Sex and age differences in sleep macroarchitecture in childhood and adolescent depression.

SUBJECT OBJECTIVE: To evaluate age and sex differences in sleep macroarchitecture in children and adolescents with major depressive disorder. DESIGN: Ninety-seven (50 F, 47 M) symptomatic unmedicated depressed outpatients were compared with 76 healthy controls (42 F, 34 M) matched for age and sex. SETTING: Participants spent 2 consecutive nights in the sleep laboratory. PARTICIPANTS: One hundred seventy-three children and adolescents, aged 8 to 18 years. MEASUREMENTS AND RESULTS: Significant group-by-age-by-sex interactions were evident for total sleep period, percentage of Stage 1 sleep, percentage of Stage 2, percentage of slow-wave sleep, and rapid eye movement (REM) sleep latency. The depressed adolescent boys had the greatest sleep disturbance with the highest amount of percentage of Stage 1 sleep, the shortest REM latency, and the least percentage of slow-wave sleep and number of minutes of slow-wave sleep in the first non-REM period. There were minimal age differences in sleep parameters between depressed children and adolescent girls. Within age groups, the sex differences were minimal in the healthy controls. The sex differences within the depressed group were substantially larger than controls. CONCLUSIONS: These findings suggest a differential developmental influence on sleep in early-onset depression that is heavily dependent on sex. Sex differences are substantially smaller in healthy individuals compared with those with depression, in agreement with previous studies in depressed adults.

The effect of acid suppression on upper airway anatomy and obstruction in patients with sleep apnea and gastroesophageal reflux disease.

STUDY OBJECTIVES: This study was designed to assess the effect of acid suppression on upper airway structure and function in patients with obstructive sleep apnea syndrome (OSAS) and gastroesophageal reflux disease (GERD). METHODS: This is a single-site within-subjects design. Twenty five patients with documented mild OSAS and objectively documented GERD via 24-hour pH measurement were included in the study. Patients were studied before and after 8 weeks of treatment with rabeprazole, 20 mg, twice a day. Subjects underwent laryngoscopy, polysomnography, and 24-hour pH monitoring. Subjective assessments of sleep obtained included the Pittsburg Sleep Quality Index and the Epworth Sleepiness Scale. RESULTS: Posterior commissure edema was significantly reduced (p < 0.05), and the Reflux Finding Score was improved (p < 0.07). Objective and subjective sleep parameters were significantly improved, sleep-onset latency was significantly reduced (26.2 vs 11.2, p < 0.05), and sleep-related acid contact time was significantly reduced (8.0% vs 1.7% p < 0.001). There was no significant change in the apnea-hypopnea index. CONCLUSIONS: In patients with mild OSAS and documented GERD, acid suppression improves upper airway abnormalities, as well as objective and subjective measures of sleep quality. Aggressive treatment of GERD in patients with OSAS may be helpful in the overall treatment of this select patient population.

Sleep symptoms and gastroesophageal reflux.

BACKGROUND: This study was to determine whether patients with significant nighttime heartburn had more disturbed sleep and more gastroesophageal acid reflux than those without significant nighttime heartburn. METHODS: Thirty-three reflux patients were stratified into 2 groups (nighttime heartburn, without nighttime heartburn). All patients completed questionnaires assessing daytime and nighttime heartburn and subjective sleep by Pittsburgh Sleep Quality Index. All participants underwent 24-hour esophageal pH monitoring and an overnight polysomnographic study. RESULTS: The number of reflux events longer than 5 minutes was significantly greater in patients with nighttime heartburn than in those without nighttime heartburn for the total (P=0.004) and upright (P=0.01) position periods. Acid contact time was significantly greater in patients with nighttime heartburn during the upright (P=0.003) period and during the total (P=0.001) period. Patients with nighttime heartburn reported significantly greater subjective sleep impairment (8.1+/-0.7) than those without nighttime heartburn (6.1+/-0.4; P=0.02), but no difference could be observed in any objective sleep parameter by an overnight polysomnographic study between the groups. CONCLUSIONS: Patients with significant nighttime heartburn seem to have more acid reflux compared with those without nighttime heartburn. Nighttime heartburn together with sleep complaints is associated with excessive gastroesophageal reflux.

Sleep-related autonomic disturbances in symptom subgroups of women with irritable bowel syndrome.

The objective was to investigate whether predominant symptom patterns in women with irritable bowel syndrome (IBS) affect autonomic activity during sleep. Seventy-five women with IBS underwent a polysomnographic sleep study. Twenty-two of the IBS patients were diarrhea-predominant (IBS-D), 33 were constipation-predominant (IBS-C), and 20 patients had alternating symptoms (IBS-A). Autonomic activity was measured by heart rate variability. The IBS-D group had significant vagal withdrawal compared to the IBS-A group during REM and non-REM sleep (P < 0.05). The IBS-D symptom subgroup had significantly (P < 0.05) greater sympathetic dominance during non-REM than IBS-A patients. Lower abdominal pain correlated with sympathetic dominance during sleep in the IBS-D group (r=0.54, P < 0.01). The IBS-D patients were physiologically distinct with regard to autonomic functioning during sleep compared to the alternating patients, but not the constipated patients. Sleep appears to unmask differences in autonomic activity that may distinguish IBS patients.

Modulation of sleep quality and autonomic functioning by symptoms of depression in women with irritable bowel syndrome.

The objective of this study was to determine how depressive symptoms affect autonomic activity during sleep, objective and subjective sleep, and gastrointestinal symptom severity in women with irritable bowel syndrome (IBS). Seventy women who met the Rome II criteria for IBS and 21 healthy volunteers participated. All participants were recruited from the surrounding community. IBS patients were stratified into two groups based on their Beck Depression Inventory II score and 44 IBS patients with depressive symptoms (IBS+DS) were compared to 26 IBS patients without depressive symptoms (IBS-DS). Autonomic activity was measured by heart rate variability (HRV) analysis. Fifteen-minute segments were selected from a baseline presleep period, stage 2, slow-wave sleep, and rapid-eye movement sleep for heart rate variability spectral analysis. Subjective sleep quality was assessed by the Pittsburg Sleep Quality Index (PSQI) and gastrointestinal symptom severity was assessed by an 18-item questionnaire. The IBS+DS group reported significantly (P < 0.01) more sleep complaints, measured by the PSQI, than the IBS-DS group and healthy controls. The IBS+DS group took significantly (P < 0.05) longer to enter their first rapid-eye movement period than healthy controls. The IBS+DS group reported significantly (P = 0.01) increased gastrointestinal symptom severity compared to the IBS-DS group. There were no significant group differences in autonomic activity during the baseline presleep period or sleep stages. The results demonstrated that IBS patients with significant depressive symptoms had increased gastrointestinal symptom severity, increased sleep complaints, and alterations in sleep architecture compared to healthy controls and IBS patients without significant depressive symptoms.