Department of Global Public Health and Primary Care, University of Bergen , Bergen , Norway .
Chronobiol Int. 2014 Feb;31(1):72-86. doi: 10.3109/07420528.2013.823200. Epub 2013 Oct 21.
Delayed sleep phase disorder (DSPD) is assumed to be common amongst adolescents, with potentially severe consequences in terms of school attendance and daytime functioning. The most common treatment approaches for DSPD are based on the administration of bright light and/or exogenous melatonin with or without adjunct behavioural instructions. Much is generally known about the chronobiological effects of light and melatonin. However, placebo-controlled treatment studies for DSPD are scarce, in particular in adolescents and young adults, and no standardized guidelines exist regarding treatment. The aim of the present study was, therefore, to investigate the short- and long-term effects on sleep of a DSPD treatment protocol involving administration of timed bright light and melatonin alongside gradual advancement of rise time in adolescents and young adults with DSPD in a randomized controlled trial and an open label follow-up study. A total of 40 adolescents and young adults (age range 16-25 years) diagnosed with DSPD were recruited to participate in the study. The participants were randomized to receive treatment for two weeks in one of four treatment conditions: dim light and placebo capsules, bright light and placebo capsules, dim light and melatonin capsules or bright light and melatonin capsules. In a follow-up study, participants were re-randomized to either receive treatment with the combination of bright light and melatonin or no treatment in an open label trial for approximately three months. Light and capsules were administered alongside gradual advancement of rise times. The main end points were sleep as assessed by sleep diaries and actigraphy recordings and circadian phase as assessed by salivary dim light melatonin onset (DLMO). During the two-week intervention, the timing of sleep and DLMO was advanced in all treatment conditions as seen by about 1 h advance of bed time, 2 h advance of rise time and 2 h advance of DLMO in all four groups. Sleep duration was reduced with approximately 1 h. At three-month follow-up, only the treatment group had maintained an advanced sleep phase. Sleep duration had returned to baseline levels in both groups. In conclusion, gradual advancement of rise time produced a phase advance during the two-week intervention, irrespective of treatment condition. Termination of treatment caused relapse into delayed sleep times, whereas long-term treatment with bright light and melatonin (three months) allowed maintenance of the advanced sleep phase.
延迟睡眠期障碍（DSPD）被认为在青少年中很常见，可能会对上学和白天的功能产生严重影响。DSPD 的最常见治疗方法是基于给予明亮的光线和/或外源性褪黑素，辅以或不辅以附加行为指令。人们通常了解光线和褪黑素的生理节律作用。然而，DSPD 的安慰剂对照治疗研究很少，特别是在青少年和年轻人中，并且没有关于治疗的标准化指南。因此，本研究的目的是在一项随机对照试验和一项开放标签随访研究中，调查在青少年和年轻人中使用定时明亮的光线和褪黑素以及逐渐提前起床时间的 DSPD 治疗方案对睡眠的短期和长期影响。总共招募了 40 名被诊断为 DSPD 的青少年和年轻人（年龄范围 16-25 岁）参加这项研究。参与者被随机分配到四种治疗条件之一接受为期两周的治疗：暗光和安慰剂胶囊、明亮的光和安慰剂胶囊、暗光和褪黑素胶囊或明亮的光和褪黑素胶囊。在随访研究中，参与者在大约三个月的开放标签试验中重新随机接受明亮的光和褪黑素联合治疗或不治疗。光线和胶囊与逐渐提前起床时间一起给予。主要终点是通过睡眠日记和活动记录仪评估的睡眠和通过唾液褪黑素微光起始（DLMO）评估的昼夜节律相位。在为期两周的干预期间，所有治疗条件下的睡眠和 DLMO 时间都提前了，所有四组的睡眠时间提前了约 1 小时，起床时间提前了 2 小时，DLMO 提前了 2 小时。睡眠时间减少了约 1 小时。在三个月的随访中，只有治疗组保持了提前的睡眠阶段。两组的睡眠时间均已恢复到基线水平。总之，无论治疗条件如何，逐渐提前起床时间都会在两周的干预中产生相位提前。治疗结束后，睡眠时间会恢复到延迟状态，而长期使用明亮的光和褪黑素（三个月）可以维持提前的睡眠阶段。
