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Over the last decade, emerging studies have related the gut microbiome and gut dysbiosis to sleep and sleep disorders. For example, intermittent hypoxia associated with obstructive sleep apnea was shown to reproducibly alter the gut microbiome. Circadian rhythm disorders (CRD) (eg, shift work disorders, delayed sleep phase syndrome, and advanced sleep phase syndrome) constitute another group of conditions that might be influenced by gut dysbiosis. Indeed, both central and peripheral clocks can affect and be affected by gut microbiota and their metabolites. In addition, the tight rhythmic regulation of almost all metabolic pathways involved in the anabolism and catabolism of carbohydrates, protein, and lipids in addition to detoxification processes that take place in specific cells could be ultimately linked to changes in the microbiota. Since there are no studies to date examining the impact of gut dysbiosis on delayed sleep phase and advanced sleep phase syndrome, and considering the ever-increasing number of people engaging in shift work, more accurate and informed delineation of the association between gut dysbiosis and shift work can provide guidance and opportunities for new avenues of treating circadian rhythm disorders and preventing the metabolic complications of shiftwork via restoration of gut dysbiosis. In this review, the potential bidirectional relationships between gut dysbiosis and circadian rhythm misalignment, their impact on different metabolic pathways, and the potential development of metabolic and systemic disorders, especially in shift work models are critically assessed.

High rates of delayed sleep phase disorder have been observed in inpatients with obsessive compulsive disorder (OCD). Up to one-third of patients with OCD do not respond to treatment; therefore, new interventions or methods of enhancing current interventions are imperative. The theory of inpatient circadian care (TICC) posits that enhancing inpatient settings through environmental changes, such as, a set lights out time and consistent scheduling may facilitate symptom improvements in both medical and psychiatric illnesses. Symptom improvements related to these environmental changes have yet to be explored in inpatient and residential OCD treatment program outcomes. Therefore, data on OCD inpatient and residential programs were collected through a meta-analysis conducted by Veale and colleagues (2016). The programs listed in this meta-analysis were contacted to ask follow-up questions regarding their program's scheduling and lights out times. Programs who reported increased consistency in their patients' schedules were significantly more likely to be coded as obtaining treatment response (a post-treatment mean Y-BOCS score16

STUDY OBJECTIVES: Studies have shown racial differences in circadian rhythm in African Americans when compared to non-Hispanic whites, and an association between circadian dyssynchrony and depression. We hypothesized that the prevalence of delayed sleep time is greater in African Americans when compared to whites and that delayed sleep time is associated with depression. METHODS: We analyzed data from the Sleep Heart Health Study (SHHS), a large community-based sample. Delayed sleep time was defined as self-reported weeknight bedtime after midnight. Depression was defined based on participant's response to the question, “In the past 4 weeks have you felt downhearted and blue?” or reported antidepressant use. We performed multivariate linear and logistic regression, adjusting for age, sex, race, body mass index, smoking, apnea-hypopnea index, alcohol use, and caffeine consumption. RESULTS: Adjusted weekday bedtime was 15 ± 7 minutes later in African Americans compared to whites (P < .001). Similarly, weekend bedtime was 18 ± 7 minutes later in African Americans compared to whites (P = .025). The prevalence of delayed sleep time was greater in African Americans (33.3%) compared to whites (18.7%; P < .001). After adjusting for confounders, when compared to whites, a greater proportion of African Americans had delayed sleep time (adjusted odds ratio [aOR] 2.03; 95% confidence interval [95% CI] 1.5, 2.4; P < .0001). Depression was independently associated with delayed sleep time after adjustment (aOR 1.4; 95% CI 1.1, 1.7; P = .007). CONCLUSIONS: African Americans are more likely to have a delayed sleep time compared to whites, and delayed sleep time was independently associated with depression. CITATION: Bailey O, Combs D, Sans-Fuentes M, Havens CM, Grandner MA, Poongkunran C, Patel S, Berryhill S, Provencio N, Quan SF, Parthasarathy S. Delayed sleep time in African Americans and depression in a community-based population. J Clin Sleep Med. 2019;15(6):857–864.

ObjectiveTo investigate whether later high school start time is associated with lower migraine frequency in high school students with migraine.BackgroundAdequate sleep is thought to be important in managing adolescent migraine. The American Academy of Sleep Medicine recommends teenagers sleep≥8hours/night. Adolescents have a physiologically delayed sleep phase, going to bed, and waking later than children and adults. The American Academy of Pediatrics (AAP) accordingly recommends high schools start no earlier than 8:30 AM.MethodsCross-sectional observational study of U.S. high schoolers with migraine. Participants were recruited nationally using social media. Respondents attending high schools starting at 8:30 AM or later were compared to those attending earlier start time schools. The primary outcome was headache days/month.ResultsTwo hundred and fifty-six subjects constituted the analysis set: 115 later group vs 141 earlier group. Age and sex did not differ. Mean (SD) self-reported headache days/month were 7 (5) vs 8 (7), respectively, (P=.985); mean difference (95% CI for the difference) was -0.8 (-2.3-0.7) days. Median (IQR) self-reported total hours of sleep/school night were: 5.6 (5.0-6.6) vs 5.6 (4.5-6.4), P=.058. Students attending later start time schools woke later (median [IQR] 6:38 AM [55minutes] vs 6:09 AM [59minutes], P&nbsp

BACKGROUND The main objective of this study was to assess the link between sleep duration, quality of life and depression in adolescents. The secondary objective was to study the sleeping behavior of a large sample of adolescents from different socioeconomic backgrounds. METHODS Study subjects were high school students studying in or around Paris with a general, vocational or technological training background. A survey was conducted to evaluate the subject's perception of their own sleep, quality of life and depression. RESULTS The survey analyzed 855 students between 14 and 19 years of age, with equal numbers of males and females. The average sleep duration was 7 h 14 min ±1 h 20 min and was inversely correlated with age (r=-0.142, P

Introduction Substance use disorders are reaching epidemic proportions among adolescents and young adults. While disturbed, insufficient sleep is known to be associated with substance use, little is known about the role of circadian misalignment in precipitating or perpetuating substance misuse. Methods The Penn State Child Cohort is a population-based sample of 700 children (Mdn=9y), who were followed-up 8 years later as adolescents (N=421, Mdn=16y) and 15 years later as young adults (N=492, Mdn=24y). In adolescence, a delayed sleep phase was defined as a 7-night actigraphy-measured mean sleep midpoint later than 4:00 AM, while an irregular circadian phase as a within-subjects standard deviation in sleep midpoint greater than 1 hour. Alcohol, tobacco, and drug use was ascertained by parent- and/or self-reports in adolescence, while alcohol, tobacco and marijuana use was ascertained by self-reports in young adulthood. Logistic regression models tested the association between delayed and irregular circadian phase with substance use adjusted for age, sex, race/ethnicity, BMI, SES, mental health problems and psychoactive medications. Results Adolescents with a delayed sleep phase (n=164) showed later bed and wakeup times, lower morningness scores and greater circadian phase irregularity. Cross-sectionally, a delayed sleep phase in adolescence was associated with 1.9-fold odds (95%CI=1.1–3.2) of alcohol, tobacco and/or drug use; specifically, the odds of alcohol and tobacco use associated with a delayed sleep phase were 1.9-fold (95%CI=1.1–3.4) and 2.4-fold (95%CI=1.1–5.3), respectively, while non-significant for drug use (n=28) for which mental health problems were among the strongest risk factors (OR=3.0, 95%CI=1.3–6.8). Longitudinally, an irregular circadian phase in adolescence was associated with 2.2-fold odds (95%CI=1.1–4.5) of alcohol, tobacco and/or marijuana use in young adulthood; specifically, the odds of alcohol use in young adulthood associated with an irregular circadian phase in adolescence were 1.9-fold (95%CI=1.1–3.5), while non-significant for tobacco (n=58) or marijuana use (n=76) for which mental health problems were the strongest risk factor (OR=2.2, 95%CI=1.3–3.7). Conclusion A delayed or irregular circadian phase in adolescence is associated with substance use, particularly alcohol use in the transition to adulthood. Beyond disturbed and insufficient sleep, circadian misalignment should become a target of early interventions to prevent substance use disorders. Support (if any) R01MH118308, R01HL136587, R01HL97165, R01HL63772, UL1TR000127

IntroductionResearch has shown that ADHD and sleep disorders are intimately intertwined in the majority of patients in both childhood and adulthood. Circadian rhythm sleep disturbances, esp. the delayed sleep phase syndrome, as well as several other sleep disorders, such as Insomnia, Restless Legs, Periodic Limb Movement Disorder and Sleep apnea are associated with ADHD. With a prevalence rate of 80% of sleep disorders in adults with ADHD, the question not only is what is chicken and egg, but even if both conditions share a joint pathophysiology.ObjectivesTo investigate the consequences of this comorbid sleep disorders on severity of ADHD, mood and health, as well as to find evidence on improvement of ADHD by treatment of the sleep disorder(s).MethodsRecent research will be evaluated to formulate answers to these questions.ResultsSleep loss resulting from sleep disorders increases ADHD severity due to more impairment of cognition and memory as well as mood instability. Sleep loss in the longer term also leads to obesity, with negative consequences for health in general. First studies showing a decrease of ADHD symptoms by treatment of sleep disorders will be discussed.ConclusionsADHD and sleep disorders come together in the majority of patients and need both assessment and treatment. Treatment of ADHD by improving sleep, is an intriguing research question with potential new treatment options.

Summary Splitting of the behavioural activity phase has been found in nocturnal rodents with suprachiasmatic nucleus (SCN) coupling disorder. A similar phenomenon was observed in the sleep phase in the diurnal human discussed here, suggesting that there are so-called evening and morning oscillators in the SCN of humans. The present case suffered from bipolar disorder refractory to various treatments, and various circadian rhythm sleep disorders, such as delayed sleep phase, polyphasic sleep, separation of the sleep bout resembling splitting and circabidian rhythm (48 h), were found during prolonged depressive episodes with hypersomnia. Separation of sleep into evening and morning components and delayed sleep-offset (24.69-h cycle) developed when lowering and stopping the dose of aripiprazole (APZ). However, resumption of APZ improved these symptoms in 2 weeks, accompanied by improvement in the patient's depressive state. Administration of APZ may improve various circadian rhythm sleep disorders, as well as improve and prevent manic–depressive episodes, via augmentation of coupling in the SCN network.

Objective: We evaluated whether the association between Adult Attention-Deficit/Hyperactivity Disorder (ADHD) and Seasonal Affective Disorder (SAD) was mediated by the circadian rhythm.Method: Data of 2239 persons from the Netherlands Study of Depression and Anxiety (NESDA) were used. Two groups were compared: with clinically significant ADHD symptoms (N = 175) and with No ADHD symptoms (N = 2064). Sleep parameters were sleep-onset and offset times, mid sleep and sleep duration from the Munich Chronotype Questionnaire. We identified the prevalence of probable SAD and subsyndromal SAD using the Seasonal Pattern Assessment Questionnaire (SPAQ). Clinically significant ADHD symptoms were identified by using a T score>65 on the Conners Adult ADHD Rating Scale.Results: The prevalence of probable SAD was estimated at 9.9% in the ADHD group (vs. 3.3% in the No ADHD group) and of probable s-SAD at 12.5% in the ADHD group (vs 4.6% in the No ADHD group). Regression analyses showed consistently significant associations between ADHD symptoms and probable SAD, even after adjustment for current depression and anxiety, age, sex, education, use of antidepressants and benzodiazepines (B = 1.81, p Conclusion: Both seasonal and circadian rhythm disturbances are significantly associated with ADHD symptoms. Delayed sleep onset time in ADHD may explain the increase in SAD symptoms. Treating patients with SAD for possible ADHD and delayed sleep onset time may reduce symptom severity in these complex patients. (C) 2016 Elsevier Ltd. All rights reserved.

Delayed sleep-wake phase disorder (DSWPD) is commonly defined as an inability to fall asleep and wake at societal times resulting in excessive daytime sleepiness. Although the cause is multifaceted, delays in sleep time are largely driven by misalignment between the circadian pacemaker and the desired sleep-wake timing schedule. Current treatment approaches focus on correcting the circadian delay; however, there is a lack of data investigating combined therapies for treatment of DSWPD.

Objective Individual and socio-demographic factors have been found to be associated with sleep disturbances in children. Few studies have examined these factors among children presenting for care at pediatric sleep clinics. This study examined individual and socio-demographic factors in association with presenting problems and diagnostic impressions for new patients at an interdisciplinary pediatric sleep clinic. Methods Data were collected from electronic medical records of 207 consecutive patients (54% male, 59% White, Mean age = 7.73, SD = 5.62). Results Older age, female gender, and White race were associated with higher likelihood of presenting with difficulty falling asleep; younger age, male gender, and Black race were associated with higher likelihood of presenting with obstructive sleep apnea (OSA)-related concerns. Older age was associated with diagnostic impressions of inadequate sleep hygiene, insufficient sleep, circadian rhythm disorder/delayed sleep phase disorder, periodic limb movement disorder/restless legs syndrome, and insomnia, while younger age was associated with provisional OSA and behavioral insomnia of childhood (BIC) diagnoses. Male gender was associated with provisional OSA. White race was associated with BIC. Age-based analyses were also conducted to further understand the findings within a developmental context. Conclusions Age- and gender-related findings converged with prevalence literature on pediatric sleep disorders. Race was only associated with presenting concern and BIC, and one association for neighborhood disadvantage was found within the age-based analysis. Results suggest a potential service delivery gap, with racial/ethnic minority youth being less likely to present for sleep services, despite prevalence data on the increased likelihood of sleep disturbances among these youth.

The aims of this observational study of patients with euthymic bipolar disorder and sleep disturbance were to 1) compare characteristics related to mood and sleep between two groups with stable and unstable rest-activity cycles and 2) detect between-group differences in motor activity patterns.43 patients wore an actigraph for 6-8 days while reporting daily mood and sleep. Patients were defined as having an unstable rest-activity cycle if their diurnal active period duration presented variation above 2h from the mean during one week: 22 patients had stable and 21 unstable rest-activity cycles. Mood variability was defined as at least moderate symptoms and a change across two levels on a 7-point mood scale during one week.Patients with unstable rest-activity cycles were younger (37 vs. 48 years, p=0.01) and displayed more mood variability (p=0.02). Ten of 11 patients diagnosed with delayed sleep phase disorder were in the unstable group (p0.01), and the unstable group had later and more variable get-up-times and bedtimes. In actigraphy recordings, the mean activity counts per minute did not differ between groups, but the minute-to-minute variability was elevated (p=0.04) and increased relative to the overall variability (p=0.03).A relatively small study sample and a 1-week study period prevent exploration of long-term clinical implications of results.A subgroup of euthymic patients with bipolar disorder displayed unstable rest-activity cycles combined with mood variability and motor activity patterns that resemble findings in affective episodes.

Clinical trials with light therapy (LT) for delayed sleep phase disorder (DSPD) are sparse and little is known about factors that are favorable for improvements. In this study, LT with scheduled rise times was conducted at home for 14 days by 44 participants with DSPD aged 16-26 years. Primary outcomes were sleep onset and sleep offset. Potential predictors were demographic characteristics, chronotype, dim light melatonin onset, the number of days the LT lamp was used, the daily duration of LT, daytime sleepiness, anxiety, depression, worry, and rumination. Significant advances were observed in sleep onset and sleep offset from baseline to the end of treatment. The number of days of LT predicted earlier sleep onset and sleep offset.

Because our circadian rhythms have a strong influence on sleepiness/alertness, inappropriate timing of these rhythms with respect to the attempted sleep period can produce insomnia. Relatively delayed circadian rhythms have been associated with sleep-onset insomnia and advanced or early timed rhythms have been associated with early morning awakening insomnia. Therefore, management of these insomnias need to include treatments, such as bright light and melatonin, that will retime the circadian rhythms to be more in synchrony with the timing of sleep.

Contains fulltext : 173048.pdf (Publisher’s version ) (Closed access) Objective: This review updates information on sleep and circadian rhythmicity in adult ADHD, especially circadian rhythmicity and the influence of stimulants. Method: Investigations into sleep, chronotype, and circadian rhythm in adult ADHD were searched in the Cochrane Library, Embase, Medline, and PsycInfo databases. Results: ADHD in adults is associated with longer objective sleep latency, irrespective of insomnia complaints. Sleep maintenance is disturbed and waking up time is delayed. Adult ADHD is associated with increased eveningness, delayed dim light melatonin onset (DLMO), and later waking up time. Stimulant treatment induces delay of nonparametric circadian parameters, whereas light therapy (LT) induces shifts toward morningness, which is associated with a reduction of ADHD symptoms. Conclusion: Adult ADHD is associated with delayed circadian rhythmicity and analogous sleep characteristics, which are typical of a delayed sleep phase disorder. Stimulants induce delay of circadian rhythmicity. 13 p.

It has been recently discovered that blue wavelengths form the portion of the visible electromagnetic spectrum that most potently regulates circadian rhythm. We investigated the effect of blue light-blocking glasses in subjects with delayed sleep phase disorder (DSPD). This open-label trial was conducted over 4 consecutive weeks. The DSPD patients were instructed to wear blue light-blocking amber glasses from 21:00 p.m. to bedtime, every evening for 2 weeks. To ascertain the outcome of this intervention, we measured dim light melatonin onset (DLMO) and actigraphic sleep data at baseline and after the treatment. Nine consecutive DSPD patients participated in this study. Most subjects could complete the treatment with the exception of one patient who hoped for changing to drug therapy before the treatment was completed. The patients who used amber lens showed an advance of 78 min in DLMO value, although the change was not statistically significant (p = 0.145). Nevertheless, the sleep onset time measured by actigraph was advanced by 132 min after the treatment (p = 0.034). These data suggest that wearing amber lenses may be an effective and safe intervention for the patients with DSPD. These findings also warrant replication in a larger patient cohort with controlled observations.

Study Objectives: Individual differences in sleep timing have been widely recognized and are of particular relevance in adolescents and young adults who often show mild to severely delayed sleep. The biological mechanisms underlying the between-subject variance remain to be determined. Recent human genetics studies showed an association between sleep timing and melanopsin gene variation, but support for functional effects on downstream pathways and behavior was not demonstrated before. We therefore investigated the association between the autonomic (i.e., pupil diameter) and behavioral (i.e., sleep timing) readouts of two different downstream brain areas, both affected by the same melanopsin-dependent retinal phototransduction: the olivary pretectal nucleus (OPN) and the suprachiasmatic nucleus (SCN). Methods: Our study population included 71 healthy individuals within an age range with known vulnerability to a delayed sleep phase (16.8-35.7 y, 37 males, 34 females). Pupillometry was performed to estimate functionality of the intrinsic melanopsin-signaling circuitry based on the OPN-mediated post-illumination pupil response (PIPR) to blue light. Sleep timing was quantified by estimating the SCN-mediated mid-sleep timing in three different ways in parallel: using a chronotype questionnaire, a sleep diary, and actigraphy. Results: All three measures consistently showed that those individuals with a later mid-sleep timing had a more pronounced PIPR (0.03 < P < 0.05), indicating a stronger blue-light responsiveness of the intrinsic melanopsin-based phototransduction circuitry. Conclusions: Trait-like individual differences in the melanopsin phototransduction circuitry contribute to individual differences in sleep timing. Blue light-sensitive young individuals are more prone to delayed sleep. Significance Biological mechanisms underlying individual differences in sleep timing are insufficiently understood. We show an association of individual differences in sleep timing with specific functionality of melanopsin-containing intrinsically photosensitive retinal ganglion cells (ipRGCs). Focusing on adolescents and young adults, an age range with known vulnerability to a delayed sleep phase, we measured the post-illumination pupil response after blue light. This measure of intrinsic ipRGC functionality was consistently associated with three independent measures of sleep timing (i.e., a chronotype questionnaire, a sleep diary, and actigraphy). Individuals with a later sleep timing had a stronger intrinsic ipRGC responsiveness to blue light. Clinical interventions for delayed sleep phase syndrome may benefit from considering hypersensitivity to blue light.

No statistical data is available on the number of employees working on night shifts in Turkey. Working on shifts is associated with decreased sleep time, decreased daily sleep quality, and decreased alertness during night shifts. Increased incidences of cardiovascular disorders, peptic ulcers, and some types of cancer in shift workers are well known. Exposure to light at nighttime suppresses melatonin production. In non-synchronized circadian rhythm, disturbed melatonin secretion may lead to excessive sleep, hunger for carbohydrates, and weight gain. Melatonin is the hormone that governs sleep. It seems to be the key regulator of the sleep/wake rhythm. Exposure to light at night and disturbance of the circadian rhythm contribute to the health problems of night shift workers by disturbing melatonin production. In this review, the definitions of social jetlag, delayed sleep phase syndrome, and insomnia will be discussed. Sleep disorders in psychiatric diseases will be reviewed. Melatonergic drugs available on the market will be listed, including their contraindications and side effects. The physiopathology of sleep, sleep disorders, depression, and melatonin will be given with an extended discussion. Two recent reviews about the effect of melatonin on sleep patterns will be discussed. Finally, other treatments for sleep disorders will be summarized. In conclusion, in shift workers, sleep problems are a complex subject in which multiple pathophysiological mechanisms play roles. The double-blind randomized controlled studies, systematic reviews, and meta-analyses that have been conducted can provide only weakly positive data about the beneficial effect of melatonin use in shift workers. In the future, multi-centered and multi-participant studies will shed more light on this issue. (Eurasian J Emerg Med 2016; 15: 48-53)

Background Theoretical models of Bipolar Disorder (BD) highlight that sleep disturbances may be a marker of underlying circadian dysregulation. However, few studies of sleep in BD have reported on the most prevalent circadian sleep abnormality, namely Delayed Sleep Phase (DSP). Methods A cross-sectional study of 404 adults with BD who met published clinical criteria for insomnia, hypersomnia or DSP, and who had previously participated in a study of sleep in BD using a comprehensive structured interview assessment. Results About 10% of BD cases with a sleep problem met criteria for a DSP profile. The DSP group was younger and had a higher mean Body Mass Index (BMI) than the other groups. Also, DSP cases were significantly more likely to be prescribed mood stabilizers and antidepressant than insomnia cases. An exploratory analysis of selected symptom item ratings indicated that DSP was significantly more likely to be associated with impaired energy and activity levels. Limitations The cross-sectional design precludes examination of longitudinal changes. DSP is identified by sleep profile, not by diagnostic criteria or objective sleep records such as actigraphy. The study uses data from a previous study to identify and examine the DSP group. Conclusions The DSP group identified in this study can be differentiated from hypersomnia and insomnia groups on the basis of clinical and demographic features. The association of DSP with younger age, higher BMI and impaired energy and activity also suggest that this clinical profile may be a good proxy for underlying circadian dysregulation.

Short sleep duration is associated with significant negative consequences, including poor school performance, behavioral problems, obesity, and hypertension. There is prior evidence that there are disparities in sleep duration related to ethnicity; however, there are no specific data on Hispanic children. We aimed to test the hypothesis that there are ethnic differences in parent-reported sleep duration in a community-based cohort of Hispanic and Caucasian children.We examined the parent-reported sleep patterns of a community-based prospective cohort (Tucson Children's Assessment of Sleep Apnea study [TuCASA]) involving 338 Hispanic and Caucasian children at two time points approximately five years apart.In the initial phase of the TuCASA study with a cohort median age of 8.8 years (interquartile range (IQR), 7.6-10.1 years), parent-reported sleep duration during weekdays was shorter in Hispanic (median, 9.5 h; IQR, 9.0, 10.0 years) than in Caucasian children (10 h; IQR, 9.5, 10.0 h; p 0.0001); however, this difference was not seen 5 years later when the cohort was older (median age, 13.3 years; IQR, 11.9-14.6 years; p = 0.43). In addition, Hispanic children had a significantly later bedtime at both time points (p 0.02). In the initial phase, parent-reported sleep duration during weekends tended to be shorter in Hispanic than in Caucasian children (p = 0.06).Short sleep duration in Hispanic children may contribute to health disparities. Our research suggests that in Hispanic children, behavioral interventions toward improving sleep duration accomplished by earlier bedtimes or delayed school start times and mechanistic studies to unravel any inherent tendency toward a delayed sleep phase are needed.

Melatonin is the most well-known regulator of the circadian rhythms of all living organisms and the main substrate synthesized at night. There are 4 stages in the synthesis of melatonin. This review focuses on the 2nd, 3rd, and 4th stages. The review is aimed at analyzing publications on molecular genetic association studies on the role of single nucleotide polymorphisms (SNPs) of the DDC (AADC), AANAT and ASMT genes encoding melatonin synthesis enzymes in the pathogenesis of socially significant neuropsychiatric disorders in humans. The authors analyzed the available full-text articles from several databases, as well as materials from electronic resources. Search depth was 15 years. The analysis of these studies over the past decade show the association of some SNPs of the studied genes with the risk of neuropsychiatric disorders such as delayed sleep phase disorder, attention deficit hyperactivity disorder, autism spectrum disorder, migraine, Parkinson's disease, depression, anxiety, bipolar-affective disorder, schizophrenia.

Sleep disturbances are frequent in attention deficit hyperactivity disorder (ADHD). Sleep complaints in individuals with ADHD may be due to behavioral factors (such as limit setting disorder), specific primary sleep disorders (including primary insomnia, delayed sleep phase disorder, parasomnias, restless legs syndrome, and sleep disordered breathing), the effect of the pharmacological treatment, or comorbid disorders. Therefore, sleep disturbances should be systematically screened for at each visit with patients referred for ADHD by means of subjective or objective tools. Empirical evidence for the treatment of sleep disturbances associated with ADHD is currently limited, although some trials show the efficacy/effectiveness and good tolerability of melatonin for sleep onset delay and a few studies provide support to behavioral interventions. Here, we provide an overview of the main sleep disturbances/disorders associated with ADHD, their diagnostic assessment and available therapeutic options. Our therapeutic recommendations are based on the integration of existing empirical evidence with our clinical experience.

Background: Sleep disturbances are prevalent in severe mental disorders but their type and frequency across diagnostic categories has not been investigated in large scale studies. Methods: Participants with Schizophrenia spectrum disorders (SCZ, (N = 617)), Bipolar disorders (BD, (N = 440)), and Healthy Controls (HC, (N = 173)) were included in the study. Sleep disturbances (insomnia, hypersomnia and delayed sleep phase) were identified based on items from the Inventory of Depressive Symptoms – Clinician rated scale. Clinical symptoms were assessed with the Positive and Negative Syndrome scale and level of functioning with the Global assessment of Functioning scale. Results: The rate of any sleep disturbance was 78% in SZ, 69% in BD and 39% in HC. Insomnia was the most frequently reported sleep disturbance across all groups. Both diagnostic groups reported significantly more of any sleep disturbances than HC (P

The present study proposes a classification model for the differential diagnosis of primary insomnia (PI) and delayed sleep phase disorder (DSPD), applying machine learning methods to circadian parameters obtained from ambulatory circadian monitoring (ACM). Nineteen healthy controls and 242 patients (PI = 184; DSPD = 58) were selected for a retrospective and non-interventional study from an anonymized Circadian Health Database (https://kronowizard.um.es/). ACM records wrist temperature (T), motor activity (A), body position (P), and environmental light exposure (L) rhythms during a whole week. Sleep was inferred from the integrated variable TAP (from temperature, activity, and position). Non-parametric analyses of TAP and estimated sleep yielded indexes of interdaily stability (IS), intradaily variability (IV), relative amplitude (RA), and a global circadian function index (CFI). Mid-sleep and mid-wake times were estimated from the central time of TAP-L5 (five consecutive hours of lowest values) and TAPM10 (10 consecutive hours of maximum values), respectively. The most discriminative parameters, determined by ANOVA, Chi-squared, and information gain criteria analysis, were employed to build a decision tree, using machine learning. This model differentiated between healthy controls, DSPD and three insomnia subgroups (compatible with onset, maintenance and mild insomnia), with accuracy, sensitivity, and AUC >85%. In conclusion, circadian parameters can be reliably and objectively used to discriminate and characterize different sleep and circadian disorders, such as DSPD and OI, which are commonly confounded, and between different subtypes of PI. Our findings highlight the importance of considering circadian rhythm assessment in sleep medicine., This work was supported by the Ministry of Economy and Competitiveness, the Instituto de Salud Carlos III through CIBERFES (CB16/10/00239) and grants 19899/GERM/15 awarded to JM and the Ministry of Science Innovation and Universities RTI2018-093528-B-I00 to MR (all of them co-financed by FEDER).

This case is that of a 14-year-old male who presented to the sleep clinic with daytime somnolence and sleep-onset insomnia which were hindering the child’s day-to-day functioning and performance. Further studies delineated the problem to be delayed sleep phase, after sleep apnea was ruled out. Actigraphy confirmed the diagnosis. Treatment strategies and differential diagnoses are discussed. Namely, treatment involves behavioral modification and keeping consistent schedules, and low-dose melatonin can also be tried. Additionally, the role of light therapy has been discussed. The challenges in correctly identifying and treating this disorder because it is present in adolescents are also touched upon. In summary, this care highlights the common clinical components present in a case of delayed sleep phase. Sleep study helps rule out sleep apnea, an important overlapping disorder which should not be overlooked. Actigraphy objectively confirms the delayed sleep schedule. The treatment which is a combination of behavioral and medical interventions improves adolescent functioning. Delayed sleep phase is mostly prevalent in the adolescent population.

A temporal relationship between the nocturnal rise in melatonin secretion and the increase in sleep propensity at the beginning of the night, coupled with the sleep-promoting effects of exogenous melatonin, supports the view that melatonin is involved in the regulation of sleep. Both meta-analyses and consensus agreements give credibility to the therapeutic use of melatonin in sleep disorders. Administration of melatonin will cue the circadian phase of sleep/wake cycles in a variety of disorders including jet lag problems, shift work maladaptation, advanced and delayed sleep phase disorders, major affective disorder, seasonal affective disorder, and disrupted rhythms in attention deficit hyperactivity disorder, autism, and schizophrenia. This action is attributed to MT1 and MT2 melatonin receptors present in the hypothalamic suprachiasmatic nucleus (SCN) and in other brain areas. Almost every single neuron in the SCN contains GABA, and many results in animals point out to a melatonin interaction with GABA-containing neurons. In addition, central-type benzodiazepine (BZD) antagonism that obliterates GABAA receptor function blunted melatonin behavioral effects including sleep. The sleep-promoting activity of melatonin is relevant because the BZD and type Z-drugs usually prescribed as sleep promoters have many adverse effects, such as next-day hangover, dependence, and impairment of memory. This chapter discusses available data on the efficacy of melatonin to curtail chronic BZD/Z-drug use in insomnia patients.

Study objective The aim of this study was to assess sleep behavior, sleep problems and mental health in childhood as possible candidate precursors for the development of delayed sleep phase (DSP) during adolescence. Methods A longitudinal cohort study of 2200 children at age 7-9 (T1), 11-13 (T2), and 16-19 (T3) years. DSP was assessed at T3, and mental health problems by the Strength and Difficulties Questionnaire and time in bed and sleep problems at T1 and T2. Logistic regression analyses were used to examine associations between sleep and mental health at T1 and T2, and subsequent DSP at T3. Estimated marginal means were computed to compare mental health at T1 and T2 in adolescents with and without DSP. Results Sleeping less than 9 hours per night at age 11-13 was significantly associated with DSP at 16-19 years (adjusted odds ratio = 3.37). Sleep problems at 11-13 years of age were more frequent among those who developed DSP compared to children who did not develop DSP (20% vs. 12%) but the results did not remain significant when controlling for early mental health problems. Sleep problems and mental health at 7-9 years of age was not related to later DSP. In the crude analyses, all Strengths and Difficulties Questionnaire (SDQ) subscales at 11-13 years was significantly associated with later DSP, but in the fully adjusted analysis, only the SDQ total score and hyperactivity subscale remained statistically significant. Conclusion Children with DSP in adolescence possess identifiable risk indicators in childhood.

Background: Decreases in subjective sleep quality are prevalent among nurses and midwives engaged in rotating shift work. Objectives: The present study aimed to examine the relationship between differences in work schedules and subjective sleep quality among female nursing staff. Design: A cross-sectional survey design was used for descriptive and logistic regression analyses. Data collection was conducted from December 2016 to September 2017. Settings: Participants were recruited from five regional core hospitals in Japan. Participants: A total of 1253 nurses and midwives were included in the final analysis. Methods: Subjective sleep quality was assessed using the Japanese version of the Pittsburgh Sleep Quality Index. Chronotype and social jet lag were calculated for both work day and work-free day. Symptoms related to restless legs syndrome/Willis-Ekbom disease were assessed using the Japanese version of the Cambridge-Hopkins questionnaire short form 13. Participants with the urge to move their legs, though not fulfilling the restless legs syndrome/Willis-Ekbom disease criteria, were classified as having leg motor restlessness. Logistic regression analyses for poor sleep were adjusted for age, body mass index, smoking, drinking, menstruation status, the presence of premenstrual syndrome, and the presence of a spouse. Results: Rates of poor sleep (Pittsburgh Sleep Quality Index score ?6) among those working, day shifts, rotating 12.5 hour night shifts, rotating 16 hour night shifts, and three-shift rotations were 41.2%, 51.1%, 44.5%, and 60.4%, respectively. Approximately 40% of three-shift rotation workers experienced difficulty initiating sleep. Shift workers tended to exhibit evening chronotype, delayed sleep phase, and high social jet lag. The prevalence of restless legs syndrome/Willis-Ekbom disease was 2.5%. Leg motor restlessness was observed in. 15.5% of participants. The adjusted odds ratios (95% confidence interval) of three-shift work (vs. day shift), evening chronotype (vs. morning chronotype), and the presence of leg motor restlessness (vs. no leg motor restlessness) for those with poor sleep were 2.20 (1.47?3.30), 1.95 (1.29?2.94),and 1.66 (1.15?2.39), respectively. Conclusions: Regardless of the working schedules, rates of poor sleep were high among female hospital nurses and midwives. Our findings suggest that poor sleep quality is influenced by three-shift rotation, the evening chronotype, and leg motor restlessness., International Journal of Nursing Studies, 95, pp.103-112; 2019

This study investigated the utility of the pupillary light reflex as a method of differentiating DSPD patients with delayed melatonin timing relative to desired/required sleep time (circadian type) and those with non-delayed melatonin timing (non-circadian type). All participants were young adults, with a total of 14 circadian DSPD patients (M = 28.14, SD = 5.26), 12 non-circadian DSPD patients (M = 29.42, SD = 11.51) and 51 healthy controls (M = 21.47 SD = 3.16) completing the protocol. All participants were free of central nervous system acting medications and abstained from caffeine and alcohol on the day of the assessment. Two pupillary light reflex measurements were completed by each participant, one with a 1s dim (~10 lux) light exposure, and one with a 1s bright (~1500 lux) light exposure. Circadian DSPD patients showed a significantly faster pupillary light reflex than both non-circadian DSPD patients and healthy controls. Non-circadian patients and healthy controls did not differ significantly. Receiver operating characteristic curves were generated to determine the utility of mean and maximum constriction velocity in differentiating the two DSPD phenotypes, and these demonstrated high levels of sensitivity (69.23–-100%) and specificity (66.67–91.67%) at their optimal cut offs. The strongest predictor of DSPD phenotype was the mean constriction velocity to bright light (AUC = 0.87). These results support the potential for the pupillary light reflex to clinically differentiate between DSPD patients with normal vs. delayed circadian timing relative to desired bedtime, without the need for costly and time-consuming circadian assessments.

Background Sleep disturbances are an early and prominent feature of Huntington's disease (HD). Objective The current study investigated the relation between sleep quality impairment and cognitive and psychiatric symptoms in patients with HD. Methods Sleep quality, daytime sleepiness, and neurocognitive symptoms were assessed in 38 mutation carriers (23 premanifest and 15 early stage) and 38 age-and sex-matched controls using standardized questionnaires (the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, the cognitive section of the Unified Huntington's Disease Rating Scale, the Hospital Anxiety and Depression Scale, and the Irritability Scale). Results Compared to controls, HD patients had worse sleep quality (p = 0.016), which was associated with more severe cognitive impairment and higher anxiety, depression and irritability scores. These findings suggest that HD patients may have a delayed sleep phase, as indicated by the increased sleep onset latency (p = 0.019) and later wake-up time (0.013), which was associated with worse cognitive performance and greater depressive and anxiety symptoms. Conclusions Our data provide further evidence for an association between sleep quality in HD and cognitive performance and psychiatric symptoms.

Study Objectives We evaluated the relationship between leukocyte telomere length (LTL) and sleep duration, insomnia symptoms, and circadian rhythm, to test whether sleep and chronobiological dysregulations are associated with cellular aging. Methods Data from the Netherlands Study of Depression and Anxiety (N = 2,936) were used at two waves 6 years apart, to measure LTL. Telomeres shorten during the life span and are important biomarkers for cellular aging. LTL was assessed by qualitative polymerase chain reaction and converted into base pair number. Sleep parameters were: sleep duration and insomnia symptoms from the Insomnia Rating Scale. Circadian rhythm variables were: indication of Delayed Sleep Phase Syndrome (DSPS), mid-sleep corrected for sleep debt on free days (MSFsc), sleep-onset time, and self-reported chronotype, from the Munich Chronotype Questionnaire. Generalized estimating equations analyzed the associations between LTL, sleep, and chronobiological factors, adjusted for baseline age, sex, North European ancestry, and additionally for current smoking, depression severity, obesity, and childhood trauma. Results Indicators of delayed circadian rhythm showed a strong and consistent effect on LTL, after adjustment for sociodemographic and health indicators. Late MSFsc (B = −49.9, p = .004), late sleep-onset time (B = −32.4, p = .001), indication of DSPS (B = −73.8, p = .036), and moderately late chronotype in adulthood (B = −71.6, p = .003) were associated with significantly shorter LTL across both waves; whereas sleep duration and insomnia symptoms were not. Extremely early chronotype showed significantly less LTL shortening than intermediate chronotype (B = 161.40, p = .037). No predictors showed accelerated LTL attrition over 6 years. Conclusions Individuals with delayed circadian rhythm have significantly shorter LTL, but not faster LTL attrition rates.

We report the relationship between daily rest-activity patterns and trait impulsivity in healthy young adults. The Barratt Impulsiveness Scale was used to identify high and low impulsive individuals among a group of 51 volunteers. Participants' sleep behaviour and circadian rhythm function was assessed using week-long actigraphy. High impulsive individuals displayed phase-delayed patterns of sleep, a decreased total sleep time and sleep efficiency, and disrupted circadian function. Such outcomes were also associated with greater self-reported attention deficit hyperactivity disorder symptoms. The results highlight that sleep and circadian rhythm disturbances may be associated with impulsive traits replicating relationships described in psychiatric illnesses in which impulsivity is a core feature.

The timing, duration, and consolidation of sleep result from the interaction of the circadian timing system with a sleep-wake homeostatic process. When aligned and functioning optimally, this allows wakefulness throughout the day and a long consolidated sleep episode at night. Mismatch between the desired timing of sleep and the ability to fall and remain asleep is a hallmark of the circadian rhythm sleep-wake disorders. This article discusses changes in circadian regulation of sleep with aging; how age influences the prevalence, diagnosis, and treatment of circadian rhythm sleep-wake disorders; and how neurologic diseases in older patients affect circadian rhythms and sleep.

Hericium erinaceus (HE), an edible mushroom, has been used as a herbal medicine in several Asian countries since ancient times. HE has potential as a medicine for the treatment and prevention of dementia, a disorder closely linked with circadian rhythm. This study investigated the effects of the intake of HE extracts on behavioral rhythm, photosensitivity of the circadian clock, and clock gene mRNA expression in the suprachiasmatic nucleus (SCN), a central clock, in mice. Although the HE ethanol extract only affected the offset time of activity, the HE water extract advanced the sleep-wake cycle without affecting the free-running period, photosensitivity, or the clock gene mRNA expression in SCN. In addition, both extracts decreased wakefulness around end of active phase. The findings of the present study suggest that HE may serve as a functional food in the prevention and treatment of Alzheimer's disease and delayed sleep phase syndrome.

Sleep disorders are common in childhood and can have significant effects on the health and wellbeing of both children and their families. This article discusses the management of the sleep disorders most commonly encountered in primary care, including insomnia, delayed sleep phase disorder and parasomnias, as well describing the less common but more serious conditions that require referral for specialist investigation.

The dim light melatonin onset (DLMO) is the most reliable measure of central circadian timing in humans. However, it is not always possible to measure the DLMO because sample collection has to occur in the hours before usual sleep onset, it requires staff support and considerable participant effort, and it is relatively expensive. Questionnaires that ask people about the timing of their behavior, such as their sleep, may provide an easier and less expensive estimate of circadian timing. The objective of this analysis was to compare the MEQ score derived from the Morningness-Eveningness Questionnaire (MEQ) and the MSFsc derived from the Munich ChronoType Questionnaire (MCTQ) to the DLMO in the largest sample to date ( N = 60). Our hypothesis was that MSFsc would correlate more highly with the DLMO than MEQ score. Our sample of 36 healthy controls and 24 patients with delayed sleep phase disorder ranged in age from 18 to 62 years. All participants slept at times of their own choosing for a week before the assessment of their DLMO. The DLMO correlated significantly with both the MEQ score ( r = −0.70, p < 0.001) and MSFsc ( r = 0.68, p < 0.001). A linear regression using MEQ, MSFsc, and age to predict the DLMO explained 60% of the DLMO variance. The strongest predictor of the DLMO was MSFsc (beta = 0.51, p = 0.001), followed by MEQ (beta = −0.41, p = 0.004), and age (beta = 0.26, p = 0.013). The beta values for MSFsc and MEQ score were not statistically different from each other. Nonetheless, around a 4-h range in the DLMO was observed at a given MEQ score and a given MSFsc, indicating that neither questionnaire should be exclusively used to time light or exogenous melatonin treatment, as this could result in the mistiming of these treatments relative to the DLMO, thereby potentially worsening circadian misalignment.

The teenage years are a period of particular vulnerability to the desynchronization of the biological clock. Beyond geneticfactors, puberty is associated with a significant delay in the circadian phase of sleep, responsible for increasing dificulties with sleep onset at night and thus with awakening in the morning. The prevalence of Delayed Sleep Phase Syndrome (DSPS) is high in the adolescent population, affecting up to 16 % of teenagers. As sleep needs remain remarkably stable, adolescent sleep phase delay causes chronic sleep depriva- tion and subsequently daytime fatigue or even excessive daytime sleepiness, and also metabolic disturbances, neurocognitive problems associated with decreased school perfor- mance, as well as mood disorders. Whereas genetic and biological factors have been investigated by a number of studies, research on social, cognitive-behavioural or psychological factors is still limited to date. Among the latte; the technological revolution of the past decades, most importantly exposure to screens- has significantly modied adolescent behavior. This article discusses the latest research on the complex interaction of these different factors. It focusses particularly on the impact of media use on circadian disorders of sleep in adolescence.

Delayed sleep phase disorder (DSPD) is common among young people, but there is still no evidence-based treatment available. In the present study, the feasibility of cognitive behavioral therapy (CBT) was evaluated as an additive treatment to light therapy (LT) in DSPD. A randomized controlled trial with participants aged 16 to 26 years received LT for two weeks followed by either four weeks of CBT or no treatment (NT). LT advanced sleep-wake rhythm in both groups. Comparing LT+CBT with LT+NT, no significant group differences were observed in the primary endpoints. Although anxiety and depression scores were low at pretreatment, they decreased significantly more in LT+CBT compared to LT+NT. The results are discussed and some suggestions are given for further studies.

Purpose: Assessment of the influence of gender and increasing years at university on sleep health of students. Methods: Four hundred and eighteen students from different streams across years of undergraduate to postgraduate courses participated. Descriptive statistics, test of differences, and correlation were used. The sleep health data comprised of subjective evaluation using a questionnaire and personal interviews. Results: Overall, 43.1% had sleep problems, females were more affected (51.67% vs. 48.33% in males) but were early bed goers. The prevalence of circadian rhythm sleep disorder (11.6% vs. 9.5%) and delayed sleep phase syndrome (4.5% vs. 2.7%) was slightly higher in males. The daytime dysfunction and hypnotic use significantly differed in students of the same class among gender. Bedtime got significantly delayed along years [H(2)=29.769, p Conclusion: Gender and years of university education influence sleep among university students both separately and concomitantly.

A significant delay in the timing of endogenous circadian rhythms has been associated with delayed sleep phase disorder (DSPD). More recently, other mechanisms have also been proposed to account for this disorder. To further explore the etiology of DSPD, the present study compared nocturnal melatonin profiles of 26 DSPD patients (18 males, 8 females; age, 21.73 ± 4.98 years) and 17 normally timed good sleepers (10 males, 7 females; age, 23.82 ± 5.23 years) in a time-free, dim-light (

Study objectives The absence of a screening questionnaire for delayed sleep phase disorder (DSPD) remains a barrier to its detection and subsequent clinical evaluation. We developed a questionnaire to screen for DSPD risk and assessed its impact on self-reported absenteeism and functioning in work/school, social, and family life. Design Cross-sectional, with 13,844 individuals responding to a survey through an Internet survey provider, from which 1315 completed surveys were obtained from eligible participants. Participants A total of 1315 individuals who self-identified as evening type (n = 979) or as non-evening type (n = 356). Measurements and results A total of 295 participants were at high risk for DSPD, which is 5.1% of the total eligible survey respondents and 22.4% of our final sample with completed surveys. Compared to those who were not at high risk for DSPD, those who were at high risk were more likely to report frequent absenteeism, frequent loss of productivity, disruption to work or school activities, disruption to social life or leisure activities, and disruption to family life or home responsibilities. Difficulty with daytime sleepiness was more common in those at high risk for DSPD than those who were not. Increased sleep deficit on nights before school or work was also associated with more frequent difficulties with daytime sleepiness; 15.4% of those with no sleep deficit reported always or usually having difficulties with daytime sleepiness compared to 55.7% of those with a sleep deficit of 3 hours or more. Conclusions DSPD risk is associated with increased absenteeism and impaired functioning in work/school, social, and family life.

Sleep is common to all animals and yet there are so many mysteries surrounding its function. Insomnia, the most common sleep disorder, is prevalent and debilitating and has been shown to play a role in the onset and maintenance of other mental health disorders, such as depression, anxiety, and bipolar disorder. This chapter outlines a basic overview of sleep, followed by a summary of cutting-edge research investigating insomnia as well as its relationship to other psychiatric disorders. It is suggested that a bidirectional relationship exists between sleep and emotion and research supporting this framework is addressed briefly. We describe the treatment of choice for insomnia, cognitive behavioral therapy, as well as outline other exciting developments in the treatment of insomnia, including bright light therapy, intensive sleep retraining therapy, and Internet-based treatments. Finally, we end on a discussion of areas that are ripe for future investigation, including biological mechanisms, sleep medications, and other sleep disorders such as hypersomnia. Keywords: sleep; insomnia; treatment; CBT-I ; hypersomnia; emotion; delayed sleep phase disorder

The circadian clock disorders in humans remain poorly understood. However, their impact on the development and progression of major human conditions, from cancer to insomnia, metabolic or mental illness becomes increasingly apparent. Addressing human circadian disorders in animal models is, in part, complicated by inverse temporal relationship between the core clock and specific physiological or behavioral processes in diurnal and nocturnal animals. Major advantages of a macaque model for translational circadian research, as a diurnal vertebrate phylogenetically close to humans, are further emphasized by the discovery of the first familial circadian disorder in non‐human primates among the rhesus monkeys originating from Cayo Santiago. The remarkable similarity of their pathological phenotypes to human Delayed Sleep Phase Disorder (DSPD), high penetrance of the disorder within one branch of the colony and the large number of animals available provide outstanding opportunities for studying the mechanisms of circadian disorders, their impact on other pathological conditions, and for the development of novel and effective treatment strategies. Am. J. Primatol. 78:117–126, 2016. © 2016 The Authors. American Journal of Primatology published by Wiley Periodicals, Inc.

Bipolar disorder is a severe and chronic disorder, ranked in the top 10 leading causes of disability worldwide. Sleep disturbances are strongly coupled with inter-episode dysfunction and symptom worsening in bipolar disorder. Experimental studies suggest that sleep deprivation can trigger manic relapse. There is evidence that sleep deprivation can have an adverse impact on emotion regulation the following day. The clinical management of the sleep disturbances experienced by bipolar patients, including insomnia, hypersomnia delayed sleep phase and irregular sleep-wake schedule, may include medication approaches, psychological interventions, light therapies and sleep deprivation. Psychological interventions, as described here, are advantageous in that they are low in side effects, may be preferred by patients, are durable and have no abuse potential.