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ObjectivePediatric insomnia is one of the most commonly reported disorders, especially in children with neurodevelopmental disorders. Better Nights, Better Days for Children with Neurodevelopmental Disorders (BNBD-NDD) is a transdiagnostic, self-guided, eHealth behavioral sleep intervention developed for parents of children with NDDs ages 4–12 years with insomnia. After usability testing, a randomized controlled trial (RCT) was conducted to evaluate the effectiveness of the BNBD-NDD program. By interviewing RCT participants after their outcome measures were collected, we sought to determine the barriers and facilitators that affect the reach, effectiveness, adoption, implementation, and maintenance of the BNBD-NDD intervention, as well as to assess whether barriers and facilitators differ across levels of engagement with the program and NDD groups.MethodTwenty parents who had been randomized to the treatment condition of the RCT participated in this study. These parents participated in virtual semi-structured qualitative interviews about their experiences with the BNBD-NDD program. Rapid analysis was used, in which one researcher facilitated the interview, and another simultaneously coded the interview using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.ResultsOverall, more facilitators than barriers were identified for Reach, Effectiveness, Implementation, and Maintenance, whereas for Adoption more barriers emerged. Participants who were engaged reported more facilitators about the BNBD-NDD program design and behavior change, while unengaged participants mentioned needing more support to help facilitate their use of the program. Lastly, parents of children with ASD reported more facilitators and more barriers than did parents of children with ADHD.ConclusionWith this feedback from participants, we can optimize BNBD-NDD for large-scale implementation, by modifying the program to better support parents, helping them implement the strategies effectively at home, and increasing the accessibility of this evidence-based treatment.

BACKGROUND Children with neurodevelopmental disorders have a high risk of sleep disturbances, with insomnia being the most common sleep disorder (i.e., chronic and frequent difficulties with going and staying asleep). Insomnia adversely affects the well-being of these children and their caregivers. Pediatric sleep experts recommend behavioral interventions as the first-line treatment option for children. Better Nights, Better Days for Children with Neurodevelopmental Disorders (BNBD-NDD) is a five-session eHealth behavioural intervention delivered to parents to improve outcomes (e.g., Pediatric Quality of Life Inventory) for their children (4-12 years) with insomnia and who have a diagnosis of mild-to-moderate attention-deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, and/or fetal alcohol spectrum disorder. If effective, BNBD-NDD can be a scalable intervention that provides value to an underserved population. OBJECTIVE This protocol outlines an economic evaluation conducted alongside the BNBD-NDD randomized controlled trial (RCT) that aims to assess its costs and effectiveness compared to usual care. METHODS The BNBD-NDD RCT evaluates the impacts of the intervention on children’s sleep and quality of life, as well as parent daytime functioning and psychosocial health. Parent participants were randomized to the BNBD-NDD treatment or to usual care. The economic evaluation assesses outcomes at baseline and 8 months later, which include the Pediatric Quality of Life Inventory (PedsQL) as the primary measure. Quality of life outcomes facilitates the comparison of competing interventions across different populations and medical conditions. Cost items include the BNBD-NDD intervention and parent-reported utilization of private and publicly funded resources for their children’s insomnia. The economic evaluation involves a reference-case cost-effectiveness analysis to examine the incremental cost of BNBD-NDD per unit(s) gain in the PedsQL from the family payer perspective and a cost-consequence analysis from a societal perspective. These analyses will be conducted over an 8-month time horizon. RESULTS The BNBD-NDD RCT data collection commenced in June 2019 and ended in April 2022. The RCT data are currently being analyzed, and data relevant to the economic analysis will be analyzed concurrently. CONCLUSIONS To our knowledge, this will be the first economic evaluation of an eHealth intervention for insomnia in children with neurodevelopmental disorders. This evaluation's findings can inform users and stakeholders regarding the costs and benefits of BNBD-NDD. CLINICALTRIAL ClinicalTrial.gov ID NCT02694003

Neurological uniqueness, maladaptive behaviours, as well as atypical sleep patterns are reported to be defining characteristics of giftedness, but this has received little empirical support. We studied the polysomnography recorded sleep of gifted and typically-developing children together with features of maladaptive behaviours. The association of sleep macrostructure and sleep instability with maladaptive behaviours was also investigated in gifted children. In all, 19 gifted children (74% boys) and 17 typically-developing children (76% boys) aged 6-12 years were studied. Giftedness was identified using Renzulli's three-factor definition. The microarousal index, number of awakenings, and number of Stage shifts between sleep stages throughout the night were computed as sleep instability parameters. Maladaptive behaviours were assessed using the Child Behaviour Checklist. We found significantly more Stage N1 and less Stage N3 in gifted children compared to typically-developing children. More Stage N1 sleep was correlated with more externalising problems and less Stage N3 sleep was correlated with more internalising problems. Gifted children also displayed more rapid eye movement (REM) sleep, but this was not significantly correlated with behavioural scales. Gifted children displayed two opposing trends of sleep instability: more instability involving N1 sleep and less instability involving N2, N3 and REM sleep. More total Stage shifts were correlated with more internalising and externalising problems. The results of this study provide initial evidence of polysomnography-based characteristics of giftedness. Further studies are needed to explore common pathways linking sleep alterations and maladaptive behaviours in children with giftedness.

Objective The COVID-19 pandemic has the potential to disrupt the lives of families and may have implications for children with existing sleep problems. As such, we aimed to: (1) characterize sleep changes during the COVID-19 pandemic in children who had previously been identified as having sleep problems, (2) identify factors contributing to sleep changes due to COVID-19 safety measures, and (3) understand parents’ and children’s needs to support sleep during the pandemic. Methods Eighty-five Canadian parents with children aged 4–14 years participated in this explanatory sequential, mixed-methods study using an online survey of children’s and parents’ sleep, with a subset of 16 parents, selected based on changes in their children’s sleep, participating in semi-structured interviews. Families had previously participated in the Better Nights, Better Days (BNBD) randomized controlled trial. Results While some parents perceived their child’s sleep quality improved during the COVID-19 pandemic (14.1%, n = 12), many parents perceived their child’s sleep had worsened (40.0%, n = 34). Parents attributed children’s worsened sleep to increased screen time, anxiety, and decreased exercise. Findings from semi-structured interviews highlighted the effect of disrupted routines on sleep and stress, and that stress reciprocally influenced children’s and parents’ sleep. Conclusions The sleep of many Canadian children was affected by the first wave of the COVID-19 pandemic, with the disruption of routines influencing children’s sleep. eHealth interventions, such as BNBD with modifications that address the COVID-19 context, could help families address these challenges.

Objectives/background Intellectual giftedness is characterized by an intellectual development superior to peers, while emotional and relational developments correspond to the age norms. Few empirical researches have investigated sleep profile of gifted children (GC) and its association with their well-being, all of which used IQ as the sole definition criteria for GC. This study aimed to investigate the interaction between giftedness and sleep on socio-emotional functioning. Participants The sample consisted of 32 GC (25 boys; mean age = 9.62, SD = 1.81) and 17 typically-developing children (TD: 13 boys; mean age = 10.23 years, SD = 1.95). Giftedness was identified using Renzulli's three-factor definition of giftedness. Methods Children's sleep and socio-emotional functioning were respectively assessed with the Children's Sleep Habits Questionnaire and the Child Behavior Checklist, both completed by parents. Results Being in the GC group increased by 4.67 times the risk of having sleep problems and 14.12 times the risk of having maladaptive behaviors. Two-way ANOVA tests showed that sleep problems tended to moderate the relation between giftedness and adjustment difficulties so that the combination of giftedness and sleep problems appeared to be prejudicial to socio-emotional functioning. Conclusion Giftedness could be a risk factor for sleep disorders as well as adjustment difficulties. The present results support the importance of addressing sleep in the GC assessment to improve their well-being and eventually limit the negative impacts of sleep difficulties on emotional and behavioral functioning.

Background: The coronavirus disease 2019 (COVID-19) pandemic has caused global disruptions with serious psychological impacts. This study investigated the emergence of new psychiatric symptoms and the worsening of pre-existing mental disorders during the COVID-19 pandemic, identified factors associated with psychological worsening, and assessed changes in mental health service use. Methods: An online survey was circulated between April 3 and June 23, 2020. Respondents were asked to complete mental health questionnaires based on 2 time referents: currently (i.e., during the outbreak) and in the month preceding the outbreak. A total of 4,294 Canadians between 16 and 99 years of age were subdivided based on the presence of self-reported psychiatric diagnoses. Results: The proportion of respondents without prior psychiatric history who screened positive for generalized anxiety disorder and depression increased by 12% and 29%, respectively, during the outbreak. Occurrences of clinically important worsening in anxiety, depression, and suicidal ideation symptoms relative to pre-outbreak estimates were significantly higher in those with psychiatric diagnoses. Furthermore, 15% to 19% of respondents reported increased alcohol or cannabis use. Worse psychological changes relative to pre-outbreak estimate were associated with female sex, younger age, lower income, poorer coping skills, multiple psychiatric comorbidities, previous trauma exposure, deteriorating physical health, poorer family relationships, and lower exercising. Reductions in mental health care were associated with increased suicidal ideation. Conclusion: The worsening in mental health symptoms and the decline in access to care call for the urgent development of adapted interventions targeting both new mental disorders and pre-existing psychiatric conditions affected by the COVID-19 pandemic.

Contexte La disparition de la nomenclature des troubles du sommeil dits primaires ou secondaires, rendue obsolète par le Manuel diagnostique et statistique des troubles mentaux (DSM-5), représente bien l’engouement académique actuel pour ce domaine de recherche. Il est de plus en plus reconnu que les troubles du sommeil sont plus que de simples conséquences d’un trouble psychiatrique et qu’ils peuvent persister malgré un traitement adéquat de la condition comorbide et même précéder ou exacerber cette dernière. Les troubles du sommeil dans les troubles psychotiques, très fréquents, sont donc devenus un sujet d’actualité, représentant une cible d’intervention jusqu’ici sous-estimée.Objectif Cet article vise à présenter l’état des connaissances actuelles sur la relation entre les troubles du sommeil et les troubles psychotiques ainsi que sur l’utilisation de la thérapie cognitivo-comportementale (TCC) pour traiter les troubles du sommeil dans ce contexte.Méthode L’article fait une recension narrative de la littérature pour décrire la relation bidirectionnelle entre la psychose et les troubles du sommeil, les corrélations cliniques et les traitements ciblant l’insomnie chez les patients psychotiques.Résultats Malgré la présence d’une relation entre les troubles du sommeil et les troubles psychotiques, les mécanismes neuronaux, hormonaux et socioculturels régissant cette relation demeurent encore incertains. Bien que l’association reliant les troubles du sommeil et les troubles psychotiques demeure à clarifier, les études démontrent qu’elle serait bidirectionnelle et peut engendrer un cercle vicieux où ces deux composantes s’aggravent mutuellement. Dans ce contexte de comorbidités, les modèles unifiés en TCC deviennent un traitement de choix, à condition d’adapter les protocoles de TCC pour insomnie (TCC-i) à une population avec trouble psychotique (TCC-ip).Conclusion Malgré la complexité de la relation entre les troubles psychotiques et ceux du sommeil, la TCC-i a été démontrée efficace pour traiter les troubles du sommeil dans une population psychotique et pourrait, dans certains cas, permettre d’alléger la symptomatologie psychotique. De futures études sur ce domaine pourraient permettre le développement de protocoles de thérapie cognitivo-comportementale pour les troubles du sommeil mieux adaptés à la population avec troubles psychotiques., Context Psychotic disorders are severe mental disorders that can cause a loss of contact with reality. Along with positive symptoms (delusions and hallucinations), they also encompass many other dysfunctions, such as sleep problems, which themselves can cause great distress and impairment in patients.Objective To review current literature on the relationship between sleep disorders and psychosis, on the clinical impact of such a relationship, and the psychological treatment of sleep disorders in the context of psychosis.Method Narrative overview of the literature synthesizing the findings about the relationship between psychosis and sleep disorders, and the psychological treatment of the latter, retrieved from searches of computerized databases, hand searches, and authoritative texts.Results Evidence shows a bidirectional relationship between psychosis and sleep disorders. Despite many hypotheses involving genetics, hormones, or neuronal functions regarding the nature of this association, the exact mechanism remains elusive. However, sleep-related problems are an interesting therapeutic target to improve quality of life and psychotic symptoms and respond well to psychological interventions.Conclusion Patients with psychotic disorders can benefit from CBT for insomnia, given a few adaptations to existing protocols. Additional studies are necessary to determine which patients are most likely to benefit from such interventions and to clarify the relationship between psychosis and sleep disorders, and the clinical implications of them co-existing.

This commentary highlights the critical role of sleep as a public health issue, particularly during a stressful life period such as the COVID-19 pandemic, and provides evidence-based practical guidelines to manage sleep disturbances during this crisis. The COVID-19 pandemic and the imposed social confinement have produced significant stress, anxiety, and worries about health and the fear of being infected, jobs and financial problems, and uncertainty about the future. The incidence of sleep disturbances has also increased dramatically during this period. Aside from stress and anxiety, two other factors are likely to contribute to increased sleep disturbances during this crisis. First, alterations of our daily routines such as arising at a specific time, showing up at work, eating, exercising, and engaging in social and leisure activities at relatively fixed times are all important timekeepers for our sleep-wake cycles to remain synchronized with the day (light) and night (dark) cycles. Alterations of these timekeepers, combined with reduced daylight exposure, also essential to keep our biological clock synchronized, are likely to disrupt sleep and circadian rhythms. Sleep plays a fundamental role for mental and physical health, and adequate sleep duration and quality are essential for coping with major life events such as the COVID-19 pandemic. Public health education is warranted to keep the population well informed about the importance of sleep and healthy sleep practices in order to cope with the pandemic and prevent or minimize long-term adverse outcomes.

Theoretical models of sleep and attention deficit hyperactivity disorder (ADHD) suggest that symptoms of ADHD are associated with daytime sleepiness, but it has received little support. The present study aimed at testing an alternative model involving the association of attentional instability with sleep instability, i.e., sleep stage transitions and arousals. Twelve ADHD and 15 healthy control (HC) boys aged between 8 and 12 years old underwent polysomnography recording and attentional testing. The microarousal index, the number of awakenings, and the number of stage shifts between stages 1, 2, 3, 4 and REM sleep throughout the night were computed as sleep stability parameters. Attentional functioning was assessed using the Continuous Performance Test-II. We found significantly higher sleep instability in ADHD compared to HC. Sleep arousals and stage transitions (micro arousal index, stage 4/3 and 2/4 transitions) in ADHD significantly correlated with lower attentional scores. No association whatsoever was found between sleep instability and attentional functioning in HC. The results show that sleep instability is associated with lower attentional performance in boys with ADHD, but not in HC. This could be compatible with a model according to which attention and sleep stability share a common neural substrate in ADHD.

Objectives/background This paper outlines the current state of Canadian training, clinical services, research, and advocacy initiatives related to non-respiratory sleep disorders, with a specific focus on insomnia, the most common sleep problem in children. Methods Information for this narrative review was collected from peer-reviewed publications, web-resources, and personal communications and experiences. Results It is estimated that approximately one-third of Canadian children and youth present with insomnia, and that this is impacting their physical and mental health, as well as learning in school. Training in pediatric sleep is limited and highly inconsistent within and across disciplines. While there are some publicly and privately funded pediatric sleep services available, these are mostly focused on respiratory sleep problems and are not equally accessible across the country. Conclusions Pediatric assessment and treatment services for non-respiratory sleep disorders needs to be more integrated into the Canadian health care system.

Background An upsurge in dream and nightmare frequency has been noted since the beginning of the COVID-19 pandemic and research shows increases in levels of stress, depression and anxiety during this time. Growing evidence suggests that dream content has a bi-directional relationship with psychopathology, and that dreams react to new, personally significant and emotional experiences. The first lockdown experience was an acute event, characterized by a combination of several unprecedent factors (new pandemic, threat of disease, global uncertainty, the experience of social isolation and exposure to stressful information) that resulted in a large-scale disruption of life routines. This study aimed at investigating changes in dream, bad dream and nightmare recall; most prevalent dream themes; and the relationship between dreams, bad dreams, nightmares and symptoms of stress, depression and anxiety during the first COVID-19 lockdown (April-May 2020) through a national online survey. Methods 968 participants completed an online survey. Dream themes were measured using the Typical Dreams Questionnaire; stress levels were measured by the Cohen’s Perceived Stress Scale; symptoms of anxiety were assessed by Generalized Anxiety Disorder (GAD-7) scale; and symptoms of depression were assessed using the Quick Inventory of Depressive Symptomatology. Results 34% (328) of participants reported increased dream recall during the lockdown. The most common dream themes were centered around the topics of 1) inefficacy (e.g., trying again and again, arriving late), 2) human threat (e.g., being chased, attacked); 3) death; and 4) pandemic imagery (e.g., being separated from loved ones, being sick). Dream, bad dream and nightmare frequency was highest in individuals with moderate to severe stress levels. Frequency of bad dreams, nightmares, and dreams about the pandemic, inefficacy, and death were associated with higher levels of stress, as well as with greater symptoms of depression and anxiety. Conclusions Results support theories of dream formation, environmental susceptibility and stress reactivity. Dream content during the lockdown broadly reflected existential concerns and was associated with increased symptoms of mental health indices.

Les données recueillies lors de crises et tragédies passées prouvent que les problèmes de sommeil survenant durant ou peu de temps après un événement traumatique sont reliés à une probabilité accrue de développer des symptômes psychiatriques durables. Or la pandémie COVID-19 et ses conséquences à moyen et long-terme combinent plusieurs facteurs de risque pour le sommeil, tant pour les intervenants de la santé que la population générale. Notre relevé mensuel des publications scientifiques qui combinent COVID-19 et sommeil/insomnie entre janvier et juillet 2020 révèle un taux de croissance comparable pour les articles qui portent plus précisément sur la santé mentale mais aucune ne porte sur les résultats d’une intervention. Nous proposons qu’il faille agir rapidement sur les difficultés de sommeil en cette période de pandémie afin de protéger l’équilibre psychologique individuel à moyen et long terme, d’autant plus que les outils nécessaires à la prévention de l’insomnie, sa détection et son traitement sont à la portée de tous les professionnels de la santé mentale.

IntroductionThe negative impacts of COVID-19 have rippled through every facet of society. Understanding the multidimensional impacts of this pandemic is crucial to identify the most critical needs and to inform targeted interventions. This population survey study aimed to investigate the acute phase of the COVID-19 outbreak in terms of perceived threats and concerns, occupational and financial impacts, social impacts and stress between 3 April and 15 May 2020.Methods6040 participants are included in this report. A multivariate linear regression model was used to identify factors associated with stress changes (as measured by the Cohen’s Perceived Stress Scale (PSS)) relative to pre-outbreak retrospective estimates.ResultsOn average, PSS scores increased from low stress levels before the outbreak to moderate stress levels during the outbreak (pConclusionCross-sectional analyses showed a significant increase from low to moderate stress during the COVID-19 outbreak. Identified modifiable factors associated with increased stress may be informative for intervention development.Trial registration numberNCT04369690; Results.

Context Psychotic disorders are severe mental disorders that can cause a loss of contact with reality. Along with positive symptoms (delusions and hallucinations), they also encompass many other dysfunctions, such as sleep problems, which themselves can cause great distress and impairment in patients. Objective To review current literature on the relationship between sleep disorders and psychosis, on the clinical impact of such a relationship, and the psychological treatment of sleep disorders in the context of psychosis. Method Narrative overview of the literature synthesizing the findings about the relationship between psychosis and sleep disorders, and the psychological treatment of the latter, retrieved from searches of computerized databases, hand searches, and authoritative texts. Results Evidence shows a bidirectional relationship between psychosis and sleep disorders. Despite many hypotheses involving genetics, hormones, or neuronal functions regarding the nature of this association, the exact mechanism remains elusive. However, sleep-related problems are an interesting therapeutic target to improve quality of life and psychotic symptoms and respond well to psychological interventions. Conclusion Patients with psychotic disorders can benefit from CBT for insomnia, given a few adaptations to existing protocols. Additional studies are necessary to determine which patients are most likely to benefit from such interventions and to clarify the relationship between psychosis and sleep disorders, and the clinical implications of them co-existing.

This study aimed to evaluate changes in sleep during the COVID-19 outbreak, and used data-driven approaches to identify distinct profiles of changes in sleep-related behaviours. Demographic, behavioural and psychological factors associated with sleep changes were also investigated. An online population survey assessing sleep and mental health was distributed between 3 April and 24 June 2020. Retrospective questions were used to estimate temporal changes from before to during the outbreak. In 5,525 Canadian respondents (67.1% females, 16-95 years old: Mean ± SD = 55.6 ± 16.3 years), wake-up times were significantly delayed relative to pre-outbreak estimates (p

BackgroundUnderstanding the multifaceted impacts of the Coronavirus-19 (COVID-19) outbreak as it unfolds is crucial to identify the most critical needs and to inform targeted interventions.MethodsThis population survey study presents cohort characteristics and baseline observations linked to the acute-mid phase of the COVID-19 outbreak in terms of perceived threats and concerns, occupational and financial impacts, social impacts and stress as measured by the Cohen’s Perceived Stress Scale (PSS) collected cross-sectionally between April 3 and May 15, 2020. A multivariate linear regression model was used to identify factors associated with stress changes relative to pre-outbreak estimates.Findings6,040/6,685 (90·4%) participants filled out at least 1/3 of the survey and were included in the analyses. On average, PSS scores increased from 12·9+6·8 before the outbreak to 14·9+8·3 during the outbreak (pInterpretationCross-sectional analyses showed a significant increase from average low to moderate stress during the COVID-19 outbreak. Identified modifiable factors associated with an increase in stress may be informative for intervention development.

Background/aims Insomnia is highly prevalent in children with neurodevelopmental disorders (NDDs), yet little research exists on sleep treatment access, utilization, and provision in this population. This study explores barriers and facilitators to access, use, and provision of treatment for sleep problems as experienced by parents of children with NDDs, including Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD), Cerebral Palsy (CP) and Fetal Alcohol Spectrum Disorder (FASD), and health care professionals who work with children with these conditions. Method Transcripts from online focus groups and interviews, conducted separately with parents of children with NDDs (n = 43) and health care professionals (n = 44), were qualitatively analyzed using content analysis for key themes. Results Barriers included limited access to/availability of treatment, lack of knowledge/training, NDD-specific factors (e.g., symptoms, medications, and comorbidities), parent factors (e.g., capacity to implement treatment, exhaustion), and the challenging, intensive nature of sleep treatment. Facilitators included positive beliefs and attitudes, education, support, and ability to modify treatments for NDD symptoms. Barriers and facilitators were similar across all four NDDs. Conclusions Results highlight a need for more education about sleep in NDDs and to develop accessible interventions, as well as the potential of a transdiagnostic approach to sleep treatment in this population.

Background: Understanding the multifaceted impacts of the Coronavirus-19 (COVID-19) outbreak as it unfolds is crucial to identify the most critical needs and to inform targeted interventions. Methods: This population survey study presents cohort characteristics and baseline observations linked to the acute-mid phase of the COVID-19 outbreak in terms of perceived threats and concerns, occupational and financial impacts, social impacts and stress as measured by the Cohen's Perceived Stress Scale (PSS) collected cross-sectionally between April 3 and May 15, 2020. A multivariate linear regression model was used to identify factors associated with stress changes relative to pre-outbreak estimates. Findings: 6,040/6,685 (90·4%) participants filled out at least 1/3 of the survey and were included in the analyses. On average, PSS scores increased from 12·9+6·8 before the outbreak to 14·9+8·3 during the outbreak (p

Children with neurodevelopmental disorders (NDD) are at high risk for sleep problems, especially insomnia. It is currently not known whether behavioural sleep interventions developed for typically developing (TD) children are effective for children with NDD, and if interventions need to be modified for each diagnostic group. The aim of this systematic review was to identify and evaluate commonalities, trends in outcomes, and the methodological quality of parent-delivered behavioural sleep interventions for children with NDD, specifically Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), Cerebral Palsy, and Fetal Alcohol Spectrum Disorder. Nine databases were searched. A total of 40 studies met eligibility criteria. The majority of studies were conducted with ASD and ADHD populations. Common sleep problems were evident across the NDD populations. The most frequently reported included bedtime resistance, night-waking, early morning awakening, and co-sleeping. The most common interventions used were implementation of healthy sleep practices, reinforcement, graduated extinction, and faded bedtime. All studies reported at least one behavioural treatment component as effective. Commonalities across NDD populations, as well as the TD population, for both sleep problems reported and behavioural interventions implemented, suggest the feasibility of developing a transdiagnostic behavioural sleep intervention suitable for children with a range of NDD.

Sleep problems in teenagers seriously disturb the active process of learning. Given the absence of sleep data from Lebanon, a study to determine sleep quality among adolescents is vital.To understand sleep habits and patterns that affect sleep quality, and assess the amplitude of possible sleep problems in Lebanese adolescents, raising awareness of the effects of good sleep hygiene on general health in adolescents.A cross-sectional survey of 500 high-school students in Beirut was conducted using a self-filled questionnaire inquiring about sociodemographics, health-risk behaviour and sleep quality. The effect of several factors related to sleep habits of the students was investigated using bivariate analysis and logistic regression.We found that 76.5% of teenagers were not satisfied with their sleep quality; 56% did not have the appropriate amount of sleep (8 hours); and 82.4% used mobile phones and electronic devices in bed before falling asleep. Moreover, 3.2% faced a real problem with sleep initiation, 11.3% with sleep maintenance and 8.7% with early awakening.A large proportion of high-school students in Beirut have poor sleep patterns. It is therefore necessary to increase awareness of the problem in education in order to prevent its escalation.تقييم جودة النوم لدى طلاب المدارس الثانوية اللبنانية وعلاقته بنمط الحياة: دراسة ارتيادية في بيروت.رامز شاهين، ريتا فرح، ميشيل شحود، آلان حرب، رامي طراباي، إيريك سولو، روجر غودبوت.تسبب مشاكل النوم عند المراهقين اضطراباً خطيراً في عملية التعلم الفعَّالة. ونظراً لغياب البيانات الواردة من لبنان حول النوم، تعد دراسة تحديد جودة النوم بين المراهقين أمراً حيوياً.فهم عادات النوم وأنماطه التي تؤثر على جودة النوم، وتقييم مدى مشاكل النوم المحتملة لدى المراهقين اللبنانيين، ورفع مستوى الوعي بالآثار الصحية الجيدة للنوم على الصحة العامة لدى المراهقين.أجريت دراسة مسح مقطعي شملت 500 طالباً في المدارس الثانوية في بيروت باستخدام استبيان يُمْلَ ذاتياً حول السلوك الاجتماعي السكاني والسلوك المعرّض للمخاطر الصحية وجودة النوم. وتمت دراسة تأثير العديد من العوامل المتعلقة بعادات النوم لدى الطلاب باستخدام التحليل الثنائي المتغيرات والتَّحَوُّف اللوجستي.وجدنا أن 76.5 % من المراهقين غير راضين عن جودة نومهم؛ وأن 56 % منهم لم يحصلوا على القدر المناسب من النوم (أقل من 8 ساعات)؛ وأن 82.4 % منهم يستخدمون الهواتف المحمولة والأجهزة الإلكترونية في السرير قبل الدخول في النوم. علاوة على ذلك، واجه 3.2 % مشكلة حقيقية في بدء النوم، وواجه 11.3 % مشكلة الاستمرار في النوم وواجه 8.7 % مشكلة اليقظة المبكرة.تعاني نسبة كبيرة من طلاب المدارس الثانوية في بيروت من سوء أنماط النوم. لذلك من الضروري زيادة الوعي بالمشكلة أثناء التعليم من أجل منع تفاقمها.Évaluer la qualité du sommeil des élèves du secondaire au Liban en fonction de leur mode de vie : étude pilote à Beyrouth.Les troubles du sommeil chez les adolescents perturbent gravement l’activité du processus d’apprentissage. Étant donné l’absence de données concernant le sommeil au Liban, il est essentiel de mener une étude sur la qualité du sommeil chez les adolescents.Comprendre les habitudes et les tendances qui perturbent la qualité du sommeil et évaluer l’importance des éventuels problèmes chez les adolescents libanais, alerter l’opinion sur les effets d’une bonne hygiène de sommeil sur l’état de santé général des adolescents.Une étude transversale a été conduite auprès de 500 élèves du secondaire à Beyrouth à l’aide d’un questionnaire d’auto-évaluation. Les thèmes recouvraient les caractéristiques sociodémographiques, les comportements à haut risque et la qualité du sommeil. Une analyse bivariée et la régression logistique ont été utilisées pour examiner l’effet que pouvaient avoir divers facteurs associés aux habitudes de sommeil.L’étude a révélé que 76,5 % des adolescents n’étaient pas satisfaits de la qualité de leur sommeil, 56 % ne dormant pas un nombre suffisant d’heures (8 heures) ; et que 82,4 % utilisaient leur téléphone mobile ou des appareils électroniques dans leur lit avant de dormir. De plus, 3,2 % éprouvaient de réelles difficultés pour s’endormir, 11,3 % au niveau du maintien du sommeil et 8,7 % se réveillaient tôt.Une grande partie des élèves du secondaire à Beyrouth présentent de mauvaises habitudes de sommeil. Il est donc nécessaire de sensibiliser davantage la population dans le cadre de l’enseignement afin d’éviter toute aggravation de ce problème.

Delta EEG activity (0.75-3.75 Hz) during non-Rapid eye movement (NREM) sleep reflects the thalamo-cortical system contribution to memory consolidation. The functional integrity of this system is thought to be compromised in the Autism spectrum disorder (ASD). This lead us to investigate the topography of NREM sleep Delta EEG activity in young adults with ASD and typically-developed individuals (TYP). The relationship between Delta EEG activity and sensory-motor procedural information was also examined using a rotary pursuit task. Two dependent variables were computed: a learning index (performance increase across trials) and a performance index (average performance for all trials). The ASD group showed less Delta EEG activity during NREM sleep over the parieto-occipital recording sites compared to the TYP group. Delta EEG activity dropped more abruptly from frontal to posterior regions in the ASD group. Both groups of participants learned the task at a similar rate but the ASD group performed less well in terms of contact time with the target. Delta EEG activity during NREM sleep, especially during stage 2, correlated positively with the learning index for electrodes located all over the cortex in the TYP group, but only in the frontal region in the ASD group. Delta EEG activity, especially during stage 2, correlated positively with the performance index, but in the ASD group only. These results reveal an atypical thalamo-cortical functioning over the parieto-occipital region in ASD. They also point toward an atypical relationship between the frontal area and the encoding of sensory-motor procedural memory in ASD. Autism Res 2018, 11: 613-623. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. Lay summary Slow EEG waves recorded from the scalp during sleep are thought to facilitate learning and memory during daytime. We compared these EEG waves in young autistic adults to typically-developing young adults. We found less slow EEG waves in the ASD group and the pattern of relationship with memory differed between groups. This suggests atypicalities in the way sleep mechanisms are associated with learning and performance in a sensory-motor procedural memory task in ASD individuals.

Le sommeil joue un rôle fondamental dans la santé physique, mentale et cognitive des enfants. Malheureusement, les difficultés de sommeil sont très fréquentes dans la population pédiatrique (0-17 ans) et la prévalence est particulièrement élevée chez les enfants et adolescents atteints de troubles neurodéveloppementaux. Les troubles du sommeil nuisent au fonctionnement cognitif, à la capacité à réguler les émotions et aggravent de façon générale le portrait clinique. Il devient alors essentiel de documenter la présence de problèmes de sommeil dans le cadre de l’évaluation neuropsychologique. Le présent article propose ainsi une description du sommeil typique chez les jeunes, des problèmes de sommeil fréquemment associés aux troubles neurodéveloppementaux et des éléments clés à considérer dans la démarche d’évaluation neuropsychologique. L’objectif est d’outiller les neuropsychologues pour qu’ils soient en mesure d’identifier les problèmes de sommeil, les facteurs de risques et de protection, ainsi que de proposer des recommandations adaptées.

During the early days of the pandemic and in the context of a seemingly unknown global threat, several potential major sleep disruptors were identified by sleep researchers and practitioners across the globe. The COVID-19 pandemic combined several features that, individually, had been shown to negatively affect sleep health in the general population. Those features included state of crisis, restrictions on in-person social interactions, as well as financial adversity. To address the lack of a comprehensive summary of sleep research across these three distinctive domains, we undertook three parallel systematic reviews based on the following themes: 1) Sleep in times of crises; 2) Sleep and social isolation; and 3) Sleep and economic uncertainty. Using a scoping review framework, we systematically identified and summarized findings from these three separated bodies of works. Potential moderating factors such as age, sex, ethnicity, socioeconomic status, psychological predisposition, occupation and other personal circumstances are also discussed. To conclude, we propose novel lines of research necessary to alleviate the short- and long-term impacts of the COVID-19 crises and highlight the need to prepare the deployment of sleep solutions in future crises.

Over time, the sleep disturbances experienced by people with bipolar disorder (BD) can lead to a progressive accumulation of sleep debt with widespread adverse consequences on mental and physical health. This review looks at recent studies that have examined bipolar disorder in relation to sleep and cardiovascular dysfunctions. Sleep loss not only alters basal cardiometabolic features but also stress-related cardiometabolic responses, putting individuals with chronic sleep difficulties at higher risk for vascular events. Abnormalities of sleep parameters and circadian rhythms in individuals with BD point towards the necessity of sleep assessments in order to create the most effective therapeutic strategies. Risk factors and pathophysiological mechanisms inherent to BD such as extreme affective liability, obesity, diabetes, hypertension, hyperlipidemia, proinflammatory background, and psychotropic medications put patients at a higher risk for cardiovascular problems. In addition to their direct effects on cardiometabolic health, psychoactive substances commonly used by this population may also trigger diverse sleep problems and disrupt sleep processes involved in cardiovascular regulation. Overall, it is proposed that sleep loss and dysfunction in circadian rhythms related to BD can trigger or amplify cardiometabolic dysfunctions, thus adding a burden to the clinical picture. We conclude with promising avenues for optimal management and treatment strategies.

Introduction Intellectual giftedness is characterized by an intellectual development superior to peers (QI > 120) while emotional and relational development corresponds to the age norms. Anecdotal reports from parents suggest that they sleep poorly compared to typically developing (TD) peers. We measured sleep of gifted children using actigraphy. Methods Thirteen gifted children (10 boys, mean age = 10.58, SD = 2.11) were studied. Giftedness was identified using Renzulli’s three-factor definition of giftedness conceptualise in terms of above-average ability and high levels of task commitment (refined or focused form of motivation), and creativity. Sleep was measured with actigraphy for two weeks and compared to normative data from TD children using T-tests. Results Compared to normative data from TD children, gifted children had a significantly shorter sleep latency (p < 0.001), longer sleep periods (p = 0.001), shorter total sleep time and more wake time after sleep onset (p = 0.03). These differences were present both on week nights and weekend nights except that total sleep time was shorter in gifted children only during weekends (p < 0.001). Conclusion These data suggest that gifted children sleep poorly, and more so upon weekends. Whether this correlates with daytime functioning remains to be determined. Support N/A

Introduction Gifted (G) children display an asynchrony between intellectual development and social and emotional development. Twice exceptional (2e) children are G children with a neuropsychological disability. We compared the sleep and daytime behavior of G, 2e and typically developing (TD) children and we sought for group-specific relationships between sleep and daytime behavior. Methods 23 children were recruited: seven G (8.7 years old, SD = 1.7), six 2e (9.8 years old, SD = 1.8) and 10 TD children (10.0 years old, SD = 2.2). Giftedness was diagnosed with neuropsychological tools. The Children’s Sleep Habits Questionnaire (CSHQ) assessed sleep quality, the Child Behavior Checklist (CBCL) assessed daytime functioning. Sleep quality and its impact on daytime functioning was measured with a MANCOVA, with the CBCL’s three main factors as dependent variables (internalizing problems, IP; externalizing problems, EP and total problems, TP), children group as the independent variable and the CSHQ total score as the covariate. Results G, 2e and TD groups scored 39.86, 39.17 and 39.70 on the CSHQ, respectively (n.s.). The three groups were not different on the CBCL, with respective mean T scores of 57.86, 50.33 and 48.60 for IP, 56.43, 55.67 and 47.80 for EP and 55.29, 53.83 and 46.40 for TP. Pillai’s trace statistics disclosed a significant relationship between CSHQ and CBCL scores regardless of groups (p = 0.04) but the influence of sleep quality did not differ among the groups for any of the three factors. The CSHQ total score was positively and significantly related to IP (p = 0.03, r = 0.47); relationships were not significant for EP (p = 0.96, r = -0.01) and TP (p = 0.17, r = 0.31). Conclusion Sleep quality influences internalizing problems in children, without group-specific relationships, but this association does not seem to differ between gifted, twice exceptional and TD children. Support N/A

Introduction Sleep disturbance in children with attention-deficit/hyperactivity disorder (ADHD) is frequent, and lead to shorter sleep duration which has been associated with lower performance on sustained attention tasks. However, no study has investigated this association in adolescents with ADHD. We sought to explore whether the association between sleep and sustained attention performance of children with ADHD is similar in adolescents with ADHD given that sleep patterns are different. Methods Parents of 32 children (mean age = 8.0; SD = 1.3) and 10 adolescents (mean = 15.2; SD = 1.3) with ADHD completed a developmental questionnaire including sleep questions. Children and adolescents were medication free and underwent a comprehensive neuropsychological evaluation. Three sleep variables were extracted from the questionnaire, namely the duration of the sleep period during week nights and weekends as well as the difference between the two (“weekend shift”). The Continuous Performance Test was used to measure sustained attention (omission, commission, hit reaction time). Pearson correlations between sleep variables and sustained attention measures were calculated. Results Children showed a positive correlation between hit reaction time and the duration of the sleep period during week nights (r = 0.37; p =0.04), weekends (r = 0.51; p = 0.004) and the weekend shift (r = 0.37; p =0.04). No significant correlations were found in the adolescent group. Conclusion The fact that no significant associations were found in the adolescent group suggest an improvement of the arousal system through brain development in ADHD, or that other mechanisms could be involved in the etiology of ADHD in adolescents. Support Centre d’apprentissage aux 1001 astuces; Fonds de recherche du Québec - Santé

Caspase-3 activation in the limbic system and depressive-like symptoms are observed after an acute myocardial infarction (MI) and studies suggest that inflammation may play a significant role. Combined treatment with the probiotic strains Bifidobacterium longum and Lactobacillus helveticus in rats has been shown to attenuate caspase-3 activation and depressive-like behaviour together with a reduction in pro-inflammatory cytokines. The present study was designed to determine the respective contribution of these two strains on caspase-3 activity in the limbic system and on depressive-like behaviour. Sprague-Dawley rats were assigned to one of four groups: Vehicle, L. helveticus R0052, B. longum R0175 and L. salivarius HA-118, administered orally for 14 days (109CFU daily) before inducing MI by occlusion of the left anterior descending artery for 40 min followed by 14 days of reperfusion. Animals were then tested for socialisation, passive avoidance and forced swim test to assess depressive-like behaviour. At day 18 the animals were sacrificed; infarct size was estimated, plasma C-reactive protein concentration and brain caspase-3 activity were measured. Results indicated that infarct size did not vary across the different treatments. Rats treated with B. longum spent more time socializing, learned more rapidly the passive avoidance test and spent less time immobile in the forced swim test compared to the vehicle groups. Caspase-3 activity and plasma C-reactive protein concentrations were reduced in the lateral and medial amygdala as well as in the dentate gyrus of B. longum-supplemented animals. The only significant effect in the two groups receiving Lactobacilli compared to vehicle was that rats receiving L. salivarius learned more rapidly in the step-down passive avoidance test. In conclusion, most of the beneficial effects that we previously reported with the combination of two probiotic strains in our experimentation regarding post-myocardial infarction depression are related to Bifidobacterium longum.

Autism spectrum (AS) is a neurodevelopmental condition associated with poor sleep, which impairs daytime functioning. Most studies of sleep in autism have been based on subjective measures, notably parental reports. A few studies have used objective, laboratory polysomnography (PSG) measures, but often include confounding factors such as intellectual disability, sleep problems, other psychiatric illnesses, and medication. To address these limitations, we examined the relationship between sleep and behavior in prototypical AS of typical level of intelligence and non-autistic children not complaining of sleep problems. We examined sleep variables with The Children’ Sleep Habit Questionnaire (CSHQ) and a daily sleep agenda, both filled out by parents, and by PSG. These subjective and objective measures both revealed that sleep latency was longer in AS than in non-autistic children. Furthermore, AS children also showed less slow-wave sleep (SWS: stages 3 + 4), fewer sleep spindles and fewer K-complexes than non-autistic children. REM sleep, including eye movement density, was similar between the two groups. The proportion of light sleep, (stage 1 non-REM sleep) was negatively correlated with IQ (Wechsler and Raven matrices) in both groups of participants. A large amount of SWS predicted low levels of internalizing behavior in both groups and typical social functioning as determined by ADOS in AS children. These results indicate that autistic children not complaining of sleep problems may nonetheless be affected by poor sleep, which in turn influences their daytime functioning.

Objective To investigate in a sample of low-income families whether the quality of parent-child interactions mediated the association between coparenting and child sleep, and if this association was moderated by parents' anxiety. Method In sum, 81 two-parent families with a preschool child (aged 3 to 5 years) and receiving social security benefits were recruited. Mothers and fathers completed questionnaires assessing coparenting, parental anxiety, and child sleep duration and sleep problems. Quality of mother-child and father-child interactions was evaluated by independent observers from videotaped free play sequences in the home environment. Results Results showed that preschoolers' sleep duration was unrelated to paternal factors but associated with maternal factors. Specifically, coparenting predicted children's sleep duration through its effect on the quality of mother-child interactions, but only for dyads in which mothers were clinically anxious. Preschoolers' sleep problems were related to coparenting, quality of mother-child and father-child interactions, and mothers' but not fathers' anxiety. Conclusion The current results suggest that both parents play a complementary role in children's sleep. Likewise, different pathways and interactions were found in relation to sleep duration and problems, emphasizing the complexity of the links between family factors and sleep processes. Overall, this study helps to clarify some of the associations between parental characteristics and preschoolers' sleep within a sample of low-income families.

Background Sleep problems, particularly insomnia, are highly prevalent in children with neurodevelopmental disorders (NDD) and can negatively affect health and development. eHealth interventions may increase access to evidence-based care for insomnia for children with NDD, as programs are rare in most communities. Better Nights, Better Days (BNBD) is an online, parent-implemented intervention for pediatric insomnia in typically developing 1- to 10-year-olds. Aims The present study examined whether parents of children with NDD perceived the original BNBD to be usable, acceptable, and feasible, and what modifications might be necessary to adapt it for children with NDD. Methods and procedures Twenty Canadian parents/caregivers of children aged 4–10 years with NDD and insomnia implemented the BNBD intervention with their children, and completed usability questionnaires. Questionnaire data were analyzed quantitatively (descriptive statistics) and qualitatively (thematic analysis). Outcomes and results Participants reported the intervention to be usable, useful, acceptable, and feasible. Several modifications were suggested to make the intervention more appropriate and acceptable for use with children with NDD. Conclusions and implications Results support a largely transdiagnostic approach to treating sleep in children with NDD, and will inform the development of BNBD for Children with Neurodevelopmental Disorders (BNBD-NDD).

Myocardial infarction (MI) in animal models induces cognitive deficits as well as the activation of caspase in the limbic system, both can be blocked by 2 weeks of treatment following MI using tricyclic antidepressants or selective serotonin uptake blockers. Here we used three different treatment schedules to test the short- and long-term effects of the combined serotonin-norepinephrine reuptake inhibitor desvenlafaxine on post-MI-associated cognitive deficits and caspase activation. MI was induced in 39 young adult rats, and 39 rats served as sham-operated controls. Desvenlafaxine (3 mg/kg/day, i.p.) or saline was administered according to one of three schedules: (1) for 2 weeks, starting right after surgery, (2) for 16 weeks, starting 2 weeks after surgery, (3) for 16 weeks, starting right after surgery. Behavior was tested 2 weeks (social interaction, passive avoidance) and 16 weeks (forced swimming, Morris water maze) after surgery. Caspase-3 and caspase-6 activities were measured 16 weeks after surgery. At 2 and 16 weeks post-surgery, saline-treated MI rats displayed performance deficits compared to desvenlafaxine-treated rats, regardless of the treatment schedule. Caspase-3 activity was higher in the amygdala (medial and lateral) and hippocampal CA3 region in untreated MI rats, whereas caspase-6 activity was higher in the CA1 region. Caspase-6 activity correlated positively with deficits in the Morris water maze. These results indicate that, independently of treatment schedules, various treatment schedules with desvenlafaxine can prevent MI-associated cognitive deficits and decrease caspase activities in the limbic system.

Purpose of Review Melatonin is used to treat sleep difficulties associated with autism spectrum disorder (ASD). There are growing evidence that melatonin could have an effect on other symptoms than sleep, such as anxiety, depression, pain, and gastrointestinal dysfunctions. Interestingly, these symptoms frequently are found as comorbid conditions in individuals with ASD. We aimed to highlight the potential effect of melatonin on these symptoms. Recent Findings Animal and human studies show that melatonin reduces anxiety. Regarding the effect of melatonin on pain, animal studies are promising, but results remain heterogeneous in humans. Both animal and human studies have found that melatonin can have a positive effect on gastrointestinal dysfunction. Summary Melatonin has the potential to act on a wide variety of symptoms associated with ASD. However, other than sleep difficulties, no studies exist on melatonin as a treatment for ASD comorbid conditions. Such investigations should be on the research agenda because melatonin could improve a multitude of ASD comorbidities and, consequently, improve well-being.

Background: Up to 25% of 1- to 10-year-old children experience insomnia (ie, resisting bedtime, trouble falling asleep, night awakenings, and waking too early in the morning). Insomnia can be associated with excessive daytime sleepiness and negative effects on daytime functioning across multiple domains (eg, behavior, mood, attention, and learning). Despite robust evidence supporting the effectiveness of behavioral treatments for insomnia in children, very few children with insomnia receive these treatments, primarily due to a shortage of available treatment resources. Objective: The Better Nights, Better Days (BNBD) internet-based program provides a readily accessible electronic health (eHealth) intervention to support parents in providing evidence-based care for insomnia in typically developing children. The purpose of the randomized controlled trial (RCT) is to evaluate the effectiveness of BNBD in treating insomnia in children aged between 1 and 10 years. Methods: BNBD is a fully automated program, developed based on evidence-based interventions previously tested by the investigators, as well as on the extant literature on this topic. We describe the 2-arm RCT in which participants (500 primary caregivers of children with insomnia residing in Canada) are assigned to intervention or usual care. Results: The effects of this behavioral sleep eHealth intervention will be assessed at 4 and 8 months postrandomization. Assessment includes both sleep (actigraphy, sleep diary) and daytime functioning of the children and daytime functioning of their parents. Results will be reported using the standards set out in the Consolidated Standards of Reporting Trials statement. Conclusions: If the intervention is supported by the results of the RCT, we plan to commercialize this program so that it is sustainable and available at a low cost to all families with internet access. Trial Registration: ClinicalTrials.gov NCT02243501; https://clinicaltrials.gov/show/NCT02243501 (Archived by WebCite at http://www.webcitation.org/6x8Z5pBui) [JMIR Res Protoc 2018;7(3):e76]