Alterations in skin temperature and sleep in the fear of harm phenotype of pediatric bipolar disorder

Patricia J Murphy, Mark G Frei, Demitri Papolos, Patricia J Murphy, Mark G Frei, Demitri Papolos

Abstract

In children diagnosed with pediatric bipolar disorder (PBD), disturbances in the quality of sleep and wakefulness are prominent. A novel phenotype of PBD called Fear of Harm (FOH) associated with separation anxiety and aggressive obsessions is associated with sleep onset insomnia, parasomnias (nightmares, night-terrors, enuresis), REM sleep-related problems, and morning sleep inertia. Children with FOH often experience thermal discomfort (e.g. feeling hot, excessive sweating) in neutral ambient temperature conditions, as well as no discomfort during exposure to the extreme cold, and alternate noticeably between being excessively hot in the evening and cold in the morning. We hypothesized that these sleep- and temperature-related symptoms were overt symptoms of an impaired ability to dissipate heat, particularly in the evening hours near the time of sleep onset. We measured sleep/wake variables using actigraphy, and nocturnal skin temperature variables using thermal patches and a wireless device, and compared these data between children with PBD/FOH and a control sample of healthy children. The results are suggestive of a thermoregulatory dysfunction that is associated with sleep onset difficulties. Further, they are consistent with our hypothesis that alterations in neural circuitry common to thermoregulation and emotion regulation underlie affective and behavioral symptoms of the FOH phenotype.

Keywords: Fear of Harm; actigraphy; distal-proximal temperature gradient; parasomnias; pediatric bipolar disorder; phenotype; sleep diary; sleep disturbance; sleep-onset latency; thermoregulatory deficit.

Figures

Figure 1
Figure 1
Skin temperature and sleep timing in three children: (a) 8-Year old male Control (red line = distal temperature; blue line = proximal temperature); (b) 12-Year old male Fear of Harm (FOH) (red line = distal temperature; blue line = proximal temperature); (c) 10-Year old female FOH (red line = distal temperature; blue line = proximal temperature).
Figure 2
Figure 2
Skin temperature relative to Bedtime. Smoothed curves from group averages of distal and proximal temperature from the 60 min before until 180 min after Bedtime; (a) Control (thin dotted line = distal; thick dotted line = proximal); (b) FOH (thin solid line = distal; thick solid line = proximal); (c) Control vs. FOH distal (dotted line = Control; solid line = FOH); (d) Control vs. FOH Proximal (dotted line = Control; solid line = FOH).
Figure 3
Figure 3
Relationship between interval from Bedtime to distal-proximal gradient of 0 degrees and sleep onset latency for individual nights with coincident Diary and skin temperature data from both Control and FOH subjects (Spearman’s rho = 0.48; p < 0.05).

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