title: Polysomnographic features of early-onset depression: a meta-analysis.
abstract: BACKGROUND
  Undiagnosed major depressive disorder (MDD) is associated with increased morbidity in children and adolescents. This study evaluated features of sleep macro- and microarchitecture assessed by polysomnography (PSG) as diagnostic markers for MDD in children and adolescents.
  
  
  METHODS
  MEDLINE, PSYCINFO, EMBASE and PUBMED were searched from their availability dates to March 1st, 2013. The literature search identified 932 abstracts of which 51 studies were retrieved and 28 were included in the analysis. Study design, features of sleep macro- and microarchitecture, demographic and clinical characteristics of study groups were extracted for each study.
  
  
  RESULTS
  There were modest differences on sleep macroarchitecture between children and adolescents with MDD and healthy controls. The most robust difference was found in sleep latency, 31% of adolescents with MDD had increased sleep latency. Age, suicidal ideation, suicidal behavior, and psychiatric comorbidities were significant predictors of sleep macroarchitecture. Modest differences were found for sleep microarchitecture, intrahemispheric and interhemispheric temporal coherence was decreased in a third of patients with MDD. Age was a significant predictor of sleep microarchitecture.
  
  
  CONCLUSIONS
  This meta-analysis is limited by the small number of studies on sleep macroarchitecture in children with MDD and studies on sleep microarchitecture overall and by the heterogeneity in methodology between studies.
  
  
  CONCLUSIONS
  This synthetic review of the existing literature is among the largest to quantitatively assess impaired sleep as a diagnostic marker for MDD in children and adolescents. Knowledge of sleep macro- and microarchitecture in early-onset MDD may aid the clinician in developing a treatment strategy for MDD-related sleep symptoms in a subset of patients.
authors.affiliation: Department of Cell and Systems Biology, University of Toronto, Canada; Youthdale Child and Adolescent Sleep Centre, Toronto, Canada.
authors.forename: Jura L S
authors.initials: JL
authors.lastname: Augustinavicius
authors.affiliation: Centre for Addiction and Mental Health, Toronto, Canada.
authors.forename: Anosha
authors.initials: A
authors.lastname: Zanjani
authors.affiliation: Department of Psychology, University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario, Canada M1C 1A4. Electronic address: zakzanis@utsc.utoronto.ca.
authors.forename: Konstantine K
authors.initials: KK
authors.lastname: Zakzanis
authors.affiliation: Department of Cell and Systems Biology, University of Toronto, Canada; Youthdale Child and Adolescent Sleep Centre, Toronto, Canada; Department of Psychiatry, University of Toronto, Canada.
authors.forename: Colin M
authors.initials: CM
authors.lastname: Shapiro
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D002648:Child; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D017286:Polysomnography; D012890:Sleep / Q000502:physiology*
keywords: Depression; Major depressive disorder; Pediatrics; Polysomnography; Sleep; Sleep electroencephalography