RESUMO
OBJECTIVE: To test the hypothesis that sleep disruptions would be evident in 3-year-old children with a history of prenatal marijuana exposure. DESIGN: A prospective study using stratified random sampling beginning in the fourth month of pregnancy. Marijuana and other substance use were assessed by interviews at multiple time points. Offspring were followed up through age 3 years with multidomain assessments at fixed time points, including electroencephalographic sleep studies in the newborn period and at age 3 years. SETTING: Primary care, prenatal clinic at a university hospital. SUBJECTS: The sample included 18 children with prenatal marijuana exposure (mean [+/- SD] age, 39.0 +/- 4.4 months) and 20 control children (mean [+/- SD] age, 39.7 +/- 4.4 months). The two groups were similar in relationship to maternal age, race, income, education, or maternal use of alcohol, nicotine, and other substances in the first trimester. MAIN OUTCOME MEASURE: Sleep variables from polysomnographic recordings at age 3 years. RESULTS: Children with prenatal marijuana exposure showed more nocturnal arousals (mean [+/- SD], 8.2 +/- 5.3 vs 3.2 +/- 4.6; P < .003), more awake time after sleep onset (mean [+/- SD], 27.4 +/- 20.0 vs 13.7 +/- 12.4 min; P < .03), and lower sleep efficiency (mean [+/- SD], 91.0 +/- 3.8 vs 94.4 +/- 2.1; P < .03) than did control children. CONCLUSION: Prenatal marijuana exposure was associated with disturbed nocturnal sleep at age 3 years.
Assuntos
Nível de Alerta/fisiologia , Abuso de Maconha , Efeitos Tardios da Exposição Pré-Natal , Sono/fisiologia , Adolescente , Adulto , Pré-Escolar , Eletroencefalografia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Gravidez , Estudos Prospectivos , Sono REM/fisiologia , Fatores de TempoRESUMO
OBJECTIVE: Blunted stimulation of growth hormone (GH) secretion after pharmacological stimuli has been linked to depressive and anxiety disorders throughout the life span. This study sought to better characterize this dysregulation in prepubertal depression. METHOD: GH regulation was compared in 38 medically healthy prepubertal children with current major depressive disorder and 19 control children who were medically and psychiatrically healthy. The study evaluated GH stimulatory responses to three pharmacological challenge agents: (1) insulin-induced hypoglycemia, using 0.1 IU/kg intravenous regular insulin; (2) 1.3 micrograms/kg intravenous clonidine; and (3) 1.0 microgram/kg intravenous human growth hormone-releasing hormone (GHRH). RESULTS: The results provide replication and extension of earlier findings. GH responses to insulin-induced hypoglycemia and to GHRH stimulation were blunted in depressed children compared to the normal controls. Clonidine stimulation results yielded a similar picture but did not reach statistical significance. CONCLUSIONS: Overall these results further strengthen the evidence showing GH dysregulation in childhood depression. However, the blunted GH response seen with GHRH (which reflects pituitary hyporesponsivity) was in contrast to our original hypothesis and has implications regarding the site (or sites) of dysregulation.
Assuntos
Clonidina/farmacologia , Transtorno Depressivo/induzido quimicamente , Hormônio Liberador de Hormônio do Crescimento/farmacologia , Hormônio do Crescimento/metabolismo , Insulina/farmacologia , Adolescente , Criança , Clonidina/administração & dosagem , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/fisiopatologia , Feminino , Hormônio do Crescimento/sangue , Hormônio Liberador de Hormônio do Crescimento/administração & dosagem , Humanos , Hipotálamo/efeitos dos fármacos , Hipotálamo/fisiopatologia , Injeções Intravenosas , Insulina/administração & dosagem , Masculino , Hipófise/efeitos dos fármacos , Hipófise/fisiopatologia , Escalas de Graduação PsiquiátricaRESUMO
Children with major depressive disorder often fail to exhibit electroencephalographic (EEG) sleep abnormalities similar to those reported in depressed adults. It was hypothesized that a cholinergic rapid eye movement (REM) induction test would contribute to the identification of EEG sleep abnormalities in depressed children. To test this hypothesis, prepubertal children meeting research diagnostic criteria for major depressive disorder (n = 33) and carefully screened healthy control children (n = 15) were enrolled in a 4-day psychobiologic protocol that included 1 night with infusion of arecoline (0.5 mg) during the first non-REM sleep period. Although there had been no significant group differences in baseline sleep measures, results on the arecoline night revealed significantly shorter REM latency in the group of depressed children compared with the control children (mean +/- SD = 105 +/- 51 minutes vs. 140 +/- 46 minutes). The design of the protocol (with an interval break immediately preceding the arecoline night) prevented a direct estimation of arecoline effects within subjects; however, these data provide promising preliminary results regarding cholinergic REM induction tests in childhood depression.
Assuntos
Arecolina , Transtorno Depressivo/fisiopatologia , Sono REM/efeitos dos fármacos , Envelhecimento/fisiologia , Arecolina/administração & dosagem , Pressão Sanguínea/efeitos dos fármacos , Criança , Eletroencefalografia , Feminino , Hormônio do Crescimento/sangue , Frequência Cardíaca/efeitos dos fármacos , Humanos , Infusões Intravenosas , Modelos Lineares , Masculino , Fatores Sexuais , Sono REM/fisiologiaRESUMO
A recently developed technique for examining thermal sensitivity during sleep was used to assess whether skin and core temperature responses to thermal stimulation were altered by sleep state. The technique was designed to probe thermal responsivity without altering core body temperature or inducing awakening. Twenty-seven young men and women were studied during a sleep deprivation night and a sleep night three nights later. Cold water stimulation of the face alternated with an equal period of rewarming across a 40-min cycle throughout the night. Skin temperature from the finger and rectal temperature were continuously assessed. Sleep continuity and architecture were largely uninfluenced by the thermal stimulation. Finger skin temperature decreased during cold facial stimulation in both sleep and waking states. Skin temperature changes during sleep were approximately one-fifth the magnitude of those during waking. Core temperature was minimally influenced. REM sleep was associated with a greater amplitude decrease in finger temperature than was non-REM (NREM) sleep. The results support the utility of the technique as a probe of thermal responsivity during sleep and suggest a reduction of thermal responsivity during sleep and, more tentatively, an altered responsivity during REM versus NREM sleep.
Assuntos
Regulação da Temperatura Corporal/fisiologia , Temperatura Cutânea/fisiologia , Sono/fisiologia , Adulto , Face/fisiologia , Feminino , Humanos , Masculino , Polissonografia , Fatores de TempoRESUMO
The neuroendocrine response to L-5-hydroxytryptophan was compared in 37 prepubertal children who met the Research Diagnostic Criteria for major depressive disorder with that in 23 normal children with no lifetime history of any psychiatric disorder and very low rates of depression in both first- and second-degree relatives. Intravenous L-5-hydroxytryptophan (0.8 mg/kg) was given over a 1-hour interval after preloading with oral carbidopa, an inhibitor of peripheral but not central L-5-hydroxytryptophan metabolism. L-5-Hydroxytryptophan, a precursor of serotonin, increases serotonin turnover in the central nervous system when given after carbidopa. Seven (19%) of the 37 children with major depressive disorder and two (9%) of the 23 normal children had nausea or vomiting and therefore did not complete the full infusion. They were subsequently excluded from data analysis. After this stimulation, prolactin, cortisol, and growth hormone secretion were compared between diagnostic groups. The depressed children secreted significantly less cortisol (effect size, 0.70) and significantly more prolactin (effect size, 0.83). There was a sex-by-diagnosis interaction in prolactin response to L-5-hydroxytryptophan and, on examination, the prolactin hypersecretion was seen in depressed girls but not in depressed boys compared with same-sex controls. There was no significant stimulation of growth hormone in either group. These findings are consistent with dysregulation of central serotonergic systems in childhood major depression.
Assuntos
Transtorno Depressivo/diagnóstico , Hormônio do Crescimento/sangue , Hidrocortisona/sangue , Prolactina/sangue , Serotonina , Adulto , Fatores Etários , Carbidopa/administração & dosagem , Carbidopa/farmacologia , Criança , Transtorno Depressivo/sangue , Transtorno Depressivo/fisiopatologia , Diagnóstico Diferencial , Relação Dose-Resposta a Droga , Feminino , Humanos , Infusões Intravenosas , Masculino , Escalas de Graduação Psiquiátrica , Receptores de Serotonina/efeitos dos fármacos , Receptores de Serotonina/fisiologia , Serotonina/administração & dosagem , Serotonina/farmacologia , Serotonina/fisiologia , Fatores Sexuais , EstereoisomerismoRESUMO
The authors report a study of 24-hour serial cortisol determinations, measured during baseline and after the administration of 0.25 and 0.5 mg of dexamethasone in a sample of predominantly outpatient children with major depressive disorder, nonaffective psychiatric controls, and normal controls. In this sample, 24-hour baseline cortisol and the dexamethasone suppression test (DST) do not discriminate between the three groups. In addition, the authors measured 24-hour serum dexamethasone levels. There were no significant between group differences in serum dexamethasone. These results raise questions as to the utility of this test in the diagnosis of affective disorders in children. Possible reasons for the discrepancies in the dexamethasone suppression test results between in- and outpatient studies are discussed.
Assuntos
Transtorno Depressivo/diagnóstico , Dexametasona , Hidrocortisona/sangue , Administração Oral , Criança , Transtorno Depressivo/sangue , Transtorno Depressivo/psicologia , Dexametasona/farmacocinética , Relação Dose-Resposta a Droga , Feminino , Humanos , MasculinoRESUMO
Although most studies on sleep in child and adolescent depression have indicated that sleep is relatively unaffected, abnormalities have been found. We hypothesized that discrepancies occur because family history of depression and sleep abnormalities in a parent have not been taken into account. In a group of parents and offspring with a family history of depression, 57% of parents had evidence of abnormal sleep. Sleep continuity and sleep architecture were correlated, and the magnitude of these correlations increased between parents with abnormal sleep and their offspring. Abnormal sleep may be expressed at a younger age when there is familial evidence for depression and abnormal sleep in a parent.
Assuntos
Filho de Pais com Deficiência , Transtorno Depressivo/genética , Eletroencefalografia , Fases do Sono/genética , Adulto , Córtex Cerebral/fisiopatologia , Criança , Filho de Pais com Deficiência/psicologia , Pré-Escolar , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/fisiopatologia , Transtorno Depressivo/psicologia , Potenciais Evocados/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Determinação da Personalidade , Tempo de Reação/fisiologia , Fases do Sono/fisiologia , Sono REM/genética , Sono REM/fisiologiaRESUMO
Obstructive sleep apnea syndrome (OSAS) in children is commonly caused by adenotonsillar hypertrophy. The diagnostic criteria of OSAS in children are not so well delineated as in adults. We report the first case of antral choanal polyp presenting as OSAS in a 10-year-old boy that initially presented to the child psychiatry service for behavior disturbance, enuresis, and daytime somnolence. Overnight electroencephalogram sleep study revealed events consistent with OSAS. Multiple inhalant allergies, chronic maxillary sinusitis, and obstructive adenoid hypertrophy were diagnosed by the allergy and otolaryngology services. The child was scheduled for adenoidectomy when his sleep apnea symptoms persisted following antimicrobial therapy. Examination under anesthesia revealed a normal adenoid bed and a large left antral choanal polyp. Polypectomy was performed as dictated by parental consent. Postoperatively treatment with an intranasal steroid was begun. However, polypoid nasal mucosa recurred in 2 months and a Caldwell-Luc procedure was performed. Subjective reports following surgery indicated improvement in daytime irritability, attention, and mood. A follow-up overnight electroencephalogram sleep study confirmed resolution of OSAS.
Assuntos
Seio Maxilar , Pólipos/complicações , Síndromes da Apneia do Sono/etiologia , Criança , Humanos , Masculino , Sinusite Maxilar/diagnóstico , Sinusite Maxilar/etiologia , Pólipos/diagnósticoRESUMO
Two nights of electroencephalographic (EEG) sleep recording were performed in a group of prepubertal subjects with major depressive disorder (MDD) (n = 36, mean age = 10.4, SD = 1.5) and age-matched normal control children (n = 18, mean age = 10.1, SD = 1.6). All subjects were medically healthy and free of medications at the time of the study. There were no significant group differences for any major sleep variable after the initial adaptation night in this study. One subgroup of MDD subjects (n = 8) showed reduced REM latency on both recording nights, decreased stage 4 sleep, and increased REM time; this subgroup had significantly higher severity scores for depression but did not otherwise appear to be clinically distinct from the rest of the MDD subjects. Overall, the results indicate that the EEG sleep changes associated with depression in adults occurred less frequently in prepubertal MDD subjects.
Assuntos
Transtorno Depressivo , Eletroencefalografia , Sono REM , Adolescente , Adulto , Fatores Etários , Criança , Interpretação Estatística de Dados , Feminino , Humanos , Masculino , Fatores Sexuais , Fases do Sono , Fatores de TempoRESUMO
All night sleep EEG recordings were performed for three consecutive nights in 27 adolescents with a diagnosis of major depressive disorder (MDD) and 30 normal adolescent controls. Group comparisons between the entire MDD group and the normal controls revealed no significant diagnostic group differences for any of the major sleep variables. Analyses within subgroups of MDD adolescents, however, revealed heterogeneity of EEG sleep findings in association with suicidality and inpatient status. The findings of this study suggest that the discrepancies among the EEG sleep studies in adolescent MDD may be accounted for by the relative proportions of inpatients, suicidality, or bipolarity within the MDD sample being studied.
Assuntos
Nível de Alerta , Transtorno Depressivo/diagnóstico , Eletroencefalografia , Fases do Sono , Meio Social , Suicídio/psicologia , Adolescente , Transtorno Depressivo/psicologia , Feminino , Humanos , Masculino , Unidade Hospitalar de Psiquiatria , Escalas de Graduação Psiquiátrica , Sono REMRESUMO
Symptoms of sleep disturbances are commonly associated with child and adolescent psychopathology. There has been considerable interest (both clinical and research) in sleep in relation to major depressive disorder, attention deficit disorder, and Tourette's syndrome. Despite evidence of subjective sleep disturbances, objective physiological studies (for the most part) have not produced clear, specific evidence of sleep disruption which is of clinical benefit at this time. The reasons for this may be due to the technical limitations of measuring sleep which may be unable to reliably detect subtle differences or may be due to maturational factors which protect the sleep of children and mask these findings. The interaction between the regulation of sleep and clinical disorders of affect, arousal, and behavior in children and adolescents appears to be a promising field for future research.
Assuntos
Transtornos Mentais/complicações , Transtornos do Sono-Vigília/complicações , Adolescente , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Criança , Transtornos do Comportamento Infantil/complicações , Transtorno Depressivo/complicações , Humanos , Síndrome de Tourette/complicaçõesRESUMO
Recombinant interleukin-1 beta (IL-1 beta) was administered intraperitoneally for 3 days to normal C57BL/6ByJ (B6) mice. The islets from IL-1-treated and control animals were isolated and glucose-stimulated insulin secretion studied in the perifusion system. The total islet insulin content and the ultrastructure of the islets isolated from the animals treated with IL-1 did not differ from those seen in control animals. However, glucose-stimulated insulin release was significantly impaired after 3 days of in vivo administration of IL-1, either 3 micrograms/animal/day or 0.3 micrograms/animal/day. The administration of IL-1 inhibited an acute phase of glucose-induced insulin release, whereas neither basal insulin secretion nor insulin release from 10-30 min of perifusion with glucose was impaired. There was an only partial (27%) and non-significant restoration of the insulin secretory response to glucose stimulation 4 days after discontinuation of IL-1 treatment. We conclude that IL-1 administered in vivo is capable of adversely affecting pancreatic islet response to glucose stimulation. After 3 days of administration, these changes are confined to the process of insulin release, with the islet cell morphology and total insulin content being unaffected.