Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA 15213, USA.
Alcohol Clin Exp Res. 2013 Apr;37(4):558-65. doi: 10.1111/acer.12003. Epub 2013 Jan 29.
Developmental changes in sleep and circadian rhythms that occur during adolescence may contribute to reward-related brain dysfunction, and consequently increase the risk of alcohol use disorders (AUDs).
This review (i) describes marked changes in circadian rhythms, reward-related behavior and brain function, and alcohol involvement that occur during adolescence, (ii) offers evidence that these parallel developmental changes are associated, and (iii) posits a conceptual model by which misalignment between sleep-wake timing and endogenous circadian timing may increase the risk of adolescent AUDs by altering reward-related brain function.
The timing of sleep shifts later throughout adolescence, in part due to developmental changes in endogenous circadian rhythms, which tend to become more delayed. This tendency for delayed sleep and circadian rhythms is at odds with early school start times during secondary education, leading to misalignment between many adolescents' sleep-wake schedules and their internal circadian timing. Circadian misalignment is associated with increased alcohol use and other risk-taking behaviors, as well as sleep loss and sleep disturbance. Growing evidence indicates that circadian rhythms modulate the reward system, suggesting that circadian misalignment may impact adolescent alcohol involvement by altering reward-related brain function. Neurocognitive function is also subject to sleep and circadian influence, and thus circadian misalignment may also impair inhibitory control and other cognitive processes relevant to alcohol use. Specifically, circadian misalignment may further exacerbate the cortical-subcortical imbalance within the reward circuit, an imbalance thought to explain increased risk-taking and sensation-seeking during adolescence. Adolescent alcohol use is highly contextualized, however, and thus studies testing this model will also need to consider factors that may influence both circadian misalignment and alcohol use.
This review highlights growing evidence supporting a path by which circadian misalignment may disrupt reward mechanisms, which may in turn accelerate the transition from alcohol use to AUDs in vulnerable adolescents.
青少年时期睡眠和昼夜节律的发育变化可能导致与奖励相关的大脑功能障碍，从而增加酒精使用障碍（AUD）的风险。
本综述（i）描述了青少年时期昼夜节律、奖励相关行为和大脑功能以及酒精参与的显著变化，（ii）提供了证据表明这些平行的发育变化是相关的，（iii）提出了一个概念模型，即睡眠-觉醒时间与内源性昼夜节律时间的不匹配可能通过改变与奖励相关的大脑功能增加青少年 AUD 的风险。
整个青春期，睡眠的时间都在推迟，部分原因是内源性昼夜节律的发育变化，使昼夜节律变得更加延迟。这种睡眠和昼夜节律延迟的趋势与中学阶段早期的学校开始时间相冲突，导致许多青少年的睡眠-觉醒时间表与其内部昼夜节律时间不匹配。昼夜节律不匹配与增加的酒精使用和其他冒险行为以及睡眠不足和睡眠障碍有关。越来越多的证据表明昼夜节律调节奖励系统，这表明昼夜节律不匹配可能通过改变与奖励相关的大脑功能影响青少年的酒精摄入。神经认知功能也受到睡眠和昼夜节律的影响，因此昼夜节律不匹配也可能损害与酒精使用相关的抑制控制和其他认知过程。具体来说，昼夜节律不匹配可能会进一步加剧奖励回路中的皮质-皮质下不平衡，这种不平衡被认为解释了青少年时期冒险和寻求刺激的增加。然而，青少年的酒精使用是高度情境化的，因此测试该模型的研究还需要考虑可能影响昼夜节律不匹配和酒精使用的因素。
本综述强调了越来越多的证据支持昼夜节律不匹配可能破坏奖励机制的途径，这反过来可能加速易受影响的青少年从酒精使用到 AUD 的过渡。
