The Bidirectional Association Between Daytime Affect and Nighttime Sleep in Youth With Anxiety and Depression

Cousins, Jennifer; Whalen, Diana J.; Dahl, Ronald E.; Forbes, Erika E.; Olino, Thomas M.; Ryan, Neal D.; Silk, Jennifer S.

doi:10.1093/jpepsy/jsr036

Cited by 122 publications

(113 citation statements)

References 30 publications

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“…Finally, a recent investigation of PSG in the home did not replicate results for sleep onset or REM latency [10+]. Regarding actigraphy, results from a recently published comparison study of children with GAD versus controls are consistent with previous findings [11] showing no robust sleep differences between these groups [12++]. Adolescents with SOC also did not differ from controls in terms of actigraphy-based sleep patterns [13].…”

Section: Characterizing the Nature Of Sleep Disturbance In Youth Withsupporting

confidence: 52%

“…This is particularly problematic for sleep measurement in a population prone to worrying/ruminating in bed. For this reason, evidence of mildly prolonged (e.g., 5–7 minutes based on actigraphy) sleep latency found in previous studies [11, 12++] may be a conservative or inaccurate estimate of arousal prior to sleep initiation.…”

Section: Characterizing the Nature Of Sleep Disturbance In Youth Withmentioning

confidence: 95%

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Sleep and anxiety in late childhood and early adolescence

McMakin

Alfano

2015

Current Opinion in Psychiatry

170

118

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Purpose of review Adolescence is a period of dynamic change in both sleep and emotional systems, with related increases in problems controlling emotion and behavior. Youth with anxiety enter adolescence with pre-existing vulnerabilities in systems of sleep and emotion that may place them at heightened risk. This review summarizes recent research on sleep and anxiety during the transition to adolescence, and highlights emerging themes. Recent findings Prospective studies support that sleep predicts anxiety symptoms in early adolescence. Notably, robust evidence for subjective sleep problems in anxious youth is not well-corroborated by objective assessments. Longitudinal designs and methodology that carefully examine dimensions of anxiety and sleep may clarify inconsistencies. Preliminary evidence suggests that late childhood to early adolescence may be a sensitive period for escalating problems with sleep and anxiety. Recent advances in the neuroscience of sleep can further refine integrative mechanistic models of developmental psychopathology—the role of sleep in emotional learning and memory is provided as an example. Summary Sleep problems are common and prospectively predict escalating anxiety symptoms. Precision is needed regarding the nature of sleep disruption, and how and when sleep impacts various aspects of developmental trajectories. This precision, along with advances in the neuroscience of sleep, may lead to developmentally-informed translational interventions.

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Section: Characterizing the Nature Of Sleep Disturbance In Youth Withsupporting

confidence: 52%

Section: Characterizing the Nature Of Sleep Disturbance In Youth Withmentioning

confidence: 95%

Sleep and anxiety in late childhood and early adolescence

McMakin

Alfano

2015

Current Opinion in Psychiatry

170

118

View full text Add to dashboard Cite

show abstract

“…Understanding whether these sleep patterns represents unique neurobiologic features of early GAD or prodromal marker of future depression risk could inform developmental models of the disorder. Moreover, since sleep and emotional functioning are bi-directionally related, particularly in children with affective disorders (Cousins et al, 2011), behavioral interventions that target problems related to sleep initiation might serve to produce more positive and sustainable treatment outcomes by mitigating added pressure on emotional systems (Forbes and Dahl, 2005). Based on data among adult GAD patients (Bélanger et al, 2005), replacing avoidance strategies with more effective approaches for managing sleep difficulties may be especially important to consider in this population.…”

Section: Discussionmentioning

confidence: 99%

Polysomnographic sleep patterns of non-depressed, non-medicated children with generalized anxiety disorder

Alfano

Reynolds

Scott

et al. 2013

Journal of Affective Disorders

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Background Polysomnographic (PSG) studies of children with psychiatric illness have primarily focused on depressed samples. Children with generalized anxiety disorder (GAD) report high rates of sleep problems yet investigation of objective sleep patterns in non-depressed children with GAD are unavailable. Identification of unique clinical features linking early GAD with sleep disturbance, including possible HPA activation during the pre-sleep period, is needed to inform understanding of effective treatments. Method Thirty non-medicated, pre-pubescent children (ages 7–11 years) were assessed including 15 children with GAD and 15 matched healthy controls. Anxious children had GAD as their primary diagnosis and did not meet criteria for secondary mood disorders. All participants underwent structured diagnostic assessment and laboratory-based polysomnography (PSG). State anxiety and salivary cortisol were assessed prior to light out on the PSG night. Results Children with GAD showed significantly increased sleep onset latency and reduced latency to rapid eye movement (REM) sleep compared to controls. Marginal differences in form of reduced sleep efficiency and increased total REM sleep also were found in the GAD group. Pre-sleep anxiety and cortisol levels did not differ between the two groups. Limitations A small sample size, time-limited assessment of cortisol, and possible first night effects should be considered. Conclusions Results of this study provide initial evidence of PSG-based differences in children with GAD compared to controls. Follow-up studies are needed to explore the course of sleep alterations and whether targeting sleep problems early in the course of GAD might improve clinical outcomes.

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“…Thus, real-time measures of day-to-day functioning merit consideration as predictors and moderators of treatment outcome. Prior research suggests that the mean and variability of day-to-day negative and positive emotions (Forbes et al, 2012; Mor et al, 2010), emotional reactivity and regulation in response to negative events (Tan et al, 2012), parental and social interactions (Oppenheimer et al, 2016; Beidel, Turner, & Morris, 1999; Guyer et al, 2008), and sleep (Alfano, Pina, Zerr, & Villalta, 2010; Brent et al, 2008; Cousins et al, 2011; McMakin & Alfano, 2015; McMakin et al, 2016) play important roles in the daily lives of anxious youth. Both objective and subjective measures of day-to-day sleep are important to consider, as findings based on these two measurement types do not always correspond in youth with anxiety (Alfano, Patriquin, & De Los Reves, 2015) or adolescents more generally (Short et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

The role of day-to-day emotions, sleep, and social interactions in pediatric anxiety treatment

Wallace

McMakin

Tan³

et al. 2017

Behaviour Research and Therapy

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Do day-to-day emotions, social interactions, and sleep play a role in determining which anxious youth respond to supportive child-centered therapy (CCT) versus cognitive behavioral therapy (CBT)? We explored whether measures of day-to-day functioning (captured through ecological momentary assessment, sleep diary, and actigraphy), along with clinical and demographic measures, were predictors or moderators of treatment outcome in 114 anxious youth randomized to CCT or CBT. We statistically combined individual moderators into a single, optimal composite moderator to characterize subgroups for which CCT or CBT may be preferable. The strongest predictors of better outcome included: (a) experiencing higher positive affect when with one’s mother and (b) fewer self-reported problems with sleep duration. The composite moderator indicated that youth for whom CBT was indicated had: (a) more day-to-day sleep problems related to sleep quality, efficiency, and waking, (b) day-to-day negative events related to interpersonal concerns, (c) more DSM-IV anxiety diagnoses, and (d) college-educated parents. These findings illustrate the value of both day-to-day functioning characteristics and more traditional sociodemographic and clinical characteristics in identifying optimal anxiety treatment assignment. Future studies will need to enhance the practicality of real-time measures for use in clinical decision making and evaluate additional anxiety treatments.

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The Bidirectional Association Between Daytime Affect and Nighttime Sleep in Youth With Anxiety and Depression

Abstract: This relationship may be important to consider in the treatment of youth affective disorders.

Cited by 122 publications

References 30 publications

Sleep and anxiety in late childhood and early adolescence

Sleep and anxiety in late childhood and early adolescence

Polysomnographic sleep patterns of non-depressed, non-medicated children with generalized anxiety disorder

The role of day-to-day emotions, sleep, and social interactions in pediatric anxiety treatment

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