Peeking into the minds of troubled adolescents: The utility of polysomnography sleep studies in an inpatient psychiatric unit

Abstract

Background: Sleep problems are commonly associated with the primary diagnostic criteria for many psychiatric disorders. Evidence suggests sleep disturbances may precede development of psychiatric disorders and the severity of psychopathology reflects the severity of sleep problems. Polysomnography (PSG) sleep studies in child and adolescent psychiatric populations, a particularly at risk group, has considerable value but has been more elusive requiring further investigation. Methods: We performed a retrospective chart review of PSG sleep studies and psychiatrist evaluations of 106 adolescents aged 7-16 admitted to an involuntary adolescent psychiatric inpatient facility. Results: Less than 5% of cases had mild/no sleep problems. Hyperarousal hallmarked this population, and severity of sleep disturbances trends with the severity of psychopathology. Inpatients with multiple psychiatric disorders had greater frequencies of insomnia, decreased sleep efficiency, and arousals from SWS (p < 0.05). Inpatient's with self-harm behavior more frequently had elevated sleep onset latency (SOL), reduced efficiency, reduced SWS (p < 0.05), increased REM, and reduced REM latency compared to inpatients with dysthymia and/or depression. Limitations: Lacking an a priori hypothesis, this study was explorative and uncontrolled for factors such as medications. This notwithstanding however, analysis indicates the majority of inpatients were taking cocktails that "should" alleviate sleep symptoms suggesting greater associations may prevail in unmedicated populations. Conclusions: This study attests to the potential clinical utility of PSG sleep studies in the management of adolescent psychiatric disorders and contributes to the body of evidence reputing the intimate connection between sleep problems and the development and perpetuation of psychopathology with public health implications. © 2012 Elsevier B.V. All rights reserved.