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Lapidaire W, Urrila AS, Artiges E, Miranda R, Vulser H, Bézivin-Frere P, Lemaître H, Penttilä J, Banaschewski T, Bokde ALW, Bromberg U, Büchel C, Conrod PJ, Desrivières S, Frouin V, Gallinat J, Garavan H, Gowland P, Heinz A, Ittermann B, Papadopoulos-Orfanos D, Paus T, Smolka MN, Schumann G, Martinot MLP, Martinot JL. Irregular sleep habits, regional grey matter volumes, and psychological functioning in adolescents. PLoS One 2021; 16:e0243720. [PMID: 33566829 PMCID: PMC7875363 DOI: 10.1371/journal.pone.0243720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 11/28/2020] [Indexed: 01/10/2023] Open
Abstract
Changing sleep rhythms in adolescents often lead to sleep deficits and a delay in sleep timing between weekdays and weekends. The adolescent brain, and in particular the rapidly developing structures involved in emotional control, are vulnerable to external and internal factors. In our previous study in adolescents at age 14, we observed a strong relationship between weekend sleep schedules and regional medial prefrontal cortex grey matter volumes. Here, we aimed to assess whether this relationship remained in this group of adolescents of the general population at the age of 16 (n = 101; mean age 16.8 years; 55% girls). We further examined grey matter volumes in the hippocampi and the amygdalae, calculated with voxel-based morphometry. In addition, we investigated the relationships between sleep habits, assessed with self-reports, and regional grey matter volumes, and psychological functioning, assessed with the Strengths and Difficulties Questionnaire and tests on working memory and impulsivity. Later weekend wake-up times were associated with smaller grey matter volumes in the medial prefrontal cortex and the amygdalae, and greater weekend delays in wake-up time were associated with smaller grey matter volumes in the right hippocampus and amygdala. The medial prefrontal cortex region mediated the correlation between weekend wake up time and externalising symptoms. Paying attention to regular sleep habits during adolescence could act as a protective factor against the emergence of psychopathology via enabling favourable brain development.
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Affiliation(s)
- Winok Lapidaire
- National Institute of Health and Medical Research, INSERM U A10 "Trajectoires développementales & psychiatrie", University Paris-Saclay, Ecole Normale Supérieure Paris-Saclay, CNRS, Centre Borelli, Gif-sur-Yvette, France
| | - Anna S. Urrila
- National Institute of Health and Medical Research, INSERM U A10 "Trajectoires développementales & psychiatrie", University Paris-Saclay, Ecole Normale Supérieure Paris-Saclay, CNRS, Centre Borelli, Gif-sur-Yvette, France
- Department of Health, Unit of Mental Health, National Institute for Health and Welfare, Helsinki, Finland
- Department of Psychiatry / Adolescent Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Eric Artiges
- National Institute of Health and Medical Research, INSERM U A10 "Trajectoires développementales & psychiatrie", University Paris-Saclay, Ecole Normale Supérieure Paris-Saclay, CNRS, Centre Borelli, Gif-sur-Yvette, France
- Psychiatry Department, EPS Barthelemy Durand, Etampes, France
| | - Ruben Miranda
- National Institute of Health and Medical Research, INSERM U A10 "Trajectoires développementales & psychiatrie", University Paris-Saclay, Ecole Normale Supérieure Paris-Saclay, CNRS, Centre Borelli, Gif-sur-Yvette, France
| | - Hélène Vulser
- National Institute of Health and Medical Research, INSERM U A10 "Trajectoires développementales & psychiatrie", University Paris-Saclay, Ecole Normale Supérieure Paris-Saclay, CNRS, Centre Borelli, Gif-sur-Yvette, France
| | - Pauline Bézivin-Frere
- National Institute of Health and Medical Research, INSERM U A10 "Trajectoires développementales & psychiatrie", University Paris-Saclay, Ecole Normale Supérieure Paris-Saclay, CNRS, Centre Borelli, Gif-sur-Yvette, France
| | - Hervé Lemaître
- National Institute of Health and Medical Research, INSERM U A10 "Trajectoires développementales & psychiatrie", University Paris-Saclay, Ecole Normale Supérieure Paris-Saclay, CNRS, Centre Borelli, Gif-sur-Yvette, France
| | - Jani Penttilä
- National Institute of Health and Medical Research, INSERM U A10 "Trajectoires développementales & psychiatrie", University Paris-Saclay, Ecole Normale Supérieure Paris-Saclay, CNRS, Centre Borelli, Gif-sur-Yvette, France
- Adolescent Psychiatry Department, Medical School, Tampere University, Tampere, Finland
| | - Tobias Banaschewski
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Arun L. W. Bokde
- Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Uli Bromberg
- University Hospital Hamburg Eppendorf, Hamburg, Germany
| | | | - Patricia J. Conrod
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Department of Psychiatry, University of Montreal, CHU Ste Justine Hospital, Montréal, Canada
| | - Sylvane Desrivières
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- MRC Social, Genetic and Developmental Psychiatry (SGDP) Centre, London, United Kingdom
| | - Vincent Frouin
- Neurospin, Commission for Atomic and Alternative Energy, Saclay, France
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité – University Medical Centre Berlin, Berlin, Germany
| | - Hugh Garavan
- Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
- Departments of Psychiatry and Psychology, 6436 UHC, University of Vermont, Burlington, Vermont, United States of America
| | - Penny Gowland
- Sir Peter Mansfield Magnetic Resonance Centre, University of Nottingham, Nottingham, United Kingdom
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité – University Medical Centre Berlin, Berlin, Germany
| | - Bernd Ittermann
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité – University Medical Centre Berlin, Berlin, Germany
| | | | - Tomáš Paus
- Holland Bloorview Kids Rehabilitation Hospital and Departments of Psychology and Psychiatry, Bloorview Research Institute, University of Toronto, Toronto, Canada
| | - Michael N. Smolka
- Department of Psychiatry and Psychotherapy, Technical University Dresden, Dresden, Germany
| | - Gunter Schumann
- Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
- MRC Social, Genetic and Developmental Psychiatry (SGDP) Centre, London, United Kingdom
| | - Marie-Laure Paillère Martinot
- National Institute of Health and Medical Research, INSERM U A10 "Trajectoires développementales & psychiatrie", University Paris-Saclay, Ecole Normale Supérieure Paris-Saclay, CNRS, Centre Borelli, Gif-sur-Yvette, France
- Department of Child and Adolescent Psychiatry, AP-HP. Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, France
| | - Jean-Luc Martinot
- National Institute of Health and Medical Research, INSERM U A10 "Trajectoires développementales & psychiatrie", University Paris-Saclay, Ecole Normale Supérieure Paris-Saclay, CNRS, Centre Borelli, Gif-sur-Yvette, France
- Centre of Neuroimaging Research, CENIR at ICM Institute, Paris Cedex, France
- * E-mail:
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Abstract
OBJECTIVES In sleep laboratory studies, the new environment is generally considered to disturb sleep during the first night. However, older women have rarely been studied. Although menopause and hormone therapy affect sleep, their impact on the first-night effect is virtually unknown. PARTICIPANTS Four groups of women with no sleep laboratory experience: young on hormonal contraceptives (n = 11, 23.1 [0.5] years), perimenopausal (n = 15, 48.0 [0.4] years), postmenopausal without hormone therapy (HT; off-HT, n = 22, 63.4 [0.8] years) and postmenopausal with HT (n = 16, 63.1 [0.9] years). PROCEDURE A cross-sectional study. METHODS Polysomnography was performed over two consecutive nights and the first-night effect and group differences were evaluated. Questionnaire-based insomnia and sleepiness scores were correlated to sleep variables and their between-night changes. RESULTS Although sleep in young women was deeper and less fragmented than in the other groups, first-night effect was similar in all study groups. Total sleep time, sleep efficiency, and S1 and S2 sleep increased, and wake after sleep onset, awakenings per hour of sleep, S2 and REM latencies, and percentage of SWS decreased from the first to the second night. Perimenopausal women had more insomnia complaints than other women. Insomnia complaints were associated with more disturbed sleep but not with the first-night effect. CONCLUSIONS A first night in a sleep laboratory elicits a marked interference of sleep architecture in women of all ages, with a carryover effect of lighter sleep on the second study night. Menopausal state, HT use, or insomnia complaints do not modify this effect.
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Affiliation(s)
- Irina Virtanen
- a Department of Clinical Neurophysiology , TYKS-SAPA, Hospital District of Southwest Finland , Turku , Finland.,b Sleep Research Unit , University of Turku , Turku , Finland
| | - Nea Kalleinen
- b Sleep Research Unit , University of Turku , Turku , Finland.,c Department of Cardiology , Satakunta Central Hospital , Pori , Finland
| | - Anna S Urrila
- d Department of Health, Mental Health Unit , National Institute for Health and Welfare , Helsinki , Finland.,e Department of Adolescent Psychiatry , Helsinki University Hospital , Helsinki , Finland
| | - Päivi Polo-Kantola
- b Sleep Research Unit , University of Turku , Turku , Finland.,f Department of Obstetrics and Gynecology , Turku University Hospital and University of Turku , Turku , Finland
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Urrila AS, Hakkarainen A, Castaneda A, Paunio T, Marttunen M, Lundbom N. Frontal Cortex Myo-Inositol Is Associated with Sleep and Depression in Adolescents: A Proton Magnetic Resonance Spectroscopy Study. Neuropsychobiology 2018; 75:21-31. [PMID: 28793304 DOI: 10.1159/000478861] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 06/19/2017] [Indexed: 01/07/2023]
Abstract
AIM This study used proton magnetic resonance spectroscopy (1H MRS) to evaluate the neurochemistry of the frontal cortex in adolescents with symptoms of sleep and depression. METHODS Nineteen non-medicated adolescent boys (mean age 16.0 years; 9 clinical cases with depression/sleep symptoms and 10 healthy controls) underwent 1H MRS at 3 T. MR spectra were acquired from the anterior cingulate cortex (ACC), the dorsolateral prefrontal cortex, and frontal white matter. Concentrations of N-acetyl aspartate, total creatine, choline-containing compounds, total glutamine plus glutamate, and myo-inositol (mI) were compared in the 2 subgroups, and correlated with sleep and clinical measures in the total sample. Sleep was assessed with self-report questionnaires and ambulatory polysomnography recordings. RESULTS Concentrations of mI were lower in both frontal cortical regions among the depressed adolescents than in controls. No statistically significant differences in other metabolite concentrations were observed between the subgroups. Frontal cortex mI concentrations correlated negatively with depression severity, subjective daytime sleepiness, insomnia symptoms, and the level of anxiety, and correlated positively with total sleep time and overall psychosocial functioning. The correlations between mI in the ACC and total sleep time as well as daytime sleepiness remained statistically significant when depression severity was controlled in the analyses. CONCLUSION Lower frontal cortex mI may indicate a disturbed second messenger system. Frontal cortical mI may thus be linked to the pathophysiology of depression and concomitant sleep symptoms among maturing adolescents. Short sleep and daytime sleepiness may be associated with frontal cortex mI independently from depression.
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Affiliation(s)
- Anna S Urrila
- Unit of Mental Health, Department of Health, National Institute for Health and Welfare, Helsinki, Finland
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Santangeli O, Porkka-Heiskanen T, Virkkala J, Castaneda AE, Marttunen M, Paunio T, Urrila AS. Sleep and slow-wave activity in depressed adolescent boys: a preliminary study. Sleep Med 2017; 38:24-30. [PMID: 29031752 DOI: 10.1016/j.sleep.2017.06.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 06/22/2017] [Accepted: 06/23/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Adolescence is a vulnerable period of life that is characterized by increasing incidence of depression. Sleep disturbance is one of the diagnostic symptoms of depressive disorder. Adolescence is also characterized by dramatic maturational changes in sleep and its regulation. The goal of this study was to assess sleep macroarchitecture and slow-wave activity (SWA) in depressed adolescent boys. METHODS Eight non-medicated adolescent boys meeting the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for depressive disorder and 10 age-matched healthy controls (average age 16.0 years) underwent polysomnography in their home environment for two consecutive nights. Sleep macroarchitecture, SWA, and SWA dissipation were assessed in all subjects. RESULTS Depressed boys showed a flattened pattern of SWA dissipation through the night. SWA power was lower during the first non-rapid eye movement (NREM) episode in the frontal derivation and higher during the third NREM episode in the central derivation in the group of depressed boys as compared to healthy boys. The SWA dissipation pattern correlated with the severity of depressive symptoms, and the correlation was strongest in the frontal derivation. In addition, total sleep time was shorter in patients as compared to the control group, but no other differences were found in the macroarchitecture of sleep. CONCLUSION Depression in adolescent boys is characterized by more evenly distributed SWA through the night as compared to healthy subjects, and we showed for the first time that this pattern of SWA distribution is associated with severity of depressive symptoms. These findings suggest that homeostatic regulation of sleep may be impaired in adolescent depression.
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Affiliation(s)
- Olena Santangeli
- Department of Physiology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Tarja Porkka-Heiskanen
- Department of Physiology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jussi Virkkala
- Finnish Institute for Occupational Health, Helsinki, Finland
| | - Anu E Castaneda
- Equality and Inclusion Unit, Department of Welfare, National Institute for Health and Welfare, Helsinki, Finland
| | - Mauri Marttunen
- Unit of Mental Health, Department of Health, National Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tiina Paunio
- Genomics and Biomarkers Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna S Urrila
- Unit of Mental Health, Department of Health, National Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Merikanto I, Partonen T, Paunio T, Castaneda AE, Marttunen M, Urrila AS. Advanced phases and reduced amplitudes are suggested to characterize the daily rest-activity cycles in depressed adolescent boys. Chronobiol Int 2017; 34:967-976. [PMID: 28594248 DOI: 10.1080/07420528.2017.1332072] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Self-reported eveningness has been previously associated with depressed mood among adults and adolescents. Here, we study how circadian indicators based on actigraphic data differ between depressed and healthy adolescent boys. Our sample consisted of 17 medication-free adolescent boys, aged 14.5 to 17.5 years, of which eight had depressive disorder and were currently depressed and nine were healthy comparison participants. Psychiatric assessment was conducted by diagnostic interviews and complemented with observer-rating and self-rating scales. Actigraphic data were collected with wrist actigraphs for a minimum period of 25 consecutive days (range of 25 to 44 days). The behavioral trait of morningness-eveningness was measured with the 19-item Horne-Östberg Morningness-Eveningness Questionnaire. Based on the self-report, the depressed boys were more prone to eveningness than healthy controls, but based on the actigraphic data, they had earlier phases especially on school days and lower activity levels especially on weekends. On weekends, the depressed boys showed a greater shift toward later-timed phases than healthy controls. Our results confirm a mismatch of the subjective morningness-eveningness preference (late-preference) and the objective rest-activity rhythm (early-prone) during school days in depressed adolescent boys.
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Affiliation(s)
- Ilona Merikanto
- a Department of Public Health Solutions, Mental Health Unit , National Institute for Health and Welfare , Helsinki , Finland.,b Orton Orthopaedics Hospital , Helsinki , Finland
| | - Timo Partonen
- a Department of Public Health Solutions, Mental Health Unit , National Institute for Health and Welfare , Helsinki , Finland
| | - Tiina Paunio
- c Department of Health, Genetics and Biomarkers Unit , National Institute for Health and Welfare , Helsinki , Finland.,d Department of Psychiatry , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Anu E Castaneda
- e Department of Welfare, Equality and Inclusion Unit , National Institute for Health and Welfare , Helsinki , Finland
| | - Mauri Marttunen
- a Department of Public Health Solutions, Mental Health Unit , National Institute for Health and Welfare , Helsinki , Finland.,d Department of Psychiatry , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Anna S Urrila
- a Department of Public Health Solutions, Mental Health Unit , National Institute for Health and Welfare , Helsinki , Finland.,d Department of Psychiatry , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
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Virtanen I, Kalleinen N, Urrila AS, Polo-Kantola P. First-night effect on cardiac autonomic function in different female reproductive states. J Sleep Res 2017; 27:150-158. [PMID: 28548300 DOI: 10.1111/jsr.12560] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 04/10/2017] [Indexed: 11/27/2022]
Abstract
Decreases in heart rate variability, a marker of autonomic nervous system function, are associated with increased cardiovascular mortality. Heart rate variability increases in non-rapid eye movement sleep, peaking in slow-wave sleep. Therefore, decreasing the amount of deep sleep, for example, by introducing patients to a sleep laboratory environment, could decrease heart rate variability, increasing cardiovascular risk. We studied four groups of women with no previous sleep laboratory experience: young [n = 11, 23.1 (0.5) years]; perimenopausal [n = 15, 48.0 (0.4) years]; postmenopausal without hormone therapy [n = 22, 63.4 (0.8) years]; and postmenopausal on hormone therapy [n = 16, 63.1 (0.9) years], using a cross-sectional design. Polysomnography including electrocardiogram was performed over two consecutive nights. Heart rate variability was assessed overnight, and the first-night effect on heart rate variability was analysed. Furthermore, correlations between heart rate variability and sleep variables were analysed. Using combined groups, only minor changes were observed in non-linear heart rate variability, indicating increased parasympathetic tone from the first to the second night. No group differences in first-night effect were seen. Heart rate variability and sleep variables were not significantly correlated. Heart rate variability decreased with increasing age, and it was lowest in the postmenopausal women on hormone therapy. We conclude that a first night in a sleep laboratory elicits only minimal changes in overnight vagally mediated non-linear heart rate variability in women irrespective of reproductive state. This finding warrants further analyses in different sleep stages, but suggests that changes in sleep architecture per se do not predict the autonomic strain of a poor night.
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Affiliation(s)
- Irina Virtanen
- Department of Clinical Neurophysiology, TYKS-SAPA, Hospital District of Southwest Finland, Turku, Finland.,Department of Clinical Neurophysiology, University of Turku, Turku, Finland
| | - Nea Kalleinen
- Sleep Research Unit, University of Turku, Turku, Finland.,Department of Cardiology, Satakunta Central Hospital, Pori, Finland
| | - Anna S Urrila
- Department of Health, Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Päivi Polo-Kantola
- Sleep Research Unit, University of Turku, Turku, Finland.,Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
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Virtanen I, Kalleinen N, Urrila AS, Leppänen C, Polo-Kantola P. Cardiac autonomic changes after 40 hours of total sleep deprivation in women. Sleep Med 2015; 16:250-7. [PMID: 25634644 DOI: 10.1016/j.sleep.2014.10.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 09/30/2014] [Accepted: 10/15/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The effect of total sleep deprivation on heart rate variability (HRV) in groups of postmenopausal women on oral hormone therapy (HT) (on-HT, n = 10, 64.2 (1.4) years), postmenopausal women without HT (off-HT, n = 10, 64.6 (1.4) years) and young women (n = 11, 23.1 (0.5) years) was studied using a prospective case-control setup. METHODS Polysomnography was performed over an adaptation night, a baseline night, and a recovery night after 40 h of total sleep deprivation. Time and frequency domain and nonlinear HRV from overnight electrocardiogram recordings were compared between groups during baseline and recovery nights. Further, the changes in HRV from baseline to recovery were analysed and compared between groups. Finally, correlations of HRV to percentages of sleep stages and measures of sleep fragmentation were analysed during baseline and recovery. RESULTS Young women had higher HRV than older women; the most marked difference was between young and on-HT postmenopausal women. Sleep deprivation induced a decrease in frequency domain HRV in young and in off-HT women, an increase in α2 in off-HT women, and an increase in mean heart rate in on-HT women. The sleep deprivation effect was mainly uncorrelated to changes in sleep parameters. CONCLUSIONS Acute total sleep deprivation has a deleterious effect on the autonomic nervous system in young women, but an even more pronounced effect in postmenopausal women. Hormone therapy use in late postmenopause does not give protection against these changes. These harmful effects may partly explain the increased cardiovascular morbidity and overall mortality associated with sleep loss.
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Affiliation(s)
- Irina Virtanen
- Department of Clinical Neurophysiology, TYKS-SAPA, Hospital District of Southwest Finland, Turku, Finland; Sleep Research Unit, Department of Physiology, University of Turku, Turku, Finland.
| | - Nea Kalleinen
- Sleep Research Unit, Department of Physiology, University of Turku, Turku, Finland; Department of Cardiology, Turku University Hospital and University of Turku, Turku, Finland; Department of Cardiology, Satakunta Central Hospital, Pori, Finland
| | - Anna S Urrila
- Department of Physiology, University of Helsinki, Helsinki, Finland; Department of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland; Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Cecilia Leppänen
- Department of Clinical Neurophysiology, TYKS-SAPA, Hospital District of Southwest Finland, Turku, Finland
| | - Päivi Polo-Kantola
- Sleep Research Unit, Department of Physiology, University of Turku, Turku, Finland; Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
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Urrila AS, Karlsson L, Kiviruusu O, Pankakoski M, Pelkonen M, Strandholm T, Marttunen M. Sleep complaints in adolescent depression: one year naturalistic follow-up study. BMC Psychiatry 2014; 14:283. [PMID: 25603383 PMCID: PMC4196090 DOI: 10.1186/s12888-014-0283-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 09/30/2014] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Sleep complaints are highly prevalent in adolescents suffering from major depressive disorder (MDD). The aims of this study were to describe the longitudinal course of sleep complaints, and to assess the association between sleep complaints and clinical outcome in a sample of adolescents with MDD during naturalistic follow-up. METHODS A sample of adolescent outpatients (n = 166; age 13-19 years, 17.5% boys) diagnosed with MDD was followed-up during one year in naturalistic settings. Sleep symptoms and psychiatric symptoms were assessed with interviews and self-report questionnaires. RESULTS All sleep complaints were less frequent at one-year follow-up compared to baseline. Baseline sleep complaints did not adversely affect clinical outcome at one-year follow-up: severity of the sleep complaints at baseline was associated with a steeper improvement of depressive and anxiety symptoms, suicidality/self-harm symptoms, and overall psychosocial functioning over time. CONCLUSIONS Our results suggest that sleep disturbances at baseline do not necessarily lead to poorer clinical outcome during follow-up. Larger longitudinal studies combining both subjective and objective measures of sleep in depressed adolescents are needed to clarify the link between sleep and depression further.
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Affiliation(s)
- Anna S Urrila
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, P.O. Box 30, , 00271 Helsinki, Finland ,Department of Adolescent Psychiatry, Helsinki University Central Hospital, P.O. Box 83, , 00029, HUS Helsinki, Finland
| | - Linnea Karlsson
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, P.O. Box 30, , 00271 Helsinki, Finland ,Department of Child Psychiatry, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland
| | - Olli Kiviruusu
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, P.O. Box 30, , 00271 Helsinki, Finland
| | - Maiju Pankakoski
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, P.O. Box 30, , 00271 Helsinki, Finland
| | - Mirjami Pelkonen
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, P.O. Box 30, , 00271 Helsinki, Finland
| | - Thea Strandholm
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, P.O. Box 30, , 00271 Helsinki, Finland ,Department of Psychiatry, University of Helsinki, Institute of Clinical Medicine, Helsingin yliopisto, P.O. Box 20, , 00014 Helsinki, Finland
| | - Mauri Marttunen
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, P.O. Box 30, , 00271 Helsinki, Finland ,Department of Adolescent Psychiatry, Helsinki University Central Hospital, P.O. Box 83, , 00029, HUS Helsinki, Finland ,Department of Psychiatry, University of Helsinki, Institute of Clinical Medicine, Helsingin yliopisto, P.O. Box 20, , 00014 Helsinki, Finland
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Urrila AS, Karlsson L, Kiviruusu O, Pelkonen M, Strandholm T, Marttunen M. Sleep complaints among adolescent outpatients with major depressive disorder. Sleep Med 2012; 13:816-23. [PMID: 22705242 DOI: 10.1016/j.sleep.2012.04.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 03/30/2012] [Accepted: 04/03/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of our study was to examine the prevalence rates of different sleep complaints among adolescent outpatients with major depressive disorder (MDD). Further, we examined whether depressed adolescents with and without different sleep disturbances differ in terms of severity of depression, the presence of comorbid psychiatric disorders, and the symptom profile of depression. METHODS A total of 166 Finnish adolescent psychiatric outpatients (age 13-19; mean 16.5 years old; 17.5% boys) diagnosed with unipolar MDD (as defined by DSM-IV criteria) were included in the study. Their sleep complaints were assessed with self-rating scales and clinical research interviews. RESULTS The prevalence rate of subjective sleep complaints in adolescents with MDD was high: 83% of the adolescents experienced significantly disturbed sleep. The most common types of sleep complaints were nonrestorative sleep (69%) and insomnia (51%). The presence of sleep disturbances was associated with severity of depression: Hamilton Depression Rating Scale (HDRS) and Beck Depression Inventory (BDI) total sum scores were highest in adolescents with multiple sleep disturbances and lowest in adolescents with no sleep problems. Adolescents with multiple sleep disturbances differed most from adolescents with no or minor sleep disturbances in terms of thoughts about death, suicidal thoughts, and anhedonia. CONCLUSIONS These findings suggest a close link between sleep disturbances and the severity of depression in adolescent outpatients with MDD. In particular, the link between sleep disturbances and thoughts about death and suicidal thoughts calls for attention to sleep problems among depressed adolescents in clinical settings.
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Affiliation(s)
- Anna S Urrila
- National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Helsinki, Finland.
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Kalleinen N, Polo-Kantola P, Himanen SL, Alhola P, Joutsen A, Urrila AS, Polo O. Sleep and the menopause - do postmenopausal women experience worse sleep than premenopausal women? ACTA ACUST UNITED AC 2008; 14:97-104. [PMID: 18714074 DOI: 10.1258/mi.2008.008013] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine the sleep characteristics in three cross-sectional populations: young, premenopausal and postmenopausal women, and the associations between sleep, menopause, mood and cognitive performance. STUDY DESIGN Twenty-one premenopausal (45-51 years), 29 postmenopausal (59-71 years) and 11 young (20-26 years, using oral contraceptives) women were recruited. Polysomnography was used to measure objective sleep quality. Subjective sleep quality, sleepiness and mood were assessed using questionnaires. Cognitive performance was investigated by means of three attentional tests. RESULTS Total sleep time in pre- and postmenopausal women was similar (404.9 and 384.7 minutes), but shorter than in young women (448.2 minutes, P = 0.030 and <0.003, respectively). Sleep efficiency followed the same pattern, being 84.3% in premenopausal (P = 0.027), 80.2% in postmenopausal (P < 0.003) and 93.4% in young women. Pre- and postmenopausal women had less slow wave sleep (duration or activity) and more wake time after sleep onset (duration or frequency). Insomnia complaints were more frequent after the menopause (P = 0.023). Sleepiness and mood scores were similar in all groups. Reaction speeds slowed with increasing age. After the menopause, better cognitive performance was associated with more rapid eye movement sleep. CONCLUSION Objective sleep measures differed significantly between the young and postmenopausal groups. These differences may be more because of the physiology of ageing than the rapid changes across the menopause, since similar sleep characteristics were already present in the premenopausal women. The increase in sleep complaints after menopause was not associated with sleepiness or disturbances in objective sleep quality, mood or cognitive performance.
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Affiliation(s)
- Nea Kalleinen
- Sleep Research Unit, Department of Physiology, University of Turku, Dentalia, Lemminkäisenkatu 2, FIN-20520 Turku, Finland.
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11
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Urrila AS, Stenuit P, Huhdankoski O, Kerkhofs M, Porkka-Heiskanen T. Psychomotor vigilance task performance during total sleep deprivation in young and postmenopausal women. Behav Brain Res 2007; 180:42-7. [PMID: 17400306 DOI: 10.1016/j.bbr.2007.02.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Revised: 02/12/2007] [Accepted: 02/16/2007] [Indexed: 11/22/2022]
Abstract
The objective of this study was to investigate the effects of age on women's performance in the psychomotor vigilance task (PVT) during total sleep deprivation (SD). A total of 46 healthy women volunteered. They belonged to two age groups: young (n=34; age range 19-30 years; 12 without, and 22 with oral contraceptives (OC); early phase of the menstrual cycle) and older (n=12; age range 60-68; postmenopausal; without hormone therapy). During a 40-h total SD, the subjects performed the PVT and the Stanford Sleepiness Scale (SSS) at 2-h intervals. At baseline, the reaction speed of the young women was faster as compared to the older women (Mann-Whitney U-test p<0.01). During SD, all the PVT measures as well as the SSS scores changed similarly in the two age groups, when the baseline performance difference in favour of the young women was taken into account (area under curve analyses, Mann-Whitney U-tests n.s.). No age difference in the time course of the SD-related deterioration in PVT performance or subjective sleepiness was observed. OC use had no effects on any of the measures during SD. After recovery sleep, young women had higher subjective sleepiness scores than older women, the sleepiness scores being highest in young women not taking OCs. In conclusion, in women, aging has no effects on the amount or the time course of the decline in PVT performance caused by total SD. OC use does not significantly affect young women's PVT performance during SD in the early phase of the menstrual cycle.
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Affiliation(s)
- Anna S Urrila
- Department of Physiology, Institute of Biomedicine, University of Helsinki, Finland.
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12
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Kalleinen N, Polo O, Himanen SL, Joutsen A, Urrila AS, Polo-Kantola P. Sleep deprivation and hormone therapy in postmenopausal women. Sleep Med 2006; 7:436-47. [PMID: 16815746 DOI: 10.1016/j.sleep.2006.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2005] [Revised: 02/05/2006] [Accepted: 02/09/2006] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Sleep complaints increase after menopause, but literature on the effect of postmenopausal hormone therapy (HT) on sleep is controversial. The purpose of this study was to determine the effect of ageing and HT on sleep quality, assessed using polysomnography, and on the accuracy of the subjective estimation of sleep quality in women before and after sleep deprivation. PATIENTS AND METHODS Twenty postmenopausal women (aged 58-72 years) were recruited: 10 HT-users and 10 non-HT-users. Eleven young women (aged 20-26 years) served as controls. Polysomnography and subjective sleep quality were measured on four consecutive nights: adaptation, baseline, 40-h sleep deprivation and recovery. RESULTS Although the postmenopausal women slept worse than the controls at baseline, and in particular during the recovery night, their recovery response to sleep deprivation was well preserved. At baseline, HT-users had a shorter latency to rapid eye movement (REM) (P=0.043), with fewer awakenings from slow wave sleep (SWS) (P=0.029) but more from REM (P=0.033) than non-HT-users. During recovery, the HT-users had more stage 2 sleep (P=0.048) and less slow wave activity (SWA) in the first non-rapid eye movement (NREM) sleep episode (P=0.021) than the non-HT-users. The poor correlation between subjective and objective sleep quality at baseline became significant during recovery. CONCLUSIONS Although sleep in postmenopausal women was worse than in young controls, the recovery response following sleep deprivation was relatively well preserved. HT offered no significant advantage to sleep at baseline and slightly weakened the recovery response to prolonged wakefulness.
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Affiliation(s)
- Nea Kalleinen
- Sleep Research Unit, Department of Physiology, University of Turku, Dentalia, Lemminkäisenkatu 2, Turku, Finland.
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13
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Urrila AS, Hakkarainen A, Heikkinen S, Huhdankoski O, Kuusi T, Stenberg D, Häkkinen AM, Porkka-Heiskanen T, Lundbom N. Preliminary findings of proton magnetic resonance spectroscopy in occipital cortex during sleep deprivation. Psychiatry Res 2006; 147:41-6. [PMID: 16797940 DOI: 10.1016/j.pscychresns.2006.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2005] [Revised: 01/19/2006] [Accepted: 01/19/2006] [Indexed: 11/18/2022]
Abstract
Proton magnetic resonance spectroscopy ((1)H MRS) has revealed biochemical alterations in various psychiatric disorders. Changes in brain metabolites may be caused not only by the disease's progression or response to treatment, but also by physiological variability. The aim of this study was to use (1)H MRS to assess the effects of specific short-term physiological states on major metabolites. Eight healthy women underwent (1)H MRS at the beginning and end of a 40-h period of sleep deprivation. The ratios of N-acetyl-aspartate (NAA), total creatine (tCr), and choline-containing compounds (Cho) to water (H(2)O) were determined from the occipital cortex during both baseline and photic stimulation conditions. During sleep deprivation, NAA/H(2)O decreased by 7% and Cho/H(2)O by 12%. Photic stimulation had no effect on the measured metabolites in the alert state, but in the sleep-deprived state the level of Cho/H(2)O increased during neuronal activation. The results suggest that NAA/H(2)O and Cho/H(2)O may depend on the state of alertness.
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Affiliation(s)
- Anna S Urrila
- Institute of Biomedicine, University of Helsinki, Finland.
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14
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Urrila AS, Hakkarainen A, Heikkinen S, Vuori K, Stenberg D, Häkkinen AM, Lundbom N, Porkka-Heiskanen T. Stimulus-induced brain lactate: effects of aging and prolonged wakefulness. J Sleep Res 2004; 13:111-9. [PMID: 15175090 DOI: 10.1111/j.1365-2869.2004.00401.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Both aging and sleep deprivation disturb the functions of the frontal lobes. Deficits in brain energy metabolism have been reported in these conditions. Neurons use not only glucose but also lactate as their energy substrate. The physiological response to elevated neuronal activity is a transient increase in lactate concentrations in the stimulated area. We have previously shown that cognitive stimulation increases brain lactate. To study the effect of prolonged wakefulness on the lactate response we designed an experiment to assess brain lactate levels during a 40-h sleep deprivation period in young (19-24 years old; n = 13) and in aged (60-68 years old; n = 12) healthy female volunteers. Brain lactate levels were assessed with proton MR-spectroscopy ((1)H MRS) during the performance of a silent word generation task. The (1)H MRS voxel location was individually selected, using functional magnetic resonance imaging, to cover the activated area in the left frontal lobe. The degree of sleepiness was verified using vigilance tests and self-rating scales. In the young alert subjects, the silent word generation test induced a 40% increase in lactate, but during the prolonged wakefulness period this response disappeared. In the aged subjects, the lactate response could not be detected even in the alert state. We propose that the absence of the lactate response may be a sign of malfunctioning of normal brain energy metabolism. The behavioral effects of prolonged wakefulness and aging may arise from this dysfunction.
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Affiliation(s)
- Anna S Urrila
- Department of Physiology, Institute of Biomedicine, University of Helsinki, Biomedicum Helsinki, Finland.
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15
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Urrila AS, Hakkarainen A, Heikkinen S, Vuori K, Stenberg D, Häkkinen AM, Lundbom N, Porkka-Heiskanen T. Stimulus-induced brain lactate: effects of aging and prolonged wakefulness. J Sleep Res 2004. [PMID: 15175090 DOI: 10.1111/j.1365‐2869.2004.00401.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Both aging and sleep deprivation disturb the functions of the frontal lobes. Deficits in brain energy metabolism have been reported in these conditions. Neurons use not only glucose but also lactate as their energy substrate. The physiological response to elevated neuronal activity is a transient increase in lactate concentrations in the stimulated area. We have previously shown that cognitive stimulation increases brain lactate. To study the effect of prolonged wakefulness on the lactate response we designed an experiment to assess brain lactate levels during a 40-h sleep deprivation period in young (19-24 years old; n = 13) and in aged (60-68 years old; n = 12) healthy female volunteers. Brain lactate levels were assessed with proton MR-spectroscopy ((1)H MRS) during the performance of a silent word generation task. The (1)H MRS voxel location was individually selected, using functional magnetic resonance imaging, to cover the activated area in the left frontal lobe. The degree of sleepiness was verified using vigilance tests and self-rating scales. In the young alert subjects, the silent word generation test induced a 40% increase in lactate, but during the prolonged wakefulness period this response disappeared. In the aged subjects, the lactate response could not be detected even in the alert state. We propose that the absence of the lactate response may be a sign of malfunctioning of normal brain energy metabolism. The behavioral effects of prolonged wakefulness and aging may arise from this dysfunction.
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Affiliation(s)
- Anna S Urrila
- Department of Physiology, Institute of Biomedicine, University of Helsinki, Biomedicum Helsinki, Finland.
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Urrila AS, Hakkarainen A, Heikkinen S, Vuori K, Stenberg D, Häkkinen AM, Lundbom N, Porkka-Heiskanen T. Metabolic imaging of human cognition: an fMRI/1H-MRS study of brain lactate response to silent word generation. J Cereb Blood Flow Metab 2003; 23:942-8. [PMID: 12902838 DOI: 10.1097/01.wcb.0000080652.64357.1d] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Proton magnetic resonance spectroscopy (1H-MRS) allows in vivo assessment of the metabolism related to human brain functions. Visual, auditory, tactile, and motor stimuli induce a temporary increase in the brain lactate level, which may act as a rapid source of energy for the activated neurons. The authors studied the metabolism of the frontal lobes during cognitive stimulation and measured local lactate levels with standard 1H-MRS, after localizing the activated area by functional MRI. Lactate levels were monitored while the subjects either silently listed numbers (baseline) or performed a silent word-generation task (stimulus-activation). The cognitive stimulus-activation produced a 50% increase in the brain lactate level in the left inferior frontal gyrus. The results show that metabolic imaging of neuronal activity related to cognition is possible using 1H-MRS.
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Affiliation(s)
- Anna S Urrila
- Institute of Biomedicine, University of Helsinki, Finland
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