Anxiety, Obsessive-Compulsive, and Related Disorders

2020 ◽  
pp. 318-336
Author(s):  
Bruce Rohrs ◽  
Benjamen Gangewere ◽  
Alicia Kaplan ◽  
Amit Chopra
Keyword(s):  
Anxiety Disorders ◽  
Sleep Disturbance ◽  
Sleep Disturbances ◽  
Sleep Problems ◽  
Sleep Onset ◽  
Sleep Time ◽  
Sleep Onset Latency ◽  
Limited Evidence ◽  
Obsessive Compulsive ◽  
Psychotherapeutic Interventions

Despite its common comorbidity, sleep disturbance is often underrecognized and undertreated in individuals with anxiety disorders. Compared to mood disorders, sleep disturbance in this population is less well studied except for panic disorder and generalized anxiety disorder. Some evidence suggests a bidirectional link between anxiety disorders and sleep disturbance. Polysomnography findings point to some commonalities across anxiety disorders, including longer sleep onset latency, reduced total sleep time, and reduced sleep efficiency. The underlying biological mechanisms linking anxiety disorders and sleep disturbance are still unclear. However, there is limited evidence suggesting a connection between impaired executive functioning due to sleep problems and failure to inhibit anxiety related thoughts and feelings. Cortisol irregularities and disruption in the serotonergic system may also play a role. Evidence suggests that anxiety sensitivity is a transdiagnostic factor that contributes to both anxiety disorders and sleep disturbance. Further research is warranted to elucidate common biological and psychological factors underlying sleep disturbances and anxiety disorders. There is an imminent need to systematically assess the impact of sleep disturbance on symptom severity and treatment outcomes in anxiety, obsessive-compulsive, and related disorders. Limited evidence is available for medications and targeted psychotherapeutic interventions for management of sleep disturbance thus warranting the development of robust sleep interventions to achieve optimal clinical outcomes in this patient population.

scholarly journals The Cycle of Daily Stress and Sleep: Sleep Measurement Matters

2020 ◽  
Author(s):  
Danica C Slavish ◽  
Justin Asbee ◽  
Kirti Veeramachaneni ◽  
Brett A Messman ◽  
Bella Scott ◽  
...  
Keyword(s):  
Sleep Disturbances ◽  
Multilevel Models ◽  
Single Channel ◽  
Sleep Onset ◽  
Sleep Time ◽  
Sleep Diary ◽  
Sleep Onset Latency ◽  
Daily Stress ◽  
Sleep Diaries ◽  
Sleep Measurement

Abstract Background Disturbed sleep can be a cause and a consequence of elevated stress. Yet intensive longitudinal studies have revealed that sleep assessed via diaries and actigraphy is inconsistently associated with daily stress. Purpose We expanded this research by examining daily associations between sleep and stress using a threefold approach to assess sleep: sleep diaries, actigraphy, and ambulatory single-channel electroencephalography (EEG). Methods Participants were 80 adults (mean age = 32.65 years, 63% female) who completed 7 days of stressor and sleep assessments. Multilevel models were used to examine bidirectional associations between occurrence and severity of daily stress with diary-, actigraphy-, and EEG-determined sleep parameters (e.g., total sleep time [TST], sleep efficiency, and sleep onset latency, and wake after sleep onset [WASO]). Results Participants reported at least one stressor 37% of days. Days with a stressor were associated with a 14.4-min reduction in actigraphy-determined TST (β = −0.24, p = 0.030), but not with other actigraphy, diary, or EEG sleep measures. Nights with greater sleep diary-determined WASO were associated with greater next-day stressor severity (β = 0.01, p = 0.026); no other diary, actigraphy, or EEG sleep measures were associated with next-day stressor occurrence or severity. Conclusions Daily stress and sleep disturbances occurred in a bidirectional fashion, though specific results varied by sleep measurement technique and sleep parameter. Together, our results highlight that the type of sleep measurement matters for examining associations with daily stress. We urge future researchers to treat sleep diaries, actigraphy, and EEG as complementary—not redundant—sleep measurement approaches.

Sleep disturbance and quality of life in Rheumatoid Arthritis: a prospective mobile health study (Preprint)

2021 ◽  
Author(s):  
John McBeth ◽  
William G Dixon ◽  
Susan Mary Moore ◽  
Bruce Hellman ◽  
Ben James ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
Sleep Disturbance ◽  
Mobile Health ◽  
Sleep Disturbances ◽  
Total Sleep Time ◽  
Sleep Onset ◽  
Sleep Time ◽  
Domain Scores

BACKGROUND Sleep disturbance and poor health related quality of life (HRQoL) are common in people with rheumatoid arthritis (RA). Sleep disturbances, such as less total sleep time, more waking periods after sleep onset, and higher levels of non-restorative sleep, may be a driver of HRQoL. However, understanding if these sleep disturbances reduce HRQoL has, to date, been challenging due to the need to collect complex time-varying data in high resolution. Such data collection has now been made possible by the widespread availability and use of mobile health (mHealth) technologies. OBJECTIVE In a mobile health (mHealth) study we tested whether sleep disturbance (both absolute values and variability) caused poor HRQoL. METHODS The Quality of life, sleep and rheumatoid arthritis (QUASAR) study was a prospective mHealth study of adults with RA. Participants completed a baseline questionnaire, and for 30 days wore a triaxial accelerometer to objectively assess sleep, and provided daily reports via a smartphone app of sleep (Consensus Sleep Diary (CSD)), pain, fatigue, mood, and other symptoms. Participants completed the World Health Organization Quality of Life-Brief (WHOQoL-BREF) questionnaire every 10 days. Multi-level modelling tested the relationship between sleep variables and WHOQoL-BREF domains (physical, psychological, environment and social). RESULTS Of 268 recruited participants, 254 were included in this analysis. Across all WHOQoL-BREF domains, participant’s scores were lower than the population average. CSD sleep parameters predicted WHOQoL-BREF domain scores. For example, for each hour increase in the total time asleep physical domain scores increased by 1.11 points (β = 1.11 (0.07, 2.15)) and social domain scores increased by 1.65 points. These associations were not explained by sociodemographic and lifestyle factors, disease activity, medication use, levels of anxiety, sleep quality, or clinical sleep disorders. They were, however, attenuated and no longer significant when pain, fatigue and mood were included in the model. Increased variability in the total time asleep, was associated with poorer physical and psychological domain scores independently of all covariates. There were no patterns of association between actigraphy measured sleep and WHOQoL-BREF. CONCLUSIONS Optimising total sleep time, increasing sleep efficiency, decreasing sleep onset latency, and reducing the variability in total sleep time could improve HRQoL in people with RA.

Links between sleep and body mass index in bipolar disorders: An exploratory study

2015 ◽  
Vol 30 (1) ◽  
pp. 89-93 ◽  
Author(s):  
C. Boudebesse ◽  
P.-A. Geoffroy ◽  
C. Henry ◽  
A. Germain ◽  
J. Scott ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Sleep Disturbances ◽  
Sleep Onset ◽  
Bipolar Disorders ◽  
Sleep Time ◽  
Sleep Efficiency ◽  
Sleep Onset Latency ◽  
Cross Sectional ◽  
Sleep Parameters

AbstractStudy objectives:Obesity and excess bodyweight are highly prevalent in individuals with bipolar disorders (BD) and are associated with adverse consequences. Multiple factors may explain increased bodyweight in BD including side effects of psychotropic medications, and reduced physical activity. Research in the general population demonstrates that sleep disturbances may also contribute to metabolic burden. We present a cross-sectional study of the associations between body mass index (BMI) and sleep parameters in patients with BD as compared with healthy controls (HC).Methods:Twenty-six French outpatients with remitted BD and 29 HC with a similar BMI completed a 21-day study of sleep parameters using objective (actigraphy) and subjective (PSQI: Pittsburgh Sleep Quality Index) assessments.Results:In BD cases, but not in HC, higher BMI was significantly correlated with lower sleep efficiency (P = 0.009) and with several other sleep parameters: shorter total sleep time (P = 0.01), longer sleep onset latency (P = 0.05), higher fragmentation index (P = 0.008), higher inter-day variability (P = 0.05) and higher PSQI total score (P = 0.004).Conclusions:The findings suggest a link between a high BMI and several sleep disturbances in BD, including lower sleep efficiency. Physiological mechanisms in BD cases may include an exaggeration of phenomena observed in non-clinical populations. However, larger scale studies are required to clarify the links between metabolic and sleep-wake cycle disturbances in BD.

Comorbidity of ADHD and Anxiety Disorders in School-Age Children: Impact on Sleep and Response to a Cognitive-Behavioral Treatment

2015 ◽  
Vol 22 (5) ◽  
pp. 414-424 ◽  
Author(s):  
Maxime Bériault ◽  
Lyse Turgeon ◽  
Mélanie Labrosse ◽  
Claude Berthiaume ◽  
Martine Verreault ◽  
...  
Keyword(s):  
Anxiety Disorders ◽  
Sleep Disturbances ◽  
Behavioral Treatment ◽  
Sleep Onset ◽  
Cognitive Behavioral ◽  
Sleep Onset Latency ◽  
Sleep Habits ◽  
Children With Adhd ◽  
Comorbid Anxiety ◽  
The Impact

Objective: This exploratory study measured the impact of comorbid anxiety disorders on sleep in children with ADHD and tested the effect of cognitive-behavioral therapy (CBT) on these measures. Method: Fifty-seven children (8-12 years old) were assessed with the Child Sleep Habits Questionnaire. Four groups were formed: ADHD ( n = 20), ADHD + Anxiety ( n = 20), Anxiety ( n = 8), and Healthy Controls ( n = 9). A subgroup of 10 children with ADHD + Anxiety underwent CBT for anxiety. Results: The results showed that sleep difficulties were better associated with anxiety than with ADHD. CBT reduced sleep onset latency and marginally decreased the total amount of sleep problems. Conclusion: The present study demonstrates that comorbid anxiety in ADHD children is linked with specific sleep disturbances and is sensitive to CBT aimed at reducing anxiety.

Sleep Disturbance in Preschool-Aged Hyperactive and Nonhyperactive Children

PEDIATRICS ◽  
1987 ◽  
Vol 80 (6) ◽  
pp. 839-844 ◽  
Author(s):  
Bonnie J. Kaplan ◽  
Jane McNicol ◽  
Richard A. Conte ◽  
H. K. Moghadam
Keyword(s):  
Attention Deficit ◽  
Attention Deficit Disorder ◽  
Sleep Problems ◽  
Sleep Onset ◽  
Sleep Time ◽  
Sleep Onset Latency ◽  
Significant Group ◽  
The Third ◽  
Night Sweats ◽  
Definition Of

In spite of inadequate laboratory demonstrations of sleep problems in children with attention deficit disorder with hyperactivity, the belief persists that such problems exist. Sleep restlessness is, in fact, one of the criteria in the Diagnostic and Statistical Manual of Mental Disorders, ed 3, definition of attention deficit disorder with hyperactivity, and sleep problems are listed on two major checklists often used for describing the symptoms of this disorder. In a series of three studies, sleep problems were investigated in preschool-aged children with attention deficit disorder relative to control children without the disorder. Results of the first two studies demonstrated clearly that parents of hyperactive children considered their children to have many more sleep problems than did parents of the control children. Parental daily documentation, which is less likely to be affected by reporting bias, was used in the third study. Although the results of the third study supported the finding of increased frequency of night wakings in these children, there was no difference in total sleep time or sleep onset latency between the two groups. Two other significant group differences (enuresis and night sweats) were primarily due to subgroups of children with attention deficit disorder and hyperactivity. The greater number of sleep wakings, which disrupt parents' sleep, may be responsible for the clinical reports that these children are poor sleepers.

scholarly journals 1071 Subjective Measures Of Hyperarousal Predict Subjective Longitudinal And Retrospective Measures Of Sleep Quality In Individuals Exposed To Trauma

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A408-A408
Author(s):  
A Kram Mendelsohn ◽  
C Daffre ◽  
K I Oliver ◽  
J Seo ◽  
N B Lasko ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Sleep Disturbances ◽  
Traumatic Event ◽  
Behavioral Therapy ◽  
Sleep Onset ◽  
Sleep Time ◽  
Sleep Onset Latency ◽  
Wake Time ◽  
Sleep Diaries ◽  
Dsm 5

Abstract Introduction Hyperarousal and disturbed sleep are intrinsic symptoms of posttraumatic stress disorder (PTSD). We explored whether self-reported indices of hyperarousal predict longitudinally measured objective, subjective, and retrospective evaluations of sleep quality in trauma-exposed individuals. Methods Individuals exposed to a DSM-5 PTSD Criterion-A traumatic event within the past two years (N=130, 91 females), aged 18-40 (mean 24.43, SD 5.30), 51.54% of whom met DSM-5 criteria for PTSD, completed 14 days of actigraphy and sleep diaries. Participants also completed the PTSD Checklist for DSM-5 (PCL-5), the Clinician-Administered PTSD Scale (CAPS-5), published Hyperarousal (HAS) and Hypervigilance (HVQ) scales, and the Pittsburgh Sleep Quality Index (PSQI) (N=108-125 for different scales). Mean total sleep time (TST), sleep onset latency (SOL), sleep efficiency (SE) and sleep midpoint were calculated from actigraphy and subjective SOL, SE, number of awakenings, and time spent awake from diaries. Simple regressions were used to predict associations of the PCL-5, HAS, and HVQ scores with measures of sleep quality. Results Hyperarousal indices predicted diary but not actigraphy measures of sleep quality. Longer diary-reported SOL was predicted by higher scores for: PCL-5 total score (R=0.290, p=0.001), PCL-5 hyperarousal items without the sleep item (R=0.261, p=0.004), and HAS without sleep items (R=0.220, p=0.016). Diary-reported number of awakenings and wake time after sleep onset were predicted by higher HAS scores without the sleep question: (R=0.373, p<0.001; r=0.352, p<0.001). Similarly, all hyperarousal indices significantly predicted PSQI global score (PCL-5: R=0.482, p<0.001; PCL-5 hyperarousal: R=0.389, p<0.001; HVQ: R=0.214, p=0.017; HAS without sleep question: R=0.415, p<0.001). Conclusion Self-reported hyperarousal measures predict subjective longitudinal (especially SOL) and retrospective measures, but not objective measurements of sleep quality. Similar discrepancies between self-reported and objective measures of sleep quality have been reported in patients with insomnia disorder. Cognitive-behavioral therapy for insomnia may be especially effective in treating post-traumatic sleep disturbances. Support R01MH109638

scholarly journals Melatonin in Treatment of Chronic Sleep Disorders in Adults with Pervasive Development Disorders: A Retrospective Study

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
N. Deriaz ◽  
G. Galli-Carminati ◽  
G. Bertschy
Keyword(s):  
Intellectual Disability ◽  
Sleep Disorders ◽  
Pervasive Developmental Disorders ◽  
Sleep Disturbances ◽  
Developmental Disorders ◽  
Sleep Onset ◽  
Sleep Time ◽  
Sleep Onset Latency ◽  
Safe Alternative ◽  
Pervasive Development Disorders

Background:Melatonin may be used to treat sleep disorders in both children and adults with intellectual disability. the evidence for its efficacy, potential adverse effects and drug interactions are reviewed in the context of prescribing to people with intellectual disability.Methods:This study presents the use of melatonin to treat severe circadian sleep-wake disturbances in 6 adults with pervasive developmental disorders. Melatonin was initiated at a daily dose of 3 mg at nocturnal bedtime. If this proved ineffective, the melatonin dose was titrated over the following 4 weeks at increments of 3mg/2weeks up to a maximum of 9 mg, unless it was tolerated. Assessments included the Clinical Global Impression-Severity (CGI-S) and CGI-Improvement (CGI-I).Results:Melatonin administered in the evening dramatically improved the sleep-wake pattern in all patients. Melatonin appears to be effective in reducing sleep onset latency and is probably effective in improving nocturnal awakenings and total sleep time in adults with pervasive developmental disorders. Its effectiveness remained stable for the 6-months period of administration. Melatonin was well-tolerated in all patients and no side effects were noted during the therapy.Conclusions:Melatonin appears to be promising as an efficient and seemingly safe alternative for treatment of severe circadian sleep disturbances in adults with intellectual disability. There may be heterogeneity of response depending on the nature of the sleep problem and cause of the intellectual disability or associated disabilities. Further studies are necessary before firm conclusions can be drawn and guidelines for the use of melatonin for people with ID formulated.

scholarly journals Sleep Disturbances in Survivors of Pediatric Acute Lymphoblastic Leukemia and Their Siblings

2020 ◽  
Vol 45 (7) ◽  
pp. 707-716 ◽  
Author(s):  
K Brooke Russell ◽  
Erin L Merz ◽  
Kathleen Reynolds ◽  
Fiona Schulte ◽  
Lianne Tomfohr-Madsen
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Sleep Disturbances ◽  
Sleep Problems ◽  
Lymphoblastic Leukemia ◽  
Sleep Onset ◽  
Sleep Time ◽  
Sleep Diary ◽  
National Guidelines ◽  
Sleep Habits ◽  
Survivor Group

Abstract Objective Sleep disturbances have been identified by patients with cancer as common and distressing; however, conflicting evidence about the prevalence of these outcomes exists for survivors of childhood cancers. Additionally, little is known about how the experience of cancer might impact survivor siblings’ sleep. The current study compared the sleep of survivors of acute lymphoblastic leukemia who were 2–7 years off therapy and their siblings to healthy control/sibling dyads. Methods Participants (survivors, n = 45; survivor siblings, n = 27; controls, n = 45; control siblings, n = 41; 58% male) aged 8–18 (m = 11.64) completed a 7-day sleep diary and seven consecutive days of actigraphy. Parents (n = 90) completed the Children’s Sleep Habits Questionnaire for each of their children. Results No between-group differences were found on measures of sleep diaries or actigraphy. Parents reported that survivor siblings had significantly poorer sleep habits than survivors or controls. For survivors, greater time off treatment and younger age at diagnosis were associated with less total sleep time, more wake after sleep onset, and decreased sleep efficiency via actigraphy. Conclusion Sleep across all groups was consistent and below national guidelines. Although the survivor group did not have poorer sleep compared to their siblings or matched controls, within the survivor group, those who were diagnosed at an earlier age and those who were further off treatment had more disrupted sleep. Parent reports suggested that survivor siblings may be at risk for sleep problems.

scholarly journals Actigraphy-Derived Sleep Profiles of Children with and without Attention-Deficit/Hyperactivity Disorder (ADHD) over Two Weeks—Comparison, Precursor Symptoms, and the Chronotype

2021 ◽  
Vol 11 (12) ◽  
pp. 1564
Author(s):  
Mirjam Ziegler ◽  
Anna Kaiser ◽  
Christine Igel ◽  
Julia Geissler ◽  
Konstantin Mechler ◽  
...  
Keyword(s):  
Sleep Disturbances ◽  
Sleep Problems ◽  
Neuropsychological Functioning ◽  
Sleep Onset ◽  
Onset Time ◽  
Individual Variability ◽  
Sleep Onset Latency ◽  
Neurocognitive Performance ◽  
Children With Adhd ◽  
Underlying Mechanisms

Although sleep problems are common in children with ADHD, their extent, preceding risk factors, and the association between neurocognitive performance and neurobiological processes in sleep and ADHD, are still largely unknown. We examined sleep variables in school-aged children with ADHD, addressing their intra-individual variability (IIV) and considering potential precursor symptoms as well as the chronotype. Additionally, in a subgroup of our sample, we investigated associations with neurobehavioral functioning (n = 44). A total of 57 children (6–12 years) with (n = 24) and without ADHD (n = 33) were recruited in one center of the large ESCAlife study to wear actigraphs for two weeks. Actigraphy-derived dependent variables, including IIV, were analyzed using linear mixed models in order to find differences between the groups. A stepwise regression model was used to investigate neuropsychological function. Overall, children with ADHD showed longer sleep onset latency (SOL), higher IIV in SOL, more movements during sleep, lower sleep efficiency, and a slightly larger sleep deficit on school days compared with free days. No group differences were observed for chronotype or sleep onset time. Sleep problems in infancy predicted later SOL and the total number of movements during sleep in children with and without ADHD. No additional effect of sleep problems, beyond ADHD symptom severity, on neuropsychological functioning was found. This study highlights the importance of screening children with ADHD for current and early childhood sleep disturbances in order to prevent long-term sleep problems and offer individualized treatments. Future studies with larger sample sizes should examine possible biological markers to improve our understanding of the underlying mechanisms.

scholarly journals 0552 Investigating Pre-Sleep Processes and How They Influence Sleep: A Diary and Actigraphy Study

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A211-A211
Author(s):  
T Maeder ◽  
J Whitford ◽  
P Feinaigle ◽  
W Karlen ◽  
E Seifritz ◽  
...  
Keyword(s):  
At Risk ◽  
Medical Students ◽  
Sleep Disturbances ◽  
Linear Models ◽  
Sleep Onset ◽  
Sleep Time ◽  
Negative Influence ◽  
Sleep Onset Latency ◽  
Subjective Sleep Quality ◽  
Subjective Sleep

Abstract Introduction The current study examined the relationship between pre-sleep processes and sleep in the context of real-world stress exposure in medical students during an internship. Medical students are often exposed to a variety of stressors and potentially traumatic events and have been shown to be at risk to develop psychopathology. Previous research has shown an association between stress, psychological distress, and sleep disturbances. In this context, studies have investigated possible predictors for sleep disturbances. Recently, the period just prior to sleep onset has received increased interest. At the moment, little is known, however, about the influence of such pre-sleep processes. In this study, we investigated the influence of pre-sleep rumination and mindfulness on sleep disturbances. Methods In a prospective study, we examined a sample of 50 medical students from the University of Zurich. All participants completed their first medical internship over 9 months as part of medical school. Pre-sleep processes and sleep were indexed mid-internship using sleep diaries over seven consecutive days. Additionally, a Fitbit tracking device was used to objectively measure sleep. Correlational analyses and multilevel linear models were conducted. Results Results show associations between pre-sleep processes and sleep disturbances in this stress-exposed at-risk population. Multilevel mixed-effects models showed that over the period of 7 consecutive nights, pre-sleep rumination was a significant predictor of lower subjective sleep quality (B = -.085, SE = .036, p = .02), lower subjective total sleep time (B = -.124, SE = .043, p = .005), higher subjective sleep onset latency (B = 1.535, SE = .678, p = .025), and higher subjective wake-up frequency (B = .033, SE = .011, p = .003). Conclusion Together, our data suggest pre-sleep processes as potential targets for stress-prevention programs that could help reduce the negative influence of stress in at risk populations. Support NA

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