الفهرس 
Anatomy and Physiology of SleepOnly 14 pages are availabe for public view
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Abstract
Childhood is generally considered the golden age of sleep, with brief latency to sleep onset, high efficiency, and easy awakening; yet parasomnias, psychological factors, and sleep disturbances associated with childhood depression disrupt this idealistic notion. Many children, adolescents, and adults with depression report chronic difficulties with falling asleep, awakening and/or maintaining adequate daytime alertness.
Many polysomnographic studies have failed to find objective evidence of these disturbances, despite clinical evidence of subjective sleep complaints in depressed children.
The work in our thesis divided into 2 main parts:
A. Our comparative review aims to find the relation between sleep profile disturbances and depression in children regarding, etiology, clinical picture, treatment.
B. In the clinical part of our thesis, we select our cases very sensitively to exclude factors that may affect the sleep profile of our depressed children to get the aim of our study. Therefore, our results were promising, despite the presence of some limitations that hinders generalization and lead us to end our thesis with some recommendations for future research.
A-Review:
Chapter (I): Anatomy and physiology of sleep
Chapter (II): Sleep studies
Chapter (III): Depression in children.
Chapter (IV): Pediatric sleep disorders.
Chapter (V): Interplay of sleep and depression.
Chapter (VI): Treatment of sleep disturbances in children.
Chapter (VII): Treatment of depression in children.
B -Clinical part
Subjects and Method:
1) Patient group:
The sample consists of 20 Egyptian children diagnosed with depression.
Selection of cases:
The cases were selected randomly from patients attending the child psychiatry clinic in the Institute of Psychiatry, Ain Shams University Hospital. This clinic has been working since 20 years. The flow of patients is around 30-50 patients per day 6 days a week. It serves a large catchment’s area in Cairo and other governorates.
The study was performed in the period from (July 2011) till (March 2012). Our study is considered as a cross sectional case control study. An informed written consent was obtained from the parents and a verbal assent from the child.
2) Control Group:
The control group consists of 20 Egyptian children with no apparent physical or psychiatric morbidity selected randomly (non-referred community sample). They were matched for age, sex, and other demographic variables as far as possible with the patient group
Methods
1) Patient group:
The history and examination were obtained using the psychiatric institute sheet for assessment of children, and patients were diagnosed according to the (DSM-IV) research criteria.
After the diagnosis was established, each patient and a close reliable family member were subjected to the following:
a. The (MINI Kid-Arabic version) which is a structured interview: for fulfilling the inclusion and exclusion criteria. This Arabic version questionnaire that was developed by Ghanem et al. (2000) is based on the (MINI Kid) that was developed by Sheehan et al. (1998).
b- The (Child sleep Habits questionnaire CSHQ Arabic version) which is a structured interview for assessment of the sleep–wake profile of the children. The questionnaire of 33 items was develop by Owens et al., (2000) was used in its Arabic version was develop by Asaad and Kahla (2001)
2) Control Group:
The control group were subjected to the same structured questionnaires, investigations and polysomnography.
The main findings in the study were:
1- characteristics of the sample:
The study sample consisted of 30 children, 20 cases and 10 controls, distributed: 60% were males (n=12) and 40% were females (n=8), with age range from 8-12 years (mean 9.95) for cases, among controls 60 % were males (n=6) and 40 % were females (n=4) with age range from 8-10 years (mean 10.3).
Our sample (cases and controls) were matched regarding age, sex, religion and education.
2- Sleep Profile:
Our study yielded great significance of many sleep parameters in our study cases compared to controls (except for Age, REM, REMD and I.Q which showed no significance maybe due to the small sample size):
Increased sleep latency in cases compared to controls, decreased sleep efficiency, increased stage NI, increased stage NII, decreased stage NIII (deep sleep), decreased REM latency, increased bed time resistance, increased time to sleep, decreased sleep period, marked increase in sleep related anxiety, with relevant increased DOES (with no significance to age, REM sleep or REM density).
Discussion and Conclusions:
When we compared our results with the results of the previous studies we found multiple differences that we referred to the diversity in methodology; but we concluded that the greatest common multiple that agreed upon by most of the studies and also ours is that children with
Polysomnographic studies of adults with major depression have consistently yielded some common findings that turned out to be similar to those in depressed children which proposes that sleep architecture changes in adults and children with depression are not heterogeneous per say, similarly, Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), demonstrates that the basic symptoms of a major depressive episode are the same in adults, adolescents and children.
Recommendations:
Clinical recommendations:
1) Increasing awareness of psychiatrists and all mental health workers regarding the importance of managing sleep problems in improving the care delivered to children with Depression. This can be achieved through clinical teaching and workshops.
2) Expanded educational efforts at all training and practice levels regarding the underlying causative factors, clinical presentation, and differential diagnosis of depressed children (as underdiagnosed) and sleep disorders in infants, children, and adolescents should clearly be a goal for the pediatric community.
Research recommendations:
1) Replication of this study in a larger scale that includes the various governorates of Egypt with the following objectives:
2) Further establishment of the validity of the sleep profile in depressed children compared to adults.
3) Determine the effects of variables on the sleep profile like the presence comorbidities and other variables (e.g. other mood disorders and subtypes of depression) and the effect of family history of mood disorders.
4) Implementation of protocols for sleep research including precise inclusion and exclusion criteria.
5) Comparing sleep profiles in different subtypes of depression with that of affective disorders, Learning disabilities and the effect of using anti-depressants in future studies.