Abstract
In children diagnosed with pediatric bipolar disorder (PBD), disturbances in the quality of sleep and wakefulness are prominent. A novel phenotype of PBD called Fear of Harm (FOH) associated with separation anxiety and aggressive obsessions is associated with sleep onset insomnia, parasomnias (nightmares, night-terrors, enuresis), REM sleep-related problems, and morning sleep inertia. Children with FOH often experience thermal discomfort (e.g., feeling hot, excessive sweating) in neutral ambient temperature conditions, as well as no discomfort during exposure to the extreme cold, and alternate noticeably between being excessively hot in the evening and cold in the morning. We hypothesized that these sleep- and temperature-related symptoms were overt symptoms of an impaired ability to dissipate heat, particularly in the evening hours near the time of sleep onset. We measured sleep/wake variables using actigraphy, and nocturnal skin temperature variables using thermal patches and a wireless device, and compared these data between children with PBD/FOH and a control sample of healthy children. The results are suggestive of a thermoregulatory dysfunction that is associated with sleep onset difficulties. Further, they are consistent with our hypothesis that alterations in neural circuitry common to thermoregulation and emotion regulation underlie affective and behavioral symptoms of the FOH phenotype.
Highlights
Sleep disturbance is a common feature of mood disorders
In children diagnosed with pediatric bipolar disorder (PBD), problems with the quality of both sleep and wakefulness are prominent, and include bedtime refusal, sleep onset insomnia, parasomnias, morning sleep inertia, and daily bouts of both hyperactivity and hypoactivity [1,2,3,4,5,6,7,8,9,10,11,12,13,14]
From the 16 Fear of Harm (FOH) children, usable Diary and Actiwatch data were obtained from 92 nights versus 37 nights from the 4 Control children
Summary
Sleep disturbance is a common feature of mood disorders. In children diagnosed with pediatric bipolar disorder (PBD), problems with the quality of both sleep and wakefulness are prominent, and include bedtime refusal, sleep onset insomnia, parasomnias, morning sleep inertia, and daily bouts of both hyperactivity and hypoactivity [1,2,3,4,5,6,7,8,9,10,11,12,13,14]. New dimensional versus previous categorical research approaches which reflect these advances have made progress toward identifying dimensions of symptoms, or phenotypes, that are more likely to lead to evidence-based diagnosis and treatment Such an example is a novel phenotype of PBD called Fear of. The FOH phenotype includes symptoms that have not previously been associated with a nosological definition of bipolar disorder or other proposed childhood phenotypes of PBD [22]. Sleep Diaries, and nocturnal skin temperature variables using a wireless temperature monitoring device, in children diagnosed with bipolar disorder, who met criteria for the FOH phenotype. These data were compared between children with FOH with a control sample of healthy children. We hypothesized that relative to the controls, children with PBD/FOH would have difficulty dissipating heat at bedtime, and further that this thermoregulatory symptom would be associated with longer latencies to sleep
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