Effectiveness of Clonidine in Child and Adolescent Sleep Disorders.

OBJECTIVE: We aimed to investigate the improvement in sleep quantity and quality when clonidine was used in children and adolescents with insomnia. We also examined how sociodemographic characteristics such as age, sex, underlying psychological problems, and levels of depression and anxiety affected the effect of clonidine. METHODS: We retrospectively reviewed outpatients aged 6 to 24 who took clonidine due to insomnia from September 2019 to September 2021 at the Department of Psychiatry at Eunpyeong St. Mary's Hospital of Catholic University. We used the Pittsburgh Sleep Quality Index (PSQI), Children's Depression Inventory (CDI), and State-Trait Anxiety Inventory (STAI) for our study. RESULTS: A total of 62 participants were included in our study (34 females, mean age 13.94±4.94 years). After using clonidine, there was a significant decrease in PSQI components 1, 2, and 5, especially PSQI component 2. There was a greater decrease in sleep latency when clonidine was used in females, those aged between 13 and 24, those with mood/anxiety disorder or attention-deficit/hyperactivity disorder, those whose sleep latency exceeded 60 minutes at baseline, and those who used clonidine for more than 14 days. Those with higher STAI-Trait scores and CDI scores at baseline showed less improvement in total PSQI scores. CONCLUSION: Considering that there are currently no Food and Drug Administration-approved sleep drugs for children and adolescents and no apparent difference in efficacy and safety among sleep drugs, we demonstrated that treatment with clonidine might be a good approach to improve sleep quality and quantity for children and adolescents.

A systematic review of the impact of COVID-19 on the game addiction of children and adolescents.

Background: During the COVID-19 pandemic, it is reported that children and adolescents who are socially isolated experience high levels of stress and various mental health problems. At present, little research has been done to collect previous studies that focused on game addiction in children and adolescents during the COVID-19 pandemic. In this research, we aimed to investigate the prevalence of gaming disorder during COVID-19 in children and adolescents and the various factors experienced by children and adolescents that affected gaming disorder. Methods: We searched PubMed, Embase, PsycINFO, and Cochrane on 5 May 2021 to identify relevant literature. We extracted the prevalence estimates of game addiction from the studies to measure the global prevalence of game addiction. Then, we found the answers to the questions raised and synthesized them into several themes. Results: We identified 2,609 articles. Among them, studies that were not related to the topic, duplicated, and that did not meet the selection criteria were excluded, and 18 studies were selected. We rated most of the studies as moderate, and a few were low, and high. A majority of studies found an increase in game usage time and game addiction score during the COVID-19 pandemic. Some children and adolescents in emotional pain play games to communicate with their peers. Regarding parenting, violent parenting and the absence of parental supervision increase levels of game addiction in children. Gaming disorder was caused by the impact of COVID-19 in a vulnerable group with predisposing factors such as depression, anxiety, and attention-deficit/hyperactivity disorder. Adolescents and males scored higher on a game addiction scale, although we could not find any quantitative correlations due to the heterogeneous scales used for gaming addiction. Conclusions: During the COVID-19 pandemic, isolated children and adolescents reported increased gaming hours as a result of coping with their psychological pain and avoiding social isolation. Their parents, who should provide proper supervision, also failed to provide appropriate support due to the stress caused by the pandemic. Mental health providers should educate children, adolescents, and their guardians on alternative ways to relieve stress and help parents effectively control their children's usage of games.

Gray Matter Volume in the Developing Frontal Lobe and Its Relationship With Executive Function in Late Childhood and Adolescence: A Community-Based Study.

Background: During late childhood and adolescence, the frontal lobe undergoes critical developmental changes, affecting a wide range of executive functions significantly. Conversely, abnormality in the maturation of the frontal lobe during this period may result in a limited ability to effectively use various executive functions. However, at present, it is still unclear how the structural development of the frontal lobe is associated with different aspects of executive functions during this developmental period. To fill the gap in evidence, we aimed to elucidate gray matter volume (GMV) in the frontal lobe and its relationship with multiple aspects of executive functions in late childhood and adolescence. Methods: We recruited our participants aged between 6 and 17 years to assess GMV in the frontal lobe and its relationship with different domains of executive functions in late childhood and adolescence. We used the voxel-based morphometry-DARTEL procedure to measure GMVs in multiple frontal sub-regions and Stroop test and Advanced Test of Attention (ATA) to measure executive functions. We then conducted partial correlation analyses and performed multiple comparisons with different age and sex groups. Results: Overall, 123 participants took part in our study. We found that many regional GMVs in the frontal lobe were negatively correlated with ATA scores in participants in late childhood and positively correlated with ATA scores in participants in adolescence. Only a few correlations of the GMVs with Stroop test scores were significant in both age groups. Although most of our results did not survive false discovery rate (FDR) correction (i.e., FDR <0.2), considering their novelty, we discussed our results based on uncorrected p-values. Our findings indicate that the frontal sub-regions that were involved in attentional networks may significantly improve during late childhood and become stabilized later in adolescence. Moreover, our findings with the Stroop test may also present the possibility of the later maturation of higher-order executive functioning skills. Conclusion: Although our findings were based on uncorrected p-values, the novelty of our findings may provide better insights into elucidating the maturation of the frontal lobe and its relationship with the development of attention networks in late childhood and adolescence.

Structural Alterations in Large-scale Brain Networks and Their Relationship with Sleep Disturbances in the Adolescent Population.

Although sleep disturbances are highly prevalent in adolescents, neuroimaging evidence on the effects of sleep disturbances on their developing brains remains limited. Therefore, we explored gray matter volumes (GMVs) at the whole-brain level and investigated their relationship to sleep disturbances in a sample of Korean adolescents in the general population. We recruited participants from one middle school and high school. All participants and their legal guardians gave informed consent before participating in our study. We used component 5 of the Pittsburgh Sleep Quality Index to measure sleep disturbances and conducted a voxel-based morphometry-DARTEL procedure to measure GMVs. We performed partial correlation analyses to examine whether the GMVs were associated with sleep disturbances. A total of 56 adolescents participated in this study. Our results revealed that GMVs in multiple global regions were negatively correlated with sleep disturbances. Moreover, most of these identified regions belong to large-scale brain networks categorized by functional neuroimaging studies. We found an association between regional GMVs in multiple global regions involved in large-scale networks and the severity of sleep disturbances in the adolescent population. Based on this evidence and previous neuroimaging evidence, we suggest that structural alterations in the networks may be linked to sleep disturbances.

The Relationship between Adverse Childhood Experiences and Sleep Problems among Adolescent Students: Mediation by Depression or Anxiety.

Adverse childhood experiences (ACEs) are known to be closely related to depression, anxiety and sleep problems. However, it remains unclear whether adolescents with ACEs have sleep problems regardless of depression or anxiety or under a mediating effect from depression or anxiety. Therefore, our aim was to examine whether depression or anxiety mediates the relationship between ACEs and sleep problems in adolescents by using a community sample. The Early Trauma Inventory Self Report-Short Form (ETISR-SF) and List of Threatening Experiences Questionnaire (LTE-Q) were used to assess traumatic ACEs. Ultimately, data from 737 students (M = 448, F = 289, 15.1 ± 1.4 years old) were included in the statistical analysis. A total of 576 (78.1%) participants reported that they had experienced one or more ACEs. Adolescents with ACEs had higher levels of depression, anxiety and sleep problems than did adolescents without ACEs, and boys tended to experience more trauma than girls. Depression and anxiety partially mediated the relationship between ACEs and sleep problems. The results of this study suggest the need for depression and anxiety interventions for adolescents with ACEs to reduce the long-term consequences, including sleep problems and physical health problems.

The relationship between risk of obstructive sleep apnea and other sleep problems, depression, and anxiety in adolescents from a community sample.

Obstructive sleep apnea (OSA) is highly related to mental health problems, such as depression and anxiety. However, previous studies on OSA and depression and anxiety have mostly been conducted in the adult population. We aimed to (1) screen for risk of OSA in a sample of adolescents from the general population using self-report questionnaires and (2) examine whether there are differences between the high- and low-risk groups for OSA in depressive and anxiety symptoms, self-esteem, and sleep-related variables. The data of 793 students (age range: 12-17 years old) were analyzed. The participants were assigned to the high-risk (n = 202, 25.5%) or the low-risk group (n = 591, 74.5%) of OSA. The participants in the high-risk group had more severe anxiety symptoms, lower self-esteem, insomnia, excessive daytime sleepiness, and higher BMI compared those in the low-risk group. This study shows that it is possible to efficiently screen for risks of various problems associated with OSA in adolescents using an easy and simple screening tool.

Porcine epidemic diarrhea vaccine evaluation using a newly isolated strain from Korea.

Porcine epidemic diarrhea virus (PEDV) infects pigs and causes an enteric disease that is characterized by vomiting and watery diarrhea. PEDV outbreaks have a tremendous financial impact on the worldwide pork industry. In South Korea, the incidence of PEDV has continued despite nationwide use of attenuated and inactivated vaccines, raising questions regarding the current vaccines' efficacy and the need for new vaccine development. In the present study, we isolated a new Korean PEDV epidemic strain, PED-CUP-B2014, in Vero cells. Phylogenetic analysis of the spike gene demonstrated that the PED-CUP-B2014 belongs in genogroup G2b and is close to PEDVs currently circulating in many countries including the United States, and is distinct from many current vaccine strains. Upon serial passages into Vero cells, PED-CUP-B2014 adapted to Vero cells, which was evidenced as higher virus growth in Vero cells and confirmed lower virulence in suckling piglets. The administration of the inactivated 65-passaged PED-CUP-B2014 to sows greatly increased the survival rate of their offspring and significantly reduced diarrhea severity after PEDV challenge. Higher serum/colostrum PEDV-specific antibodies and higher neutralizing titers were shown in sows vaccinated with PED-CUP-B2014 compared to unvaccinated sows or sows administered commercial PEDV vaccine. Altogether, our data demonstrated that the newly isolated PEDV strain conferred critical passive immune protection to pigs against epidemic PEDV infection.