The Bidirectional Association Between Daytime Affect and Nighttime Sleep in Youth With Anxiety and Depression

Objective This study examines relationships between affect and sleep in youth with affective disorders using ecological momentary assessment (EMA). Methods Participants included 94 youth, ages 8–16 (M 11.73, 53 % female) years with an anxiety disorder only (n 23), primary major depressive disorder (with and without a secondary anxiety diagnoses; n 42), and healthy controls (n 29). A cell phone EMA protocol assessed affect and actigraphy measured sleep. Results The patterns of bidirectional relationships between affect and sleep differed across diagnostic groups. Higher daytime positive affect and positive to neg-ative affect ratios were associated with more time in bed during the subsequent night for youth with primary depression and less time in bed for youth with anxiety only. More time asleep was associated with more pos-itive affect for both diagnostic groups the following day. Conclusions This relationship may be important to consider in the treatment of youth affective disorders. Key words adolescents; anxiety; children; depression; sleep. There is growing evidence to support a bidirectional rela-tionship between sleep and affect in youth. This relation-ship can create a negative synergy of cyclical sleep and emotional disturbances where impairments in one area persistently maintain impairments in the other are