Pediatric Sleep Disturbances and Symptoms of Depression in Older Adults.

We investigated the association between retrospectively reported sleep disturbances during childhood and adolescence and current symptoms of depression and anxiety in older adults. Participants included 116 older adults (M age = 68 years [SD = 6.4 years]) who completed a battery of sleep and psychological assessments. We tested two multivariate regression models using age, sex, race, physical illness burden, insomnia status, and pediatric sleep disturbances as correlates of depressive symptoms and anxiety symptoms. Pediatric sleep disturbances were significantly associated with greater depressive symptomatology (ß = 0.247, p = .010), independent of current insomnia status. Medium effect sizes were reported. Our results suggest that pediatric sleep disturbances may be a biobehavioral signal for the development of poor emotional health across the lifespan. Future research should identify critical windows of development when sleep disturbances might be most impactful on emotional health trajectories.

Childhood maltreatment moderates the effect of combat exposure on cingulum structural integrity.

Limbic white matter pathways link emotion, cognition, and behavior and are potentially malleable to the influences of traumatic events throughout development. However, the impact of interactions between childhood and later life trauma on limbic white matter pathways has yet to be examined. Here, we examined whether childhood maltreatment moderated the effect of combat exposure on diffusion tensor imaging measures within a sample of military veterans (N = 28). We examined five limbic tracts of interest: two components of the cingulum (cingulum, cingulate gyrus, and cingulum hippocampus [CGH]), the uncinate fasciculus, the fornix/stria terminalis, and the anterior limb of the internal capsule. Using effect sizes, clinically meaningful moderator effects were found only within the CGH. Greater combat exposure was associated with decreased CGH fractional anisotropy (overall structural integrity) and increased CGH radial diffusivity (perpendicular water diffusivity) among individuals with more severe childhood maltreatment. Our findings provide preliminary evidence of the moderating effect of childhood maltreatment on the relationship between combat exposure and CGH structural integrity. These differences in CGH structural integrity could have maladaptive implications for emotion and memory, as well as provide a potential mechanism by which childhood maltreatment induces vulnerability to later life trauma exposure.

Childhood maltreatment is associated with altered frontolimbic neurobiological activity during wakefulness in adulthood.

Childhood maltreatment can disturb brain development and subsequently lead to adverse socioemotional and mental health problems across the life span. The long-term association between childhood maltreatment and resting-wake brain activity during adulthood is unknown and was examined in the current study. Forty-one medically stable and medication-free military veterans (M = 29.31 ± 6.01 years, 78% male) completed a battery of clinical assessments and had [18F]-fluorodeoxyglucose positron emission tomography neuroimaging scans during quiet wakefulness. After statistically adjusting for later-life trauma and mental health problems, childhood maltreatment was negatively associated with brain activity within a priori defined regions that included the left orbital frontal cortex and left hippocampus. Childhood maltreatment was significantly associated with increased and decreased brain activity within six additional whole-brain clusters that included the frontal, parietal-temporal, cerebellar, limbic, and midbrain regions. Childhood maltreatment is associated with altered neural activity in adulthood within regions that are involved in executive functioning and cognitive control, socioemotional processes, autonomic functions, and sleep/wake regulation. This study provides support for taking a life span developmental approach to understanding the effects of early-life maltreatment on later-life neurobiology, socioemotional functioning, and mental health.

Prior exposure to interpersonal violence and long-term treatment response for boys with a disruptive behavior disorder.

Interpersonal violence (IPV) is common in children with a disruptive behavior disorder (DBD) and increases the risk for greater DBD symptom severity, callous-unemotional (CU) traits, and neuroendocrine disruption. Thus, IPV may make it difficult to change symptom trajectories for families receiving DBD interventions given these relationships. The current study examined whether IPV prior to receiving treatment for a DBD predicted trajectories of a variety of associated outcomes, specifically DBD symptoms, CU traits, and cortisol concentrations. Boys with a DBD diagnosis (N = 66; age range = 6-11 years; 54.5% of whom experienced IPV prior to treatment) of either oppositional defiant disorder or conduct disorder participated in a randomized clinical trial and were assessed 3 years following treatment. Multilevel modeling demonstrated that prior IPV predicted smaller rates of change in DBD symptoms, CU traits, and cortisol trajectories, indicating less benefit from intervention. The effect size magnitudes of IPV were large for each outcome (d = 0.88-1.07). These results suggest that IPV is a predictor of the long-term treatment response for boys with a DBD. Including trauma-focused components into existing DBD interventions may be worth testing to improve treatment effectiveness for boys with a prior history of IPV.

Validation of the Pittsburgh Sleep Quality Index Addendum for posttraumatic stress disorder (PSQI-A) in U.S. male military veterans.

Sleep disturbances are core symptoms of posttraumatic-stress disorder (PTSD), yet they bear less stigma than other PTSD symptoms. Given the growing number of returning military veterans, brief, valid assessments that identify PTSD in a minimally stigmatizing way may be useful in research and clinical practice. The study purpose was to evaluate the psychometric properties of the Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A), and to examine its ability to identify PTSD cases among U.S. male military veterans. Male military veterans (N = 119) completed the PSQI-A, as well as measures of sleep quality, combat exposure, posttraumatic stress, depression, and anxiety. Veterans with PTSD had higher PSQI-A identified disruptive nocturnal behaviors than veterans without PTSD. The PSQI-A had good internal consistency and convergent validity with sleep quality, combat exposure, PTSD symptoms, depression, and anxiety. A cutoff score ≥ 4 provided an area under the curve = .81, with 71% sensitivity, 82% specificity, and 60% positive and 83% negative predictive value for a clinical diagnosis of PTSD; correct classification was 74%. The PSQI-A is a valid measure to possibly detect PTSD among male military veterans. Assessment of disruptive nocturnal behaviors may provide a cost-effective, nonstigmatizing approach to PTSD screening without directly probing for trauma exposure(s).

Sleep and sleepiness among first-time postpartum parents: a field- and laboratory-based multimethod assessment.

The study aim was to compare sleep, sleepiness, fatigue, and neurobehavioral performance among first-time mothers and fathers during their early postpartum period. Participants were 21 first-time postpartum mother-father dyads (N = 42) and seven childless control dyads (N = 14). Within their natural environment, participants completed 1 week of wrist actigraphy monitoring, along with multi-day self-administered sleepiness, fatigue, and neurobehavioral performance measures. The assessment week was followed by an objective laboratory-based test of sleepiness. Mothers obtained more sleep compared to fathers, but mothers' sleep was more disturbed by awakenings. Fathers had greater objectively measured sleepiness than mothers. Mothers and fathers did not differ on subjectively measured sleep quality, sleepiness, or fatigue; however, mothers had worse neurobehavioral performance than fathers. Compared to control dyads, postpartum parents experienced greater sleep disturbance, sleepiness, and sleepiness-associated impairments. Study results can inform social policy, postpartum sleep intervention development, and research on postpartum family systems and mechanisms that propagate sleepiness.

Movement toward a novel activity monitoring device.

PURPOSE: Although polysomnography is necessary for diagnosis of most sleep disorders, it is also expensive, time-consuming, intrusive, and interferes with sleep. Field-based activity monitoring is increasingly used as an alternative measure that can be used to answer certain clinical and research questions. The purpose of this study was to evaluate the reliability and validity of a novel activity monitoring device (Fitbit) compared to both polysomnography and standard actigraphy (Actiwatch-64). METHODS: To test validity, simultaneous Fitbit and actigraph were worn during standard overnight polysomnography by 24 healthy adults at the West Virginia University sleep research laboratory. To test inter-Fitbit reliability, three participants also wore two of the Fitbit devices overnight at home. RESULTS: Fitbit showed high intradevice reliability = 96.5-99.1. Fitbit and actigraph differed significantly on recorded total sleep time and sleep efficiency between each other and polysomnography. Bland-Altman plots indicated that both Fitbit and actigraph overestimated sleep efficiency and total sleep time. Sensitivity of both Fitbit and actigraphy for accurately identifying sleep was high within all sleep stages and during arousals; specificity of both Fitbit and actigraph for accurately identifying wake was poor. Specificity of actigraph was higher except for wake before sleep onset; sensitivity of Fitbit was higher in all sleep stages and during arousals. CONCLUSIONS: The web-based Fitbit, available at a markedly reduced price and with several convenience factors compared to standard actigraphy, may be an acceptable activity measurement instrument for use with normative populations. However, Fitbit has the same specificity limitations as actigraphy; both devices consistently misidentify wake as sleep and thus overestimate both sleep time and quality. Use of the Fitbit will also require specific validation before it can be used to assess disordered populations and or different age groups.

Perception of partner sleep and mood: postpartum couples' relationship satisfaction.

Separate research areas indicate that sleep quality, mood, and relationship satisfaction decline among couples during the postpartum period. Furthermore, accurate partner perceptions are associated with positive relationship qualities. In this study, 21 first-time postpartum mother-father dyads, contributed 1 week of continuous wrist actigraphy along with concurrent subjective Palm Pilot monitoring to provide objective and subjective sleep measures. Parents also reported on their own as well as their perception of their partners' sleep, mood, and relationship satisfaction. Greater objectively measured total sleep time was associated with greater relationship satisfaction. Mothers (a) underestimated fathers' self-reported frequency of nocturnal awakenings, as well as (b) relationship satisfaction, and (c) overestimated fathers' self-reported sleep quality. Fathers (a) underestimated mothers' self-reported duration of wake at night, as well as (b) sleep quality, and (c) overestimated mothers' self-reported mood disturbance. Preventative measures that target sleep and improvement in perception of partner's experiences could be used to buffer against decreases in relationship satisfaction among new parents.

Assessing the efficacy to conduct the multiple sleep latency test with actigraphy.

This study explored the efficacy of 1 actigraphy (ACT) brand, at different analytic settings, for use to administer the Multiple Sleep Latency Test (MSLT). Forty-one first-time postpartum mother and father participants were administered the MSLT with concurrent ACT. To identify ACT sleep onset latency (SOL), ACT signals were interpreted with iterations of different "wake threshold value" (WTV) and "immobile minutes for sleep onset" value (IMV) settings. The different iterations of ACT-SOL values were compared to MSLT-SOL values. The WTV settings did not affect ACT-SOL, but the ACT-SOL and MSLT-SOL significantly differed at each ACT-IMV setting. ACT consistently identified SOL too soon; however, future research, along with technological innovation, may identify a viable methodology to conduct an ambulatory MSLT.

Normative longitudinal maternal sleep: the first 4 postpartum months.

OBJECTIVE: To describe the normative course of maternal sleep during the first 4 months postpartum. STUDY DESIGN: Sleep was objectively measured using continuous wrist actigraphy. This was a longitudinal, field-based assessment of nocturnal sleep during postpartum weeks 2 through 16. Fifty mothers participated during postpartum weeks 2 through 13; 24 participated during postpartum weeks 9 through 16. RESULTS: Maternal nocturnal sleep time was 7.2 (SD ± 0.95) hours and did not change significantly across postpartum weeks 2 through 16. Maternal sleep efficiency did improve across weeks 2 (79.7%; SD ± 5.5) through 16 (90.2%; SD ± 3.5) as a function of decreased sleep fragmentation across weeks 2 (21.7; SD ± 5.2) through 16 (12.8; SD ± 3.3). CONCLUSION: Though postpartum mothers' total sleep time was higher than expected during the initial postpartum months, this sleep was highly fragmented (similar to fragmenting sleep disorders) and inefficient. This profile of disturbed sleep should be considered in intervention designs and family leave policies.

Effects of two types of ambient sound during sleep.

This field study investigated whether either of two ambient sounds would improve objective sleep (via actigraphy), subjective sleep report, or morning psychomotor performance among 28 adults with self-described disturbed sleep. Nights 1 and 4 were soundless baseline and washout, respectively. On Nights 2 and 3 and 5 and 6, participants listened to double-blind counterbalanced paired nights of novel Sound A and a commercially available Sound B. Compared to baseline and washout, participants reported fewer awakenings during both Sound A and Sound B; actigraphically measured sleep was affected by Sound B but not Sound A. "Improvements" in sleep during the second exposure night probably reflect an increase in homeostatic sleep drive from sleep disturbance on the first exposure night. Differences between sounds were accounted for by user volume settings. Neither sound led to differences in psychomotor performance.

Social buffering in rats: prolactin attenuation of active interaction.

Stress may result when the present environment is interpreted as threatening, and stress is known to increase the prolactin-secretory response. In the present study, rats (N=83) were exposed to a conditioned-fear paradigm (environment paired with footshock), and on testing day, rats were exposed to the experimental chamber without shock while alone (Alone n=16), with an object (Object n=17), with a euthanized conspecific (Euthanized n=16), or with a social partner (Social n=19). The control group (Control n=15) was exposed to the experimental chamber but was never shocked. The Control group had significantly lower levels of prolactin than the Alone, Object, and Euthanized groups; however, the Control group's levels of prolactin were not significantly different than that of the Social group, which was significantly lower than that for the Alone group. Social interaction decreased fear independent of the distraction provided by a stimulus in the chamber. Active touch appeared to be crucial for social buffering to occur.

Caloric expenditure assessment among older adults: criterion validity of a novel accelerometry device.

Criterion validity of a novel accelerometry device that measures caloric expenditure (Fitbit) was evaluated against a self-report estimation of caloric expenditure (Community Healthy Activities Model Program for Seniors) in older adults. Community Health Activities Model Program for Seniors and Fitbit estimates of total caloric expenditure per day were significantly correlated (r = .61, p < .05). Bland-Altman plots indicated that 70 percent of participants' data were within 1 standard deviation of the mean difference between measures. These preliminary findings suggest that the Fitbit may be considered a viable instrument for measuring daily caloric expenditure among older adults. However, further work is required to determine the optimal measurement technique for caloric expenditure among older adults.

A mixed-method examination of maternal and paternal nocturnal caregiving.

OBJECTIVES: The study objectives were to describe and compare causes of, and activities during, postpartum parents' nocturnal awakenings. METHODS: Twenty-one primiparous postpartum couples were studied for 1 week with qualitative and quantitative methods. RESULTS: Mothers reported more awakenings per night (3.3 ± 1.1) and more wake time after going to sleep (116.0 ± 60.0 minutes) compared to fathers (2.4 ± 0.5 and 42.7 ± 39.4 minutes, respectively). "Actions taken" during maternal nocturnal awakenings were primarily for infant feeding (49.0%), general infant care (18.5%), and infant changing (12.0%). "Actions taken" during paternal nocturnal awakenings were primarily "passive awakenings" (35.9%), for self-care (18.4%), and for infant feeding (9.4%). CONCLUSIONS: Qualitative analyses revealed ways that new families can optimize the sleep of both parents while also providing optimal nocturnal infant care.

Sleep disturbance and neurobehavioral performance among postpartum women.

STUDY OBJECTIVES: Sleep disturbances cause neurobehavioral performance and daytime functioning impairments. Postpartum women experience high levels of sleep disturbance. Thus, the study objective was to describe and explore the relation between neurobehavioral performance and sleep among women during the early postpartum period. DESIGN: Longitudinal field-based study. PARTICIPANTS: There were 70 primiparous women and nine nulliparous women in a control group. INTERVENTIONS: None. METHODS AND RESULTS: During their first 12 postpartum weeks, 70 primiparous women wore continuous wrist actigraphy to objectively monitor their sleep. Each morning they self-administered the psychomotor vigilance test (PVT) to index their neurobehavioral performance. Nine nulliparous women in a control group underwent the same protocol for 12 continuous weeks. Postpartum PVT mean reciprocal (1/RT) reaction time did not differ from that of women in the control group at postpartum week 2, but then worsened over time. Postpartum slowest 10% 1/RT PVT reaction time was significantly worse than that of women in the control group at all weeks. Despite improvements in postpartum sleep, neurobehavioral performance continued to worsen from week 2 through the end of the study. Across the first 12 postpartum weeks, PVT measures were more frequently associated with percent sleep compared with total sleep time, highlighting the deleterious consequences of sleep disruption on maternal daytime functioning throughout the early postpartum period. CONCLUSIONS: Worsened maternal neurobehavioral performance across the first 12 postpartum weeks may have been influenced by the cumulative effects of sleep disturbance. These results can inform future work to identify the particular sleep profiles that could be primary intervention targets to improve daytime functioning among postpartum women, and indicate need for further research on the effectiveness of family leave policies. The time when postpartum women return to control-level daytime functioning is unknown.

Evening-type military veterans report worse lifetime posttraumatic stress symptoms and greater brainstem activity across wakefulness and REM sleep.

Evening chronotypes exhibit increased rates of affective dyregulation and sleep disturbances (e.g., insomnia and nightmares). Such symptoms are common to military veterans with posttraumatic stress disorder (PTSD); however, the influence of chronotype on this population remains unknown. We examined behavioral, psychological, and neural correlates of chronotype in 36 combat-exposed military veterans with varying degrees of posttraumatic stress symptomatology. We employed FDG-PET to assess neural activity across wakefulness and rapid eye movement (REM) sleep. We used polysomnography and diaries to monitor sleep, and a self-report survey to measure chronotype. Eveningness was associated with greater lifetime PTSD symptoms, more disturbed sleep, and more frequent and intense nightmares. Eveningness was also associated with greater brain activity in posterior cingulate/precuneus and brainstem regions across wakefulness and REM sleep, overlapping with regions related to arousal and REM sleep generation. Chronotype may be an important correlate of neural activity in REM sleep-generating and/or arousal regulatory regions among combat-exposed veterans with PTSD symptoms. Further investigations of the role of chronotype in PTSD are warranted.

Community based study of sleep bruxism during early childhood.

OBJECTIVES: The aims for this study were to determine the prevalence of sleep-bruxism among young children, explore child behavior problems that may be associated with sleep-bruxism, and identify relations among sleep-bruxism, health problems, and neurocognitive performance. METHODS: The current study was a retrospective analysis of parent report surveys, and behavioral and neurocognitive assessments. Parents of 1953 preschool and 2888 first grade children indicated their child's frequency of bruxism during sleep. A subsample of preschool children (n=249) had additional behavioral, as well as neurocognitive assessments. Among the subsample, parents also reported on their child's health, and completed the Child Behavioral Checklist; children were administered the Differential Ability Scales, and Pre-Reading Abilities subtests of the Developmental Neuropsychological Assessment. RESULTS: 36.8% of preschoolers and 49.6% of first graders were reported to brux ⩾1time per week. Among the preschool subsample, bruxing was independently associated with increased internalizing behaviors (ß=.17). Bruxism was also associated with increased health problems (ß=.19), and increased health problems were associated with decreased neurocognitive performance (ß=.22). CONCLUSIONS: The prevalence of sleep-bruxism was high. A dynamic and potentially clinically relevant relation exists among sleep-bruxism, internalizing behaviors, health, and neurocognition. Pediatric sleep-bruxism may serve as a sentinel marker for possible adverse health conditions, and signal a need for early intervention. These results support the need for an interdisciplinary approach to pediatric sleep medicine, dentistry, and psychology.

Early-life trauma is associated with rapid eye movement sleep fragmentation among military veterans.

The role of sleep in the relations between early-life trauma and the development of adverse psychological trajectories is relatively unknown and was the primary aim of the present study. Military veterans were evaluated for posttraumatic stress disorder, combat exposure, trauma history, sleep quality, disruptive nocturnal behaviors, and a subsample completed overnight polysomnography that yielded objectively measured sleep parameters. When relevant variables were controlled, increased earlier-life traumatic event exposure was associated with increased rapid-eye-movement sleep (REMs) fragmentation, and increased REMs fragmentation was associated with increased later-life disruptive nocturnal behaviors. REMs fragmentation carried an indirect relation between earlier-life trauma and later-life disruptive nocturnal behaviors. Objectively measured sleep parameters were used to describe REMs fragmentation physiology. The current findings elucidate the important role that earlier-life trauma exposure may have in the development of REM sleep physiology, and how this altered sleep physiology may have dynamic influences on subsequent posttraumatic stress symptoms in adulthood.

Use of actigraphy for assessment in pediatric sleep research.

The use of actigraphs, or ambulatory devices that estimate sleep-wake patterns from activity levels, has become common in pediatric research. Actigraphy provides a more objective measure than parent-report, and has gained popularity due to its ability to measure sleep-wake patterns for extended periods of time in the child's natural environment. The purpose of this review is: 1) to provide comprehensive information on the historic and current uses of actigraphy in pediatric sleep research; 2) to review how actigraphy has been validated among pediatric populations; and 3) offer recommendations for methodological areas that should be included in all studies that utilize actigraphy, including the definition and scoring of variables commonly reported. The poor specificity to detect wake after sleep onset was consistently noted across devices and age groups, thus raising concerns about what is an "acceptable" level of specificity for actigraphy. Other notable findings from this review include the lack of standard scoring rules or variable definitions. Suggestions for the use and reporting of actigraphy in pediatric research are provided.

Actual and perceived sleep: associations with daytime functioning among postpartum women.

Sleep and wake have a homeostatic relation that influences most aspects of physiology and waking behavior. Sleep disturbance has a detrimental effect on sleepiness and psychomotor vigilance. The purpose of this study was to identify which actual or perceived sleep characteristics accounted for the most variance in daytime functioning among postpartum mothers. Seventy first-time postpartum mothers' actual sleep (actigraphically estimated: total sleep time, number of wake bouts, length of nocturnal wake, and sleep efficiency) and perceived sleep (self-reported: number of awakenings, wake time, and sleep quality) were measured along with their daytime functioning (Stanford Sleepiness Scale [SSS], Epworth Sleepiness Scale [ESS], Visual Analogue of Fatigue Scale [VAFS], and morning Psychomotor Vigilance Test [PVT]). Data were repeatedly collected from the same sample during postpartum weeks 2, 7, and 13. Four stepwise linear regressions were calculated for each postpartum week to examine which objective and/or subjective variable(s) accounted for the most variance in daytime functioning. The SSS and VAFS were both most consistently associated with perceived sleep quality. The ESS was most consistently associated with actual total sleep time. PVT performance was most consistently associated with estimates of actual and perceived sleep efficiency. Actual and perceived sleep profiles were differentially associated with specific daytime functions. These results from postpartum mothers may indicate that populations who experience specific forms of sleep disturbance (e.g. fragmentation and/or deprivation) may also experience specific daytime conditions.