Children With Major Depression Show Reduced Rapid Eye Movement Latencies

Emslie, Graham J.; Rush, A. John; Weinberg, Warren A.; Rintelmann, Jeanne; Roffwarg, Howard P.

doi:10.1001/archpsyc.1990.01810140019003

Cited by 121 publications

(42 citation statements)

References 35 publications

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“…Evidence from a variety of patient populations and studies of healthy children suggest that children, much like adults, show improvements in sleep quality from the first to second night in the sleep laboratory, 3,[5][6][7][8][9][10]19 with some measures of sleep quality continuing to improve when data from subsequent nights are collected. 3 The most consistently reported changes are in TST, SE, WASO, and REM parameters.…”

Section: Discussion and Limitationsmentioning

confidence: 99%

“…Likewise, both Dahl et al and Emslie et al evaluated children with MDD on consecutive nights and found REM latency decreased on the second night. 9,10 In addition, Dahl found an increase in REM minutes on the second night in both MDD subjects and controls. Prihodova et al examined 31 children between the ages of 6 and 12 years with a diagnosis of ADHD and compared them to 26 age-matched typically developing controls.…”

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confidence: 94%

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First Night Effect Analysis in a Cohort of Young Children with Autism Spectrum Disorder

Buckley

Wingert

Swedo

et al. 2013

Journal of Clinical Sleep Medicine

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Study Objectives: To evaluate for the fi rst night effect (FNE) in a group of young children with autism. Design: Analysis of polysomnographic data from a 2-night sleep laboratory study. Setting: Clinical Center of the National Institutes of Health. Patients or Participants: 15 children (aged 2-10 years) with a diagnosis of an ASD. Interventions: None. Measurements and Results: Polysomnographic analysis showed the presence of a FNE for wake after sleep onset minutes, stage 2, and sleep effi ciency, but not for REM sleep parameters or TST. Conclusions S C I E N T I F I C I N V E S T I G A T I O N ST he fi rst night effect (FNE) refers to the well-accepted phenomenon of a poorer quality of sleep on the fi rst night when subjects undergo two or more consecutive nights in the sleep lab. Typically, FNE effects include lower sleep effi ciency, less total sleep time, less REM sleep, longer latency to REM sleep, and more intermittent awake time on night one.1,2 While this phenomenon is well recognized among adult populations, there are few exclusively pediatric studies that have examined FNE, and fewer still that have included young children with disorders affecting development.The largest pediatric study examining the FNE was performed in 1984. It was a laboratory-based evaluation of 87 healthy children between the ages of 6 and 15 years. This experiment reported an increase in TST and a decrease in sleep latency for night two. It also revealed similar second night fi ndings as had been seen in adult cohorts, namely, better sleep effi ciency, fewer wake after sleep onset (WASO) minutes, decreased REM latency, and increased REM percentage.3 Palm et al. conducted a 2-night at home study in 1989 on 18 healthy children between 8 and 12 years and did not fi nd such an effect. 4 Instead, there was an increase in sleep latency, an increase in percentage of stage 1 sleep, and an increase in REM latency, all on the second night.The majority of FNE data in children have come from studies using patient populations that frequently undergo overnight polysomnography (PSG) as part of a routine diagnostic assessment. Several studies have examined the FNE among children with suspected sleep disordered breathing (SDB) and obese children who are at risk for developing SDB. Scholle et al. evaluated 131 children between the ages of 2 and 17 years with suspected SDB for 2 nights in the laboratory. 5 The work concluded that while there was a FNE effect for WASO and REM percentage, a second night was not needed for pertinent respiratory parameters. Similarly, Verhulst et al. examined 70 children between the ages of 2 and 17 years, also referred for SDB, and found a FNE for REM sleep parameters but not for respiratory measures.6 Li et al. compared 46 obese children to 44 normal weight children between the ages of 7 and 15 years. 7 The groups were later further broken down for the presence or absence of SDB, and sleep architecture was examined using a 2-night, laboratory-based study. Children with and without SDB had increased TST and greater ...

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Section: Discussion and Limitationsmentioning

confidence: 99%

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confidence: 94%

First Night Effect Analysis in a Cohort of Young Children with Autism Spectrum Disorder

Buckley

Wingert

Swedo

et al. 2013

Journal of Clinical Sleep Medicine

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“…Polysomnographic (PSG) studies of sleep architecture in depressed and healthy children have demonstrated fewer differences than adolescent studies comparing PSG in depressed and healthy populations. Only one study of depressed child inpatients showed REM latency and sleep latency differences compared with healthy controls (Emslie et al 1990). Developmentally, there are substantial changes in sleep architecture, including decreases in slow wave sleep across the age group.…”

Section: Discussionmentioning

confidence: 99%

Insomnia Moderates Outcome of Serotonin-Selective Reuptake Inhibitor Treatment in Depressed Youth

Emslie

Kennard

Mayes

et al. 2012

Journal of Child and Adolescent Psychopharmacology

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Objective: Insomnia is evident in the majority of youth with depression, and is associated with poorer outcomes. There are limited data on the impact of insomnia in response to acute treatment, which is particularly relevant with serotonin-selective reuptake inhibitors, given their tendency to worsen sleep architecture. Methods: Three hundred nine children and adolescents (ages 7-18 years) were randomized to fluoxetine (n = 157) or placebo (n = 152) for 8-9 weeks (Emslie et al.1997. Substantial insomnia at baseline was defined as a child's depression rating scale-revised [CDRS-R] sleep item ‡ 4. Outcome measures were CDRS-R, response, and remission. Results: Insomnia was reported in 172/309 (55.7%) youth, and was associated with higher depression severity and greater fatigue, suicidal ideation, physical complaints, and decreased concentration. While response rates were similar in those with or without insomnia overall (51.7% vs. 55.7%), there is a significant difference by age group. Among adolescents, those with insomnia were less likely to respond to fluoxetine (39.2%; 20/51) than those without (65.9%; 27/41; p = 0.013), while in children on fluoxetine, those with insomnia were more likely to respond to fluoxetine (69.4%; 25/36) than those without insomnia (41.4%; 12/29; p = 0.027). Insomnia did not impact the response to placebo in either age group. Within adolescents, the overall least squares means for CDRS-R total score (across the 8 weeks of treatment) were significantly different between those who had insomnia versus those who did not within the fluoxetine group ( Conclusions: While adolescents reporting substantial insomnia were less likely to respond to antidepressant treatment than those without insomnia, children were more responsive to fluoxetine when they had insomnia. Additional intervention targeting sleep disturbance may be warranted in adolescents.

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“…Polysomnogram variables were aver aged across nights for each subject at each measure ment occasion (Tl and T2). Additional details relevant to scoring criteria are presented by Emslie et al (1990).…”

Section: Methodsmentioning

confidence: 99%

The Effects of Fluoxetine on the Polysomnogram of Depressed Outpatients: A Pilot Study

Hendrickse

Roffwarg

Grannemann

et al. 1994

Neuropsychopharmacol

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The effects of fluoxetine (FLU) and its active metabolite, norfluoxetine (NFLU), on the polysomnogram (PSG) of nine depressed outpatients (eight with major depression; one with bipolar II, depressed phase disorder) were investigated by contrasting PSG values prior to treatment and during administration of FLU. The PSG changes were correlated with daily dose, cumulative dosage, single serum concentrations, and the total area under the serum concentration curve (AUC) of both FLU and NFLU.KEY WORDS: Fluoxetine; Norfluoxetine; Polysomnography; Serotonin; Depression Fluoxetine (FLU)-a potent, specifIc, serotonin reup take inhibitor-is an effective treatment for major depression (for a review, see Depression Guideline Panel, 1993). Serotonin affects the regulation of the sleep-wake cycle. It plays a role in the induction and maintenance of sleep as well as the character of sleep stage macro architecture and rapid-eye-movement (REM) sleep expression Oouvet et al. 1989).Fluoxetine reportedly causes a shift toward lighter Fluoxetine clearly increased both stage 1 sleep time and rapid-eye-movement (REM) latency and decreased both percent REM and REM density. With a few exceptions, the cumulative dosage of FLU and the AUC of FLU and NFLU were better predictors of the changes in awake and movement time in the PSG than single-sample concentrations of FLU and NFLU taken at the time of PSG assessment. fNeuropsychopharmacology 10: 85-91, 1994J sleep that is reflected in increases in sleep latency and percentage of non-REM stage 1 sleep and decreases in total sleep time, sleep efficiency, and percentage of non REM stages 3 and 4 sleep (Nicholson and Pascoe 1986;Pastel and Fernstrom 1987;Kerkhofs et al. 1990;Keck et al. 1991;Keck and McElroy 1992). The duration of REM sleep and REM latency, as well as REM density, may also be affected by FLU (Nicholson and Pascoe 1988;von Bardeleben et al. 1989;Nicholson et al. 1989; Bakalian and Fernstrom 1990;Hanzel et al. 1991;Saletu et al. 1991). These effects likely depend upon both the dose and duration of FLU treatment.Changes in polysomnogram (PSG) measures as sociated with chronic FLU treatment in depressed sub jects have been incompletely studied (Schenck et al. 1992). Relationships among PSG measures and serum concentrations of FLU and its active metabolite norflu oxetine (NFLU) have not been previously reported in depressed patients. This pilot study evaluated the effect of FLU and NFLU on PSG measures in a group of medication-responsive depressed outpatients.

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Children With Major Depression Show Reduced Rapid Eye Movement Latencies

Cited by 121 publications

References 35 publications

First Night Effect Analysis in a Cohort of Young Children with Autism Spectrum Disorder

First Night Effect Analysis in a Cohort of Young Children with Autism Spectrum Disorder

Insomnia Moderates Outcome of Serotonin-Selective Reuptake Inhibitor Treatment in Depressed Youth

The Effects of Fluoxetine on the Polysomnogram of Depressed Outpatients: A Pilot Study

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