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

J C Cousins,E E Forbes,D J Whalen,J S Silk,N D Ryan,R E Dahl,T M Olino

doi:10.1093/jpepsy/jsr036

Abstract

This study examines relationships between affect and sleep in youth with affective disorders using ecological momentary assessment (EMA). Participants included 94 youth, ages 8-16 (M = 11.73, 53% female) years with an anxiety disorder only (n = 23), primary major depressive disorder (with and without a secondary anxiety diagnoses; n = 42), and healthy controls (n = 29). A cell phone EMA protocol assessed affect and actigraphy measured sleep. The patterns of bidirectional relationships between affect and sleep differed across diagnostic groups. Higher daytime positive affect and positive to negative affect ratios were associated with more time in bed during the subsequent night for youth with primary depression and less time in bed for youth with anxiety only. More time asleep was associated with more positive affect for both diagnostic groups the following day. This relationship may be important to consider in the treatment of youth affective disorders.

Highlights

We focused on five commonly used sleep variables to ascertain how youth were sleeping at night: (a) the total amount of time spent in bed at night (TIB); (b) total sleep time (TST); (c) sleep onset latency, or the time between trying to sleep and sleep onset, represented in minutes (SOL); (d) wakefulness after sleep onset, the total number of minutes spent awake at night after sleep onset (WASO); and (e) sleep efficiency (SEf), which is the percentage of time spent sleeping while in bed
Reports of greater negative affect during the day were associated with less time spent awake that same night for youth diagnosed with primary MDD (B 1⁄4 –.68, SE 1⁄4 .34, p 1⁄4 .05); this was not the case for youth with ANX only or healthy controls
Reports of PA and the PA/NA ratio during the day were associated with the amount of time spent sleeping and the amount of time spent in bed the following night; the relationship differed across diagnostic group

Summary

Methods

This report includes data of a longitudinal clinical assessment study of neurobehavioral factors in pediatric affective disorder (Birmaher et al, 2000). The data presented are from the first 2 weeks of an 8-week protocol. Participants included 94 youth (53% female), ages 8–16 years (M 1⁄4 11.73). The majority of the participants identified themselves as Caucasian (88%), with the remaining participants identified as African-American (7%), Hispanic (3%), and biracial (1%).

Results

Discussion

Conclusion