F. Bat-Pitault

Depressive feelings in children with narcolepsy.

OBJECTIVES We aimed to evaluate depressive feelings and their correlations in children and adolescents with narcolepsy collected in national reference centers for narcolepsy. METHODS We compared clinical and sleep characteristics of patients with and without depressive symptoms evaluated on the Childrens Depression Inventory (CDI). RESULTS Our study sample included 88 children (44 boys; 44 de novo patients) with a mean age of 11.9 ± 3.1 years at diagnosis (37.5% were aged ⩽ 10 years). Obesity was found in 59% of the sample and cataplexy was present in 80.7%. The DQB1*0602 allele was positive in 93.5% of our sample. There were 25% of children who had clinically depressive feelings (CDI>16), especially girls older than the age of 10 years. Bivariate associations indicated that depressive feelings were associated with fatigue (48%), hyperactivity (31%), insomnia (16%), and excessive daytime sleepiness (EDS) (14-24%). In the multivariate model adjusted for gender and age, only fatigue explained the variability of the depression score. CONCLUSION In our large cohort, high levels of depressive symptoms essentially expressed by fatigue affected 25% of children with narcolepsy. The girls older than 10 years of age were especially vulnerable. The similar prevalence of depressive feelings in treated vs never-treated patients suggests a specific need for diagnosing and managing this symptom in young patients with narcolepsy.

Quality of Life in Children with Narcolepsy

To evaluate the health‐related quality of life (HRQL) and its correlates in children and adolescents with narcolepsy.

Autonomic Nervous System: A Biomarker of Neurodevelopmental Comportment- the AuBE Study

Background: While a dysfunction of the autonomic nervous system (ANS) determined from the cardio-respiratory rhythms in children may represent a key criteria in the physiopathology of possible neurodevelopmental disorders, the normal thresholds and profile of the ANS maturation during the two first years of life have not been established. Method : The Autonomic Baby Evaluation (AuBE) study is a prospective observational prospective single-center cohort following a population of 302 consecutive term and preterm newborns. The primary objective of the “AuBE” prospective cohort is to define the autonomic nervous system maturity profile obtained, during the two first years of life, by repeated polysomnography and 24-hour ECG recordings, with a time scale values for each autonomic indices of interest and the secondary objective is to determine, the potential influence of this autonomic profile, on sleep disorders and on cognitive development at the age of 3. Parental questionnaires on sleep quality of children and mood status of the mother are collected at birth and at 6, 12, 18 and 24 months (i.e. M0, M6, M12, M18 and M24). A psychometric status is measured at 3 years for all children. Results: Study population was included between September 2009 and September 2011. During these two years, a cohort of 302 children was recruited, including 271 (89.7%) term, and 31 (10.3%) preterm newborns. After an initial polysomnography at birth (M0), Holter ECG recordings ECG Holter recordings were performed at M6, M12 M18 and M24. A temporal and frequency domain analysis of the heart rate variability is being performed on each recording. Conclusion: The strength of this study, is based on the longitudinal organization of a large cohort of newborns (n=302) including physiological maturation of cardiorespiratory systems drive, together with the quantitative and qualitative analysis of sleep and neurological and psychomotor outcome. The demonstration of such a link between autonomic disorders in the neonatal period and the subsequent onset of sleep and/or psychomotor disorders 3 years later may improve the monitoring of neonates and help schedule early and adapted therapeutic interventions.

Sleep Trajectories Among Pregnant Women and the Impact on Outcomes: A Population-Based Cohort Study

Objectives Sleep problems and deprivation are common during pregnancy, particularly in the third trimester. Previous studies are mostly descriptive or focused on specific clinical groups and late pregnancy. We aimed to identify sleep duration trajectories during the pregnancy period, their associated factors, and impact on pregnancy and birth outcomes. Methods We studied 200 women from a mother–child cohort recruited in 2009–2011 from the French general population. We used semi-parametric models to analyze data collected through questionnaires. Results We detected three sleep duration trajectories during pregnancy: short-decreasing (<6.5h/night, 10.8% of the sample), medium-decreasing (6.5-8h/night, 57.6%), and long-increasing (>8h/night, 31.6%) trajectories. Factors associated with the short-decreasing trajectory relative to the medium-decreasing trajectory were older age (odds-ratio/year = 1.13 [95%Confidence-Interval 1.00-1.29]) and working > 28 weeks of gestational age (odds-ratio = 0.30 [0.10–0.90]). Sleep duration during pregnancy in this trajectory group was modified by insomniac symptoms (regression coefficient/trimester = −0.74 [Standard-Error 0.12]) and naps (regression coefficient/trimester = 0.58 [0.25]). Restless legs syndrome was the only factor associated with the long-increasing trajectory and decreased sleep duration (regression coefficient/trimester = −0.88 [0.25]). Assisted delivery (i.e. cesarean section and/or instrumental delivery) and post-partum depression were more frequent among women with the short-decreasing and long-increasing trajectories whereas cesarean section alone was more prevalent among those with the short-decreasing trajectory. Proportion of premature births was higher in the short-decreasing trajectory group. Birth-weight-z-score was lower in the long-increasing trajectory group. Conclusion We identified sleep trajectories among pregnant women with specific risk factors that could affect both pregnancy and birth outcomes. Taking these into consideration could improve both maternal and child health.

Altered sleep architecture during the first months of life in infants born to depressed mothers

OBJECTIVE This study investigated sleep architecture in newborn and six-month-old infants who were born to depressed mothers. METHOD Sixty-four healthy full-term infants (32 males and 32 females) participated in the study. Of these, 32 were high-risk infants who were born to mothers diagnosed with depression, and 32 were low-risk infants born to mothers without a personal history of depression. 24-hour polysomnography was recorded at zero and six months of age (M0 and M6). Sleep macro-structural parameters (total sleep time, TST; awake time; non-rapid eye movement, NREM sleep (%); rapid eye movement, REM sleep %; arousal index; and sleep efficiency) were analysed at M0 and M6. Micro-architectural sleep features (slow-wave activity, SWA; delta sleep ratio, DSR; spindle density; and rapid eye movement density) were calculated at M6. The data between high-risk and low-risk groups were compared using Students t-tests. RESULTS At M0 and M6, the high-risk infants showed more awake time and fewer arousals than the low-risk infants. However, the high-risk group had less NREM% at M0 and a shorter TST as well as less REM% at M6 than the low-risk group. At M6, the high-risk group showed higher SWA, higher DSR and lower spindle density in comparison with the low-risk group. CONCLUSIONS Altered sleep structure was observed during their first months of life in infants born from depressed mothers, thereby suggesting that the prenatal environment could enhance the depression vulnerability of the child and potentially decrease their neuroplasticity.

Schizophrénie à début précoce et agénésie partielle du corps calleux

We report a case of schizophrenia with partial agenesis of the corpus callosum in a 14-year-old girl. Diagnosis of schizophrenia was confirmed in the longitudinal follow-up and partial agenesis of the corpus callosum was found on brain MRI at the prodromal stage of disease. The prodromal symptom was progressive deterioration of social and academic adjustment in a context of non-specified psychotic disorder in the father. We found no abnormality in the development but a history of seizures that did not require specific treatment. Follow-up at 8 months showed an increase in negative symptoms and the onset of delusional symptoms and disorganization leading to the prescription of antipsychotic treatment. A review of the literature shows that agenesis of corpus callosum is the most reliable brain morphology abnormality in schizophrenia and is related to the neurodevelopmental and abnormal brain connectivity hypothesis in schizophrenia. Although this abnormality may be a marker of disease severity, our case report highlights the lack of longitudinal follow-up to allow the characterization of a specific outcome pattern of schizophrenic adolescents with partial agenesis of the corpus callosum.

Influence des facteurs pré et postnataux sur les caractéristiques du sommeil : données de l’étude prospective AUBE

Résultats.— Un total de 36,4 % des sujets avaient un index de MPJS (MPJSI) > 5/h, 22,4 % avaient un MPJSI > 15/h et 11 % un MPSI > 30/h. La fréquence des MPJS augmentait avec l’âge (coefficient de corrélation : r = 0,3 ; p < 0,0001). Nous avons trouvé aussi une corrélation positive entre le MPJSI et la tension artérielle systolique (TAS, r = 0,185, p < 0,0001) et la tension artérielle diastolique (TAD, r = 0,068, p = 0,008). La comparaison entre les différents groupes de sévérité (MPJSI < 5/h, MPJSI = 5—15/h, MPJSI < 15—30/h, MPJSI > 30/h) montre une augmentation progressive significative de la TAS (122 ± 15,8, 123,7 ± 16,7, 126,5 ± 18,5, 129,9 ± 16,8 mmHg respectivement ; p < 0,001) et une tendance vers une augmentation de la TAD (moyenne 77,4 ± 10,4, 78 ± 10,1, 78,3 ± 11, 79,7 ± 10,8 mmHg respectivement ; p = 0,078). Conclusion.— La présence de MPJS est fréquente dans la population générale adulte. Leur prévalence augmente avec l’âge et ils semblent associés à une augmentation de la tension artérielle.