george capone: characterizing depression and coexisting sleep disorders in adolescents & adults with...

7/27/2019 George Capone: Characterizing Depression and Coexisting Sleep Disorders in Adolescents & Adults with Down Syndrome

1/20

Characterizing Depression and Coexisting Sleep

Disorders in Adolescents & Adults with DownSyndrome

George T Capone, MDDirector, Down Syndrome Center

Kennedy Krieger Institute

Baltimore, Marylandwww.kennedykrieger.org


2/20

DownSyndrome&MentalHealth

AAP Health Supervision Guidelines for Children (2011)Healthcare Guidelines for Adults?Depression, anxiety, other MH concerns


3/20

MentalHealthConcernsinAdolescents

&Adults

A9meforconcernedparen9ng

LifeEvents:psychosocialstressors,rela9onships,transi9ons Social:self-awareness,keepingupatwork-school,thebigpond

Lifestyle:socialrela9onships,exercise,ac9vitylevel Puberty:hormones&re-organiza9onofbrainconnec9ons Medicalcondi9ons:appe9te-weight,sleep,generalhealth

Trisomy21:con9nuingimpactonbrainfunc9onthroughoutlife?


4/20

ChallengesManagingMentalHealth

Disorders

DiscomfortwithMentalHealthIssuesinDS/ID LimitedresourcesforMentalHealthandID

Diagnos9covershadowing(DSorAD) Diagnos9cuncertainty-complexsymptompresenta9on Therapeu9cuncertainty-


5/20

Depression&DownSyndrome

Mood,anxiety,compulsivedisordersincreasepost-puberty(10-15%)

Grief,bereavementoradjustmentreac9on?IsNOTMajorDepression

DepressionmayseemtoappearunexpectedlyIsageassociatedwithriskofMajorDepression?

Mostcommonbetween15-25yr Male=Female DoesNOTappeartoshowalinearincreasewithage Demen9aprodromevsotherrisk-factors?


6/20

MajorDepressiveEpisode&DownSyndrome

Warrenetal.(18)reportedonyoungadults

Dis9nguishedmajordepressionfromAD-typedemen9a

Symptom-complexincluding:

Apathy,socialwithdrawal Func9onaldeclineincogni9ve-adap9veskills Psychomotorslowing Deteriora9onfromanestablishedbaseline

Confirmatoryreports:

Cooper&Collaco`(10s),Myers&Pueschel(15),Prasher(16) Khanetal(2002),Walkeretal(2011)forreviews


7/20


8/20

Case-ControlStudy:DS+MajorDepression

RecruitedthroughDSClinicatKKI

Diagnos(cGroups DSSubjects Func(onal

decline

MajorDepressiveEpisodeMDE) N=1 13(68%)MDE+Psychosis N= 6(66%)Ageatevalua(onyears) 21.0+5Symptomdura(onmonths) 12.8+.1

MentallyHealthyDSControls) N= 0Ageatevalua(onyears) 1.8+7.1


9/20

ThyroidFunc9on

MDE Controls

Thyroid Status N=28 N=9

Thyroid supplement 11/28 (39%) 4/9 (44%)

Euthyroid (TSH 0.5-5.5 uIU/ml) 27 (96%) 9 (100%)

Compensated (TSH > 5.5uIU/ml;normal T4)

1 0

Hypothyroid (low T4) 0 0


10/20


11/20

ReissScalesofChildrensDualDiagnosis

0

1

2

3

4

5

6

Anger

Anxiety

A`en9on

Au9sm

Conduct

DepressionSelf-Esteem

Psychosis

Somatoform

Withdrawn

OtherBehavior

"Spider-Graph"CompositeMDEvsControlsMDE Controls


12/20

IsThereanAssocia9onbetween

DepressionandSleepApnea?


13/20

NeuroanatomyofSleepApneainAdults

Brain MRI

Red = significantlyincreased gray

matter loss

Macey, et al 2002

Lal, et al 2012


14/20

SleepApnea:Severity&TonsillectomyStatus

MentalHealth

Diagnosis%with

Sleep

Apnea

Mod-

Severe

Apnea

N=16

Mild

Apnea

N=12

No

Apnea

N=9

Previous

tonsil

removal

N=15

Majordepressive

episodeMDE)N=28 86% 1554%) (32%) 4(14%) 12(43%)

NomentalhealthdiagnosisN=9 44% 1(11%) 3(33%) 555%) 3(33%)


15/20

RespiratoryEvents&Oxygena9onData

MDE Controls RespiratoryEvents N=28 N= t-test

Apnea/HypopneaIndexn/hr) 18.814.7 4.53.8 .001REM-Apnea/HypopneaIndexn/hr) 35.835. 11.10.2 .01RespiratoryDisturbanceIndexn/hr) 24.324.6 7.37.3


16/20

SleepArousalData

MDE Controls Arousals N=28 N= t-test

TotalArousalIndex 22.420.1 16.415.7 NSRespiratoryArousalIndex 14.917.9 2.73.1


17/20

SleepStageData MDE Controls

SleepArchitecture N=28 N= t-testSleepEfficiency%) 70.520.3 77.316.2 NSN1TST%) 6.07.2 6.55. NSN2TST%) 58.520.3 58.12.5 NSN3TST%) 25.016.7 21.25.0 NSREMTST%) 8.37.5 12.16.4 .15tREMlatencymin) 187.5106.2 227.165.0 NS


18/20

Limita9onsofthisStudy

SyndromeofCo-exis9ngDepression+OSA(notcharacterized)

Delayinpresenta9on-diagnosis(symptomseverity-reversibility)

Dura9onofsleep-respiratorysymptoms(chronicstress)

Medica9oneffectsonsleeppa`ern Otherpsychosocialstressors(triggers?) Demen9aprodrome(amyloid,monoamines)? Case-controldesigndoesnotaddresscausality Carefullymatchedcontrols


19/20

FurtherResearchonSleepApnea&Depression

CausalityorCo-Morbidity?

Researchsleepstudies:mul9plenights,medica9onnavesubjects

Characterizeandmeasure:

Psychiatricsymptomsandcogni9vefunc9on Social-adap9veskills,func9onaldecline Lifeevents,impactoncaretakers

Biomarkers:fordepression&OSA

Biologicalpsychologicalvulnerability(individualriskfactors)Clinicalinterven9onstudies:

Standardofcaretreatments:medica9ons,weightloss,CPAPorENTairwaymanagement


20/20

ThankYou

george capone: characterizing depression and coexisting sleep disorders in adolescents & adults with...

Documents