Sleep duration and timing in obsessive-compulsive disorder (OCD): evidence for circadian phase delay.

OBJECTIVES: To investigate potential delays in endogenous melatonin in individuals with obsessive-compulsive disorder (OCD). METHODS: First, data are presented for 15 individuals with OCD and matched healthy controls. Next, nine additional participants with OCD who did not have matched controls were added, resulting in a sample of 24 individuals with OCD. All participants were assessed for sleep and circadian rhythm disturbance. Dim light melatonin onset (DLMO) was derived from salivary melatonin and was used in conjunction with sleep diaries, interview measures, and questionnaires. A subset of the OCD group (n = 16) also used actigraphy. RESULTS: In sum, 42% percent (10/24) of the patients with OCD met the criteria for delayed sleep-wake phase disorder (DSWPD) in comparison to 0% in the control sample. DLMO was significantly later in individuals with OCD compared to controls. DLMO and bedtime were not significantly associated with the severity of obsessive-compulsive symptoms or negative affect. CONCLUSIONS: Replication of the findings presented herein, particularly the DLMO results, is warranted. Further, there are now three studies showing that nearly ½ of individuals with OCD meet criteria for a DSWPD. Future studies can explore the mechanisms underlying these connections and the implications of this comorbidity. These findings may increase our understanding of OCD and inform future interventions.

Changes in quality of life and sleep across the perinatal period in women with mood disorders.

INTRODUCTION: The perinatal period represents a time of significant life changes associated with increases in sleep difficulties, depression, and potentially impaired quality of life (QoL). Associations between QoL and sleep among women with perinatal depression are poorly understood, and changes in QoL across the perinatal period have received little attention. METHODS: Participants were the treatment-as-usual group (n = 23) from a clinical trial testing an intervention for perinatal mood disorders. They completed the WHOQOL-Bref, had depression assessed with the HAM-D-17, and wore wrist actigraphs to estimate sleep for 1 week during third trimester and at 6 weeks postpartum. RESULTS: Higher education level was associated with better environmental QoL during pregnancy (p = .044) and presence of older children was associated with worse social QoL postpartum (p = .045). Psychological health QoL worsened (p = .014) across the perinatal period. Total sleep time (p = .001) and sleep efficiency (p = .008) decreased from third trimester to postpartum week 6, but sleep measures were not associated with QoL at either time point. Depressive symptoms decreased from pregnancy to postpartum week 6 and were inversely associated with postpartum physical and social QoL (p = .031 and .048). DISCUSSION: Factors contributing to self-rated QoL are variable across multiple domains during the perinatal period. QoL among our participants was lower than population norms. In our sample of women with depression and/or anxiety, QoL was related to postpartum depressive symptoms, but not to objectively measured sleep quality, quantity, or timing. Links between QoL and sleep may be inherently complex in perinatal women.

The impact of education, country, race and ethnicity on the self-report of postpartum depression using the Edinburgh Postnatal Depression Scale.

BACKGROUND: Universal screening for postpartum depression is recommended in many countries. Knowledge of whether the disclosure of depressive symptoms in the postpartum period differs across cultures could improve detection and provide new insights into the pathogenesis. Moreover, it is a necessary step to evaluate the universal use of screening instruments in research and clinical practice. In the current study we sought to assess whether the Edinburgh Postnatal Depression Scale (EPDS), the most widely used screening tool for postpartum depression, measures the same underlying construct across cultural groups in a large international dataset. METHOD: Ordinal regression and measurement invariance were used to explore the association between culture, operationalized as education, ethnicity/race and continent, and endorsement of depressive symptoms using the EPDS on 8209 new mothers from Europe and the USA. RESULTS: Education, but not ethnicity/race, influenced the reporting of postpartum depression [difference between robust comparative fit indexes (∆*CFI) 0.01), but not between European countries (∆*CFI < 0.01). CONCLUSIONS: Investigators and clinicians should be aware of the potential differences in expression of phenotype of postpartum depression that women of different educational backgrounds may manifest. The increasing cultural heterogeneity of societies together with the tendency towards globalization requires a culturally sensitive approach to patients, research and policies, that takes into account, beyond rhetoric, the context of a person's experiences and the context in which the research is conducted.

Women with Postpartum Weight Retention Have Delayed Wake Times and Decreased Sleep Efficiency During the Perinatal Period: A Brief Report.

OBJECTIVE: This study assessed sleep and circadian rhythms across the perinatal period in new mothers with and without postpartum weight retention (PPWR). METHODS: Weight was measured at 2 and 16 weeks postpartum in 21 women with previous major depression or bipolar disorder (mean age 29.5±4.7 years) who self-reported pre-pregnancy weight during third trimester. Wrist actigraphy was acquired at 33 weeks gestation and postpartum weeks 2, 6, and 16. Circadian phase was measured at 33 weeks gestation and 6 weeks postpartum. The Horne-Östberg Morningness-Eveningness Questionnaire and Pittsburgh Sleep Quality Inventory were completed during third trimester. Women were classified as PPWR+ if weight at 16 weeks postpartum exceeded pre-pregnancy weight by ≥5kg. RESULTS: Compared to pre-pregnancy, average weight gain (±SD) was 6.3±8.8 kg at 2 weeks postpartum and 5.2±8.5 kg at 16 weeks postpartum. ANOVA showed that PPWR+ women (n=8, 38%) had later sleep offset times and lower sleep efficiencies than PPWR- women at all time points and were more likely to report snoring during pregnancy. CONCLUSIONS: Data from this small sample showed that women with PPWR had more disturbed sleep and later wake times and were more likely to report symptoms of sleep-disordered breathing. Future work in larger samples should examine whether interventions to improve sleep during pregnancy decreases PPWR.

Clinical practice guideline for the treatment of intrinsic circadian rhythm sleep-wake disorders: advanced sleep-wake phase disorder (aswpd), delayed sleep-wake phase disorder (dswpd), non-24-hour sleep-wake rhythm disorder (n24swd), and irregular sleep-wake rhythm disorder (iswrd): an update for 2015

A systematic literature review and meta-analyses (where appropriate) were performed and the GRADE approach was used to update the previous American Academy of Sleep Medicine Practice Parameters on the treatment of intrinsic circadian rhythm sleep-wake disorders. Available data allowed for positive endorsement (at a second-tier degree of confidence) of strategically timed melatonin (for the treatment of DSWPD, blind adults with N24SWD, and children/ adolescents with ISWRD and comorbid neurological disorders), and light therapy with or without accompanying behavioral interventions (adults with ASWPD, children/adolescents with DSWPD, and elderly with dementia). Recommendations against the use of melatonin and discrete sleep-promoting medications are provided for demented elderly patients, at a second- and first-tier degree of confidence, respectively. No recommendations were provided for remaining treatments/ populations, due to either insufficient or absent data. Areas where further research is needed are discussed.

Effects of melatonin administration on daytime sleep after simulated night shift work.

Disturbed sleep and on-the-job sleepiness are widespread problems among night shift workers. The pineal hormone melatonin may prove to be a useful treatment because it has both sleep-promoting and circadian phase-shifting effects. This study was designed to isolate melatonin's sleep-promoting effects, and to determine whether melatonin could improve daytime sleep and thus improve night time alertness and performance during the night shift. The study utilized a placebo-controlled, double-blind, cross-over design. Subjects (n=21, mean age=27.0 +/- 5.0 years) participated in two 6-day laboratory sessions. Each session included one adaptation night, two baseline nights, two consecutive 8-h night shifts followed by 8-h daytime sleep episodes and one recovery night. Subjects took 1.8 mg sustained-release melatonin 0.5 h before the two daytime sleep episodes during one session, and placebo before the daytime sleep episodes during the other session. Sleep was recorded using polysomnography. Sleepiness, performance, and mood during the night shifts were evaluated using the multiple sleep latency test (MSLT) and a computerized neurobehavioral testing battery. Melatonin prevented the decrease in sleep time during daytime sleep relative to baseline, but only on the first day of melatonin administration. Melatonin increased sleep time more in subjects who demonstrated difficulty in sleeping during the day. Melatonin had no effect on alertness on the MSLT, or performance and mood during the night shift. There were no hangover effects from melatonin administration. These findings suggest that although melatonin can help night workers obtain more sleep during the day, they are still likely to face difficulties working at night because of circadian rhythm misalignment. The possibility of tolerance to the sleep-promoting effects of melatonin across more than 1 day needs further investigation.

Effects of menopause and nasal occlusion on breathing during sleep.

Prevalence of sleep-disordered breathing (SDB) is reported to increase in menopausal women. We examined response to a nocturnal respiratory challenge (nasal occlusion) during overnight polysomnography in 31 women (45 to 55 yr). Thirteen were premenopausal, four perimenopausal, and 14 postmenopausal by history and hormonal assay. Nasal occlusion increased the apnea hypopnea index (AHI) (occlusion mean = 6.6 +/- 8.0 versus baseline mean = 1.6 +/- 2.6, p < 0.01) and arousal index (occlusion mean = 35.1 +/- 20.1 versus baseline mean = 20.7 +/- 11.6, p < 0.001), but did not change the oxygen saturation nadir in those with respiratory events (occlusion mean = 91.8 +/- 4.2 versus baseline mean = 92.0 +/- 11.6). Menopausal groups did not differ on AHI, arousal index, or oxygen saturation nadir in either condition. Key variables were compared between occlusion responders (n = 11) and nonresponders (n = 20). Responders and nonresponders were not distinguished by age, menopausal status, nor several cephalometric or anthropometric variables. Body mass index (31.1 +/- 8.5 versus 24.3 +/- 3.4, p < 0.003), neck circumference (34.0 +/- 2.5 versus 32.5 +/- 1.7 cm, p < 0.05), and mandibular-hyoid distance (18.5 +/- 3.8 versus 14.5 +/- 5.7 mm, p < 0.05) were greater in responders. These findings suggest hormonal factors may be less important than weight and facial morphology in midlife development of SDB in women.

Activity-based sleep-wake identification: an empirical test of methodological issues.

The effects of actigraph placement and device sensitivity on actigraphic automatic sleep-wake scoring were assessed using concomitant polysomnographic and wrist actigraphic data from dominant and nondominant hands of 20 adults and 16 adolescents during 1 laboratory night. Although activity levels differed between dominant and nondominant wrists during periods of sleep (F = 4.57; p < 0.05) and wake (F = 15.5; p < 0.0005), resulting sleep-wake scoring algorithms were essentially the same and were equally explanatory (R2 = 0.64; p < 0.0001). When the sleep-wake scoring algorithm derived from the nondominant hand was used to score the nondominant data for sleep-wake, overall agreement rates with polysomnography scoring ranged between 91 and 93% for the calibration and validation samples. Results obtained with the same algorithm for the dominant-wrist data were within the same range. Agreement for sleep scoring was consistently higher than for wake scoring. Statistical manipulation of activity levels before applying the scoring algorithm indicated that this algorithm is quite robust toward moderate changes in activity level. Use of "twin-wrist actigraphy" enables identification of artifacts that may result from breathing-related motions.