Association of sleep with emotional and behavioral problems among abused children and adolescents admitted to residential care facilities in Japan

<div><p>Background</p><p>The psychological care of abused children in the child protection system is an urgent issue in Japan. Child abuse has a serious impact on children’s emotion and behavior, but there is virtually no evidence about how child abuse affects sleep, which is closely related to behavioral and emotional control. In this study, we sought to identify sleep habits and suspected sleep disorders among abused children and adolescents admitted to residential care facilities in Japan and to investigate their association with emotional and behavioral problems.</p><p>Methods</p><p>The study targeted 273 abused children and adolescents (age range: 4 to 15 years) who had been admitted to a residential care facility in Japan. They were assessed by physicians and other personnel at facilities with expertise in childcare and abuse. Respondents completed a brief sleep questionnaire on the incidence of problematic sleep habits and suspected sleep disorders as well as a questionnaire on emotional and behavioral issues.</p><p>Results</p><p>Approximately 40% of the abused children and adolescents had some sleep-related symptoms at bedtime and waking, and 19% had suspected sleep disorder. Abused children with emotional and behavioral problems had a significantly higher incidence of suspected sleep disorders than abused children without such problems, and this incidence was particularly high among those with antisocial behavior and depressive behavior. Our predictive model also showed that antisocial behavior and depressive behavior were significant predictors of suspected sleep disorders.</p><p>Conclusion</p><p>Careful assessment and appropriate therapeutic intervention for sleep disorders are required in abused children and adolescents with emotional and behavioral problems.</p></div

Demographic and background characteristics of abused children.

<p>Demographic and background characteristics of abused children.</p

Incidence of emotional and behavioral problems by presence/absence of suspected sleep disorder in abused children.

<p>Incidence of emotional and behavioral problems by presence/absence of suspected sleep disorder in abused children.</p

Sleep habits and incidence of sleep-related symptoms and sleep disorders by presence/absence of emotional and behavioral problems in abused children.

<p>Sleep habits and incidence of sleep-related symptoms and sleep disorders by presence/absence of emotional and behavioral problems in abused children.</p

DataSheet_1_Association between sleep duration and antibody acquisition after mRNA vaccination against SARS-CoV-2.docx

IntroductionSleep enhances the antibody response to vaccination, but the relationship between sleep and mRNA vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is not fully understood.MethodsIn this prospective observational study, we investigated the influence of sleep habits on immune acquisition induced by mRNA vaccines against SARS-CoV-2 in 48 healthy adults (BNT-162b2, n=34; mRNA-1273, n=14; female, n=30, 62.5%; male, n=18, 37.5%; median age, 39.5 years; interquartile range, 33.0–44.0 years) from June 2021 to January 2022. The study measured sleep duration using actigraphy and sleep diaries, which covered the periods of the initial and booster vaccinations.ResultsMultivariable linear regression analysis showed that actigraphy-measured objective sleep duration 3 and 7 days after the booster vaccination was independently and significantly correlated with higher antibody titers (B=0.003; 95% confidence interval, 0.000–0.005; Beta=0.337; p=0.02), even after controlling for covariates, including age, sex, the type of vaccine, and reactogenicity to the vaccination. Associations between acquired antibody titer and average objective sleep duration before vaccination, and any period of subjective sleep duration measured by sleep diary were negligible.DiscussionLonger objective, but not subjective, sleep duration after booster vaccination enhances antibody response. Hence, encouraging citizens to sleep longer after mRNA vaccination, especially after a booster dose, may increase protection against SARS-CoV-2.Study registrationThis study is registered at the University Hospital Medical Information Network Center (UMIN: https://www.umin.ac.jp) on July 30, 2021, #UMIN000045009.</p

Values of spectral analysis and sleep variables for the sleep control (SC) and sleep debt (SD) sessions; <i>t</i> and <i>p</i>-values for SC vs. SD with the paired <i>t</i>-test.

<p>Data are expressed as mean (standard deviation) values; SC, sleep control; SD, sleep debt; SWS, slow wave sleep.</p><p>SWS_{2 h}, slow wave sleep of first 2 h from sleep onset; Delta_{2 h}, Delta wave power (0.5–4 Hz) of first 2 h from sleep onset.</p><p>Degrees of freedom (df) = 13.</p

Correlation between amygdala activation and amygdala–vACC functional connectivity.

<p>Amygdala activation in response to fearful facial stimuli was negatively correlated with amygdala-vACC functional connectivity, <i>r</i>(13) = .64, <i>p</i> = .0001. The selected seed region within the amygdala was a cluster that showed greater functional connectivity with vACC in the SC than SD condition (<i>p</i><0.001, uncorrected). Data from the SC and SD sessions were combined and plotted in one graph but differently colored; SD data in squares, SC in triangles. vACC, ventral anterior cingulate cortex; SC, sleep control condition; SD, sleep debt condition.</p

Difference in amygdala activation between the sleep control (SC) and sleep debt (SD) sessions.

<p>The map shows significantly greater activation in response to fearful face stimuli in the SD than SC session. Significant differences were seen in the left amygdala, peak MNI coordinate (<i>x</i>, <i>y</i>, <i>z</i>) = (−14, 4, −18) mm, <i>T</i>(13) = 5.60, <i>p</i> = .0001, <i>k</i> = 8 contiguous voxels. A similar trend was also observed in the right amygdala, (<i>x</i>, <i>y</i>, <i>z</i>) = (18, 2, −18) mm, <i>T</i>(13) = 3.41, <i>p</i> = .0005, <i>k</i> = 7. Significant clusters are rendered on a T1 anatomical referential image displayed in neurological convention, with the left side corresponding to the left hemisphere. The clusters shown are thresholded with a lenient alpha level (<i>p</i><0.01, <i>k</i>>5) for visualization purposes. MNI, Montreal Neurological Institute template.</p

Experimental protocol.

<p>The study was conducted in a randomized crossover design, involving a sleep control (SC) and sleep debt (SD) session (for 5 days in each session) with a 2-week interval between the sessions. In the observational session before the experiment, participants visited the laboratory for a briefing session and gave their informed consent. One week later, participants came to the lab for PSG screening. One week after the PSG screening, the experimental sessions were started, with the order of the sessions counter-balanced across participants (i.e., SC-SD or SD-SC). Participants stayed at home on days 1–3 within each SC and SD session, according to the restrictive sleep-wake schedule that had been already instructed in the briefing (i.e., sleep time of 8 h for SC and 4 h for SD). Participants came to the lab on night 3 of the SC and SC sessions and spent the rest of the sessions (i.e., 2 days per session) in the sleep-lab with their sleep time controlled as instructed. On nights 3 and 4 in each session, participants underwent PSG measurement in the lab. On day 5, they completed questionnaires to check their mood state and sleepiness followed by fMRI scanning with an emotional task. SC, sleep control; SD, sleep debt; PSG, polysomnography; SSS, Stanford Sleepiness Scale; STAI, State-Trait Anxiety Inventory; POMS, Profile of Mood States.</p

Difference in functional connectivity between sleep control (SC) and sleep debt (SD) sessions.

<p>The map shows greater functional connectivity between the left amygdala and other voxels in the brain in SC than SD session. Significant differences were found in the vACC, peak MNI coordinate (<i>x</i>, <i>y</i>, <i>z</i>) = (14, 32, −4) mm, <i>T</i>(13) = 4.77, <i>p</i> = .0001, <i>k</i> = 9 contiguous voxels. The significant cluster with a stronger connection with the left amygdala is rendered on a T1 anatomical referential image displayed in neurological convention, with the left side corresponding to the left hemisphere. The clusters shown are thresholded with a lenient alpha level (<i>p</i><0.01, <i>k</i>>5) for visualization purposes. MNI, Montreal Neurological Institute template; vACC, ventral anterior cingulate cortex.</p