed to children in primary schools and daycare centers to be completed by the parent/guardian. An identical second questionnaire was distributed for test-retest and interobserver reliability, which were assessed using intraclass correlation, and compared with published data. Internal consistency was assessed by Cronbach α (per subscale). Validity was analyzed by confirmatory and exploratory factor analysis.

Participants:

School-aged children.

Interventions:

None.

Measurements & Results:

The questionnaire was returned by 1502 (63%) parents, 47% returned the questionnaire for test-retest, and 32% for interobserver reliability. Test-retest reliability was moderate to good, ranging from 0.47 to 0.93. Interobserver reliability was moderate to good, ranging from 0.53 to 0.87, with the exception of Sleep duration. Cronbach α ranged from 0.47 to 0.68. In confirmatory factor analysis the domain structure of the original American CSHQ could not be confirmed. Exploratory factor analysis suggested a 4-factor structure rather than the original 8 domains.

Conclusions:

The CSHQ seems to have an adequate reliability and moderate internal consistency in a Dutch population with different sociocultural characteristics than the US population in which it was devised. Factor analysis suggests that translation, cultural background, or subscales of the original instrument may affect the performance of the CSHQ.

Citation:

Waumans RC; Terwee CB; Van den Berg G; Knol DL; Van Litsenburg RRL; Gemke RJBJ. Sleep and sleep disturbance in children: reliability and validity of the Dutch version of the Child Sleep Habits Questionnaire. SLEEP 2010;33(6):841-845.     

Temporal Relationships Between Napping and Nocturnal Sleep in Healthy Adolescents

Many adolescents do not achieve the recommended 9 hr of sleep per night and report daytime napping, perhaps because it makes up for short nocturnal sleep. This article tests temporal relationships between daytime naps and nighttime sleep as measured by actigraphy and diary among 236 healthy high school students during one school week. Mixed model analyses adjusted for age, race, and gender demonstrated that shorter actigraphy-assessed nocturnal sleep duration predicted longer napping (measured by actigraphy and diary) the next day. Napping (by actigraphy and diary) predicted shorter nocturnal sleep duration and worse sleep efficiency that night measured by actigraphy. Diary-reported napping also predicted poorer self-reported sleep quality that night. Frequent napping may interfere with nocturnal sleep during adolescence.     

Changes in Subjective Sleep Quality Before a Competition and Their Relation to Competitive Anxiety

Objective/Background: The aim of this study was to examine the effects of competitions on subjective sleep quality. Previous studies have been inconclusive and lack differentiated and standardized measurements of subjective sleep quality. Furthermore the temporal relation between precompetitive anxiety and sleep quality was investigated. Anxiety and nervousness associated with competitions are considered to cause sleep impairments. Participants: A convenience sample of N = 79 elite male athletes from various sports participated. Methods: In a time-to-event paradigm, sleep quality and competitive anxiety were assessed via standardized self-report measurements 4 days before a competition and on the day of the competition. Univariate analyses were used to examine differences between time points. To examine cross-lagged effects between anxiety and sleep quality a latent change score model (LCSM) was specified that tested an effect of anxiety on changes in sleep quality. Results: Evaluations of nocturnal sleep deteriorated significantly from 4 days before competition to the day of competition, but there were no differences regarding perceptions of the restorative value of sleep. LCSM revealed that athletes who reported more intense worry symptoms 4 days before competition also reported greater deterioration in evaluations of nocturnal sleep. Conclusions: The findings support earlier reports of impaired subjective sleep quality before competitions. Precompetitive sleep impairments appear also to be preceded by cognitive anxiety. Whereas interventions should thus address worry-cognitions associated with competition and sleep, research should address the practical importance of these perceptions of sleep impairments.     

Evidence-Based Assessment of Anxiety and Its Disorders in Children and Adolescents

We provide an overview of where the field currently stands when it comes to having evidence-based methods and instruments available for use in assessing anxiety and its disorders in children and adolescents. Methods covered include diagnostic interview schedules, rating scales, observations, and self-monitoring forms. We also discuss the main purposes or goals of assessment and indicate which methods and instruments have the most evidence for accomplishing these goals. We also focus on several specific issues that need continued research attention for the field to move forward toward an evidence-based assessment approach. Finally, tentative recommendations are made for conducting an evidence-based assessment for anxiety and its disorders in children and adolescents. Directions for future research also are discussed.     

Evidence Base Update on the Treatment of Early Childhood Anxiety and Related Problems

The controlled evaluation of treatments for early childhood anxiety and related problems has been a relatively recent area of investigation, and accordingly, trials examining early childhood anxiety treatment have not been well represented in existing systematic reviews of youth anxiety treatments. This Evidence Base Update provides the first systematic review of evidence supporting interventions specifically for the treatment of early childhood anxiety and related problems. Thirty articles testing 38 treatments in samples with mean age < 7.9 years (N = 2,228 children) met inclusion criteria. We applied Southam-Gerow and Prinstein’s (2014) review criteria, which classifies families of treatments according to one of five levels of empirical support—Well-Established, Probably Efficacious, Possibly Efficacious, Experimental, and of Questionable Efficacy. We found family-based cognitive-behavioral therapy (CBT) to be a Well-Established treatment, and Group Parent CBT and Group Parent CBT + Group Child CBT to both be Probably Efficacious treatments. In contrast, play therapy and attachment-based therapy are still only Experimental treatments for early childhood anxiety, relaxation training has Questionable Efficacy, and there is no evidence to date to speak to the efficacy of individual child CBT and/or medication in younger anxious children. All 3 currently supported interventions for early childhood anxiety entail exposure-based CBT with significant parental involvement. This conclusion meaningfully differs from conclusions for treating anxiety in older childhood that highlight the well-established efficacy of individual child CBT and/or medication and that question whether parental involvement in treatment enhances outcomes.