Triple Vulnerability? Circadian Tendency, Sleep Deprivation and Adolescence

描述（由申请人提供）：与早晨类型（“云雀”）相比，表现出昼夜节律倾向于晚上的青少年（“夜猫子”）遵循延迟的睡眠时间表，在白天晚些时候增加活动，并且更晚睡觉和起床。青少年时期的昼夜节律倾向于晚上，这是社会心理、行为和生物因素的共同作用的结果，是恶性循环的重要促成因素，甚至可能是恶性循环的原因，恶性循环加剧了健康状况不佳和主要精神病理学形式的脆弱性和风险。事实上，晚上的昼夜节律倾向与广泛的不良影响有关，包括健康状况较差，学习成绩较差，自我调节较差，更多地使用物质，更容易冲动，更多的抑郁和焦虑，更大的情绪不稳定以及更多的攻击性和反社会行为。虽然在青春期向晚上的生物转变可能很难改变，但心理社会和行为因素是可以改变的。此外，修改这些贡献者将消除加剧生物转变的关键因素。拟议的研究将推进目前的知识的作用，晚上作为一种机制，有助于在青春期较差的结果。我们的目标是通过创新的干预措施减少10-18奥尔兹少年的夜间活动; BRIGHT干预（健康成长青少年的生物节律干预），它整合了来自昼夜节律系统基础研究的循证治疗。我们将随机分配具有夜间昼夜节律倾向的青少年，以及在五个健康领域（情感，认知，行为，社会，身体）中至少有一个“处于危险之中”的青少年：（a）BRIGHT（n = 86）或（B）心理教育（n = 86）。将在治疗前、治疗后以及治疗后6个月和12个月采取措施。待检验的假设是，相对于心理教育，BRIGHT将与治疗结束时睡眠和五个健康相关领域的改善相关，并且这些改善将在6个月和12个月后保持。计划的次要分析包括评价BRIGHT相对于心理教育对早期内源性昼夜节律阶段变化以及光照时间和强度变化的影响。中介分析将检查改善睡眠或改变光照时间是否有助于降低五个健康领域的风险。还将评估由于基线人口统计学（性别、年龄、青春期状态）、基线睡眠和其他风险指标导致的干预效果变化的适度分析。多种方法包括自我报告，生态瞬时评估，行为任务和生物措施。多个告密者包括青年、家长和教师。这项研究是一项长期计划的第一步，旨在加速了解简单，可传播的心理社会干预措施对发育中的神经系统的潜在强大积极影响，这些干预措施专门针对青少年中可改变的风险因素。

DESCRIPTION (provided by applicant): Teens who exhibit a circadian tendency toward eveningness ('night-owls') follow a delayed sleep schedule, increasing activity later in the day and both going to sleep and getting up later, compared to morning-types ('larks'). The circadian tendency toward eveningness during adolescence arises from a confluence of psychosocial, behavioral and biological factors and is an important contributor to, and maybe even cause of, vicious cycles that escalate vulnerability and risk for poor health and major forms of psychopathology. Indeed, an evening circadian tendency has been associated with a wide range of adverse effects including poorer health, poorer academic performance, poorer self-regulation, greater use of substances, greater tendency for impulsivity, more depression and anxiety, greater emotional instability and more aggressive and antisocial behavior. While the biological shift toward eveningness during puberty may be difficult to modify, the psychosocial and behavioral contributors are modifiable. Moreover, modifying these contributors will eliminate key factors that exacerbate the biological shift. The proposed research will advance current knowledge on the role of eveningness as a mechanism contributing to poorer outcomes during adolescence. We aim to reduce eveningness among 10-18 year olds via an innovative intervention; the BRIGHT intervention (Biological Rhythm Intervention for Growing Healthy Teens) which integrates evidence-based treatments derived from basic research on the circadian system. We will randomly allocate adolescents with an evening circadian tendency, and who are 'at risk' in at least one of five health domains (emotional, cognitive, behavioral, social, physical), to either: (a) BRIGHT (n = 86) or (b) Psychoeducation (n = 86). Measures will be taken pre-treatment, post-treatment, and at 6 and 12 months post-treatment. The hypothesis to be tested is that BRIGHT, relative to Psychoeducation, will be associated with improvement in sleep and the five health-relevant domains at the end of treatment and that these gains will be maintained 6 and 12 months later. Planned secondary analyses include an evaluation of the effects of BRIGHT, relative to Psychoeducation, on change to an earlier endogenous circadian phase and change in the timing and intensity of light exposure. Mediation analyses will examine whether improved sleep or a change in the timing of light exposure contributes to reduced risk in the five health domains. Moderation analyses of variation in intervention effect due to baseline demographics (gender, age, pubertal status), baseline sleep and other risk measures will also be evaluated. Multiple methods include self report, ecological momentary assessment, behavioral tasks and biologic measures. Multiple informers include youth, parent/s and teacher. This research is a first step within a longer term plan to accelerate knowledge on the potentially powerful positive effects, for the developing neural system, of simple, disseminable psychosocial interventions specifically designed to target modifiable risk factors across adolescence.