Objective Sleep in Pediatric Anxiety Disorders and Major Depressive Disorder

Abstract

Objective-To examine objective and subjective sleep problems in early-onset anxiety and depression.Method-Children and adolescents (46% female, ages 7 to 17 years) with anxiety disorders (n = 24), major depressive disorder (MDD) without comorbid anxiety disorders (n = 128), or no history of psychiatric disorder (n = 101) spent two consecutive nights in a sleep laboratory and completed self-reports of sleep quality.Results-On objective measures, the anxiety group exhibited more awakenings than the MDD group, less slow-wave sleep than the control or MDD group, and greater night 2 sleep latency than the MDD or control group. The anxiety group exhibited no decrease in rapid eye movement latency from the first night to the second. The MDD group exhibited less time awake than the control group and less stage 1 sleep than the anxiety or control group. On subjective measures, young people with anxiety reported greater sleep latency on the second night and no decrease in sleep latency. Age was covaried in analyses.Conclusions-Findings provide objective and subjective evidence of sleep disturbance in children and adolescents with anxiety disorders and replicate findings of limited objective sleep disturbance in those with MDD. Sleep problems are an important consideration when treating young people with anxiety. Keywordsanxiety; depression; objective sleep; sleep problems; early onset Sleep problems and affective disorders are common and often co-occurring difficulties experienced by children and adolescents. 1-3 The co-occurrence of sleep problems with affective disorders is worthy of attention because the combination of difficulties can result in a more pernicious course and greater impairment of functioning than these problems in isolation. 4 In addition, the relation between sleep problems and affective functioning in young people appears to be bidirectional. 5 For instance, depressive symptoms predict insomnia in adolescents, 6 and sleep problems predict later anxiety and depression. 7Correspondence to Erika E. Forbes, University of Pittsburgh, 3811 O'Hara Street, WPIC Loeffler 319, Pittsburgh, PA 15213; e-mail: Email: forbese@upmc.edu. Disclosure: Dr. Birmaher has participated in forums sponsored by Solvay Pharmaceuticals and Abcomm and has also presented on bipolar disorders in children at a meeting sponsored by Solvay. The payment for this conference was given to the WPIC Residency Training Program. He also has received royalties for publications from Random House. The other authors report no conflicts of interest. Sleep problems and anxiety disorders have been linked at many points in the life span. 8 However, investigations of sleep problems in children and adolescents with a specific focus on anxiety have generally been conducted only at the level of subjective reports. For instance, a recent study with clinician and parent reports indicated that most young people with anxiety disorders experience at least three sleep-related problems. 9 Furthermore, studies have typically included population-based samp...

Sleep in Childhood and Adolescence: Age-Specific Sleep Characteristics, Common Sleep Disturbances and Associated Difficulties

“…When examining anxiety exclusively, studies have shown that the sleep--related problems are prevalent in around 88% of youths with anxiety disorders (Alfano et al 2007). As well as studies examining subjective reports of poor sleep, findings of sleep disturbance in children with anxiety is also corroborated by studies assessing sleep using PSG as indexed by increased night--wakings and longer sleep onset latency compared to controls and those with depression (Forbes et al 2008). One study specifically focusing on generalised anxiety disorder (GAD) found increased sleep onset and REM sleep latencies in 7--11 year old children with GAD compared to controls (Alfano et al 2012).…”

Anxiety Disorders and Sleep in Children and Adolescents

“…Similarly, Forbes et al [22] used EEG to assess sleep in anxiety-disordered children. Relative to those with depression and controls, anxious children displayed longer sleep latency on their second night in the laboratory.…”

The SENSE study: Post intervention effects of a randomized controlled trial of a cognitive–behavioral and mindfulness-based group sleep improvement intervention among at-risk adolescents.

“…In particular, there is robust evidence that sleep complaints are highly prevalent among anxious youth (McMakin & Alfano, 2015;Willis & Gregory, 2015). Sleep onset and maintenance poses particular problems for children and adolescents with high levels of anxiety, possibly because their selfregulatory skills are underdeveloped compared with adults and are compromised by excessive physiologic and cognitive arousal (Alfano, Reynolds, Scott, Dahl, & Mellman, 2013;Forbes et al, 2008). Indeed, researchers have proposed a reciprocal relationship between anxiety and sleep difficulties in adolescence, whereby disturbed sleep increases vulnerability to developing anxiety, while anxiety, in turn, interferes with sleep (Dahl, 1996).…”