Sleep disturbances in anorexia nervosa subtypes in adolescence
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ORIGINAL ARTICLE
Sleep disturbances in anorexia nervosa subtypes in adolescence Flora Bat‑Pitault1,2 · Catarina Da Silva1,2 · Isabelle Charvin1 · David Da Fonseca1,2 Received: 30 April 2020 / Revised: 23 September 2020 / Accepted: 25 September 2020 © Springer Nature Switzerland AG 2020
Abstract Purpose This retrospective study investigated, for the first time, sleep characteristics in anorexia nervosa (AN) subtypes and the clinical profile in adolescents, as well as the quality of life (QoL) and emotionality in these patients with poor sleep. Methods The sample included 111 adolescents with AN. First, restrictive AN (ANR) and binge eating/purging AN (ANB/P) groups were compared in terms of self-reported sleep characteristics, sleepiness and chronotype. Second, the clinical profile, QoL, and emotionality of good sleepers (GS) and poor sleepers (PS) were compared. Results Compared to the ANR group, participants with ANB/P showed significantly greater sleep disturbances and sleepiness, and also a higher preference for an eveningness chronotype. Results also showed a clinical profile significantly more severe in PS than in GS. After adjustment, only the ANB/P subtype and the EDI-2 ineffectiveness subscale remained significantly linked to poor sleep. Moreover, the QoL was lower and emotionality more negative in PS with respect to GS. Conclusion Findings suggest that subjective sleep disturbances may be used as a clinical marker for AN severity and for ANB/P subtype. Importantly, findings suggest that improving sleep quality in adolescents with AN may help managing their ED and their comorbidities, but also improve their QoL. Level of evidence Level V, descriptive study (evaluation data retrospectively studied). Keywords Anorexia nervosa · Sleep · Chronotype · Clinical marker · Adolescent
Introduction and aims Anorexia nervosa (AN) is an eating disorder characterized by a restriction of energy intake, a fear of weight gain and a disturbed body shape perception, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5, [1]). The lifelong prevalence of this disorder is high, estimated at 0.3–0.9% in adolescents and young adults [2]. Moreover, the somatic consequences linked with weight loss are considerable and despite a multidisciplinary management, the rates of relapse and mortality remain high. The article is part of the Topical Collection on Sleep and Eating and Weight Disorders. * Flora Bat‑Pitault Flora.bat@ap‑hm.fr 1
Child and Adolescent Psychiatry Unit, Salvator Hospital, Public Assistance‑Marseille Hospitals, AixMarseille University, 249 Boulevard Sainte‑Marguerite, 13009 Marseille, France
Institute of Neuroscience Timone, CNRS, Aix-Marseille University, Marseille, France
2
Thus, AN continues to be a major public health concern, and the improvement of its management remains a challenge in the actual agenda. Among these somatic consequences, sleep disturbance is often reported by patients [3]. Surprisingly, the literature about sleep in AN is limited and rema
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