Sleep Subtypes in Adolescent Depression

Study Overview
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Brief Summary
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The purpose of this study is to compare sleep neurophysiology and behavior in adolescents with MDD with hypersomnia (MDD-HYP) and insomnia (MDD-INS) with healthy controls (HC). In addition, the investigators will test the efficacy of a simple behavioral sleep restriction on mood and sleep in their sample.

Detailed Description
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The World Health Organization has identified depression as the leading cause of burden of disease amongst young people. Subjective sleep complaints are often a core symptom of depression and highly prevalent with 60-90% of depressed adolescents suffering from disrupted sleep. This sleep disruption often takes the form of insomnia (e.g., difficulty falling or staying asleep, or waking too early) or hypersomnia (prolonged sleep episodes or excessive daytime sleepiness). The aim of the trial is to examine the efficacy of a simple behavioral sleep restriction two weeks in duration on mood and sleep in adolescents ages 14 to 17 years with and without major depressive disorder. During this period sleep is objectively measured using actigraphy and monitor mood using self-report. The results of the study will inform whether a simple behavioral sleep restriction beneficially impacts mood and sleep.

Official Title
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Sleep Subtypes in Adolescent Depression: Sleep Physiology and Treatment

Conditions
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Major Depressive Disorder

Intervention / Treatment
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* Behavioral: Behavioral Sleep Restriction


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: - This study will recruit adolescents (ages 14 to 17 years) with major depressive disorder (MDD) with insomnia (MDD-INS) and with hypersomnia (MDD-HYP) and age and gender matched controls (HC). Inclusion Criteria: Key inclusion criteria for MDD Hypersomnia Group: MDD as determined through the MINI-KID Determination of hypersomnia as defined by excessive daytime sleepiness, or long sleep duration. Written informed consent Key inclusion criteria for MDD Insomnia Group: MDD as determined through the MINI-KID Determination of insomnia as defined by the insomnia severity index Written informed consent Exclusion Criteria: Key exclusion criteria for all three groups include: Current or lifetime experience of frank psychosis or mania Presence of suicidal intent representing imminent risk as indicated during clinical interview Medical or neurological condition that could impact brain functioning History of physical brain injury or blow to the head resulting in loss of consciousness greater than 5 minutes Do not meet criteria for substance or alcohol dependence in the last three months Presence of an organic sleep disorder (e.g., narcolepsy, sleep apnea) Additional exclusion criteria for healthy control group: Presence of psychiatric disorder Self-reported disrupted, short or ill-timed sleep Additional exclusion criteria for MDD-INS and MDD-HYP: • No sleep difficulties

Ages Eligible for Study
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Minimum Age: 14 Years
Maximum Age: 17 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Behavioral Sleep Restriction<br>Participants will be required to go to sleep half an hour later than their usual bedtime. Wake up time will be determined via their usual wake time. | Behavioral: Behavioral Sleep Restriction<br>* Participants will be instructed to go to bed 30 minutes later than their usual bedtime. On the other hand, wake up time will be unchanged resulting a nightly sleep restriction of 30 minutes. This protocol will be followed for two weeks.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in self-reported sleep efficiency (defined as total sleep time divided by time in bed and thus expressed as a percentage) as assessed via sleep diary | Changes in self-reported sleep efficiency will be measured via sleep diary. The data will be collected by ecological momentary assessment (EMA). Time in bed (TIB) is defined as the time between participants reporting going to bed and waking up. Total sleep time (TST) is defined as TIB minus the amount of time participants report taking to fall asleep (sleep onset latency; SOL) and the duration of waking after sleep onset (WASO). | Two weeks | 
| Change in self-reported mood assessed via the Multidimensional Mood Questionnaire | Changes in self-reported mood will be measured via ecological momentary assessment. Participants will fill out the Multidimensional Mood Questionnaire four times a day (morning, after school, at dusk and 30 minutes before bedtime). The Multidimensional Mood Questionnaire assesses the state happy/sad on a visual analog scale from 0 to 100. The mean across the day will be calculated. | Two weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Repetitive Negative Thinking (focus on problems) assessed by one question from the Response Style Questionnaire | Change in repetitive negative thinking will be measured via ecological momentary assessment. Participants will answer the question about focus on problems on a scale from 0 [not at all] to 100 [very much]) once a day (evening). | Two weeks | 
| Change in Repetitive Negative Thinking (focus on feelings) assessed by one question from the Response Style Questionnaire | Participants will answer the question about focus on feelings on a scale from 0 [not at all] to 100 [very much]) once a day (evening). | Two weeks | 
| Change in depressive symptoms from 1 to 3 days prior to the sleep manipulation and the end of the manipulation (second to last or last day of sleep manipulation) | The change in depressive symptoms from 1 to 3 days prior to the sleep manipulation and the end of the manipulation (second to last or last day of sleep manipulation) will be measured via Center for Epidemiological Studies-Depression (CES-D; measures symptoms associated with depression), Strengths & Difficulties Questionnaires (SDQ; measures strengths and difficulties in general) and the Assessment of Snaith-Hamilton Pleasure Scale (SHAPS; assesses the presence of anhedonia [the inability to experience pleasure]. | Two weeks | 
| Change in anxiety symptoms from 1 to 3 days prior to the sleep manipulation and the end of the manipulation (second to last or last day of sleep manipulation) | The change in depressive symptoms from 1 to 3 days prior to the sleep manipulation and the end of the manipulation (second to last or last day of sleep manipulation) will be measured via Screen for Child Anxiety-Related Emotional Disorders (SCARED; screens anxiety disorder categories). | Two weeks |