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Do Children of Patients with Bipolar Disorder have a Worse Perception of Sleep Quality?
¿Los hijos de pacientes con trastorno bipolar tienen una peor percepción de la calidad de sueño?
Santiago Estrada-Jaramilloa,b, Claudia Patricia Quintero-Cadavida,b, Rommel Andrade-Carrilloa,b, Sujey Gómez-Canoa,b, Juan Jose Erazo-Osorioa,b, Juan Pablo Zapata-Ospinac, Daniel Camilo Aguirre-Acevedoa,c, Johana Valencia-Echeverrya, Carlos López-Jaramilloa,b, Juan David Palacio-Ortiza,b,
Corresponding author
tdahcartagena@gmail.com

Corresponding author.
a Research Group in Psychiatry (GIPSI), Departmento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
b Programa de Trastornos del Ánimo, Fundación Hospital San Vicente, Medellín, Colombia
c Instituto de Investigación Médica, Universidad de Antioquia, Medellín, Colombia
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Bipolar disorder &#40;BD&#41; has an estimated global prevalence of 1&#37;-2&#37;&#59; in Colombia&#44; according to the 2003 Colombian National Study of Mental Health&#44; its prevalence is estimated at 1&#46;8&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> A prevalence of 1&#46;4&#37; was found in Medell&#237;n in 2009&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> BD is considered to be among the leading causes of disability&#44; with high social and family costs&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> According to various studies&#44; 20&#37;-40&#37; of affected adults report that their BD started in childhood or adolescence&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Children of parents with BD &#40;COPBD&#41; are a population at high risk of mental disorders&#46; Studying this population may offer insight into prodromes and psychiatric disease in BD&#46; A meta-analysis found that the risk of having a psychiatric disorder is 2&#46;7 times higher for COPBD&#44; and that the risk of having an affective disorder is 4 times higher than for children of control parents &#40;COCP&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Recent studies have indicated that relatives of patients with BD not only inherit the signs that make up the disorder <span class="elsevierStyleItalic">per se</span>&#44; but also may present other abnormalities without clinical expression of BD&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> For example&#44; the sleep&#8211;wake cycle has been identified as a possible endophenotype&#44; since COPBD and the high-risk population show detectable abnormalities without having been diagnosed with BD&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Sleep evaluation may be complex in children&#44; as children have normal variations related to physical and brain development&#46; Research has shown that up to 25&#37; of healthy children may report sleep difficulties ranging from mild to serious&#44; and furthermore may have sleep abnormalities due to various disorders predominantly occurring in childhood&#44; such as anxiety disorders&#44; neurodevelopmental disorders&#44; behavioural disorders and impulse-control disorders&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Actigraphy has been used to evaluate the sleep&#8211;wake cycle&#44; as it measures variability in body movements and therefore is useful in the diagnosis and follow-up of circadian rhythm disorders&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> It can also be used in the subject&#39;s natural environment&#44; which may represent an advantage in the juvenile population&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In addition&#44; sleep scales and diaries completed by parents can be leveraged to compare and correct information obtained from actigraphy&#46; These scales also collect other variables&#44; such as daytime sleepiness&#59; waking up during the night&#59; perceived sleep quality&#59; nightmares&#59; bedwetting&#59; need for company during the night&#59; use of screens before going to bed&#59; and use of caffeinated&#44; energy and alcoholic drinks&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Actigraphy has revealed that&#44; compared to healthy controls&#44; adults with BD still in remission may have longer sleep latency&#44; longer sleep duration&#44; lower sleep efficiency&#44; changes in circadian rhythm amplitude and periods&#44; and lower physical activity&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;13</span></a> Jones et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> in a comparison of 25 COPBD 13-19 years of age to 22 COCP&#44; found that the COPBD had shorter sleep latency&#44; greater sleep fragmentation and a longer duration of waking on actigraphy&#44; as well as higher perceived levels of non-reparative sleep and tiredness&#46; Sebela et al&#46;&#44;<span class="elsevierStyleSup">158</span> for their part&#44; compared 42 COPBD and 42 COCP paired by age and sex&#44; finding that the former group had symptoms of sleep abnormalities associated with psychiatric symptoms and longer sleep latency&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">These findings should be reproduced to clearly identify the most common and distinguishing patterns of activity in COPBD and to determine whether they are related to signs of psychiatric disease&#44; with a view to proposing possible endophenotypes in BD&#46; Hence&#44; this study was conducted to compare psychiatric disease&#44; sleep and activity measured by actigraphy as well as sleep scales and diaries in COPBD and COCP&#44; and to determine whether any differences between these two groups might enable early identification of subjects likely to suffer from BD&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Material and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">This was a cross-sectional analytical study&#46; It was conducted as part of the project &#34;Cambios tempranos en poblaci&#243;n de alto riesgo para bipolar I disorder&#46; Comparaci&#243;n de trastornos psiqui&#225;tricos&#44; alteraciones de sue&#241;o y neuroim&#225;genes entre hijos de pacientes con trastorno bipolar versus controles&#34; &#91;Early Changes in a Population at High Risk of Bipolar I Disorder&#58; Comparison of Psychiatric Disorders&#44; Sleep Abnormalities and Neuroimaging Among Children of Patients with Bipolar Disorder Versus Controls&#93;&#44; conducted by the Universidad de Antioquia &#91;University of Antioquia&#93; Psychiatry Research Group &#40;GIPSI&#41;&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Participants</span><p id="par0035" class="elsevierStylePara elsevierViewall">The participants were evaluated between October 2016 and November 2017&#46; The following inclusion criteria were used&#58; being 6 to 21 years of age and being in a condition to participate in a diagnostic interview and understand instructions for proper use of an actigraph unit &#40;wristwatch&#41;&#46; COPBD had to have a biological parent with a diagnosis of bipolar I disorder according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders&#44; Fourth Edition &#40;Text Revision&#41; &#40;DSM-IV-TR&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> previously made by the Diagnostic Interview for Genetic Studies &#40;DIGS&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> and belonging to the Antioquian &#40;&#34;paisa&#34;&#41; genetic isolate&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> COCP had to have both biological parents undiagnosed with BD according to the DIGS&#46; The following possible subjects were excluded&#58; those with a diagnosis of a mental disorder or autism spectrum disorder&#59; those with a history of hydrocephalus&#44; central nervous system surgery or traumatic brain injury with loss of consciousness&#59; those with structural or degenerative neurological lesions&#44; epilepsy&#44; or physical abnormalities interfering with their participation in a clinical interview&#59; and those with rubber allergy as a specific contraindication for the use of the actigraph unit&#46; Patients with sleep disorders were not excluded&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Instruments</span><p id="par0040" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0045" class="elsevierStylePara elsevierViewall">The DIGS&#44; developed by the United States National Institutes of Health&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> is used for genetic studies of schizophrenia and mood disorders&#46; It allows for a reliable differential diagnosis and a detailed evaluation of psychosis&#44; mood disorders and substance use disorders&#46; It was translated and validated for Colombia and showed comprehensibility&#44; appearance and content validity&#44; and high test&#8211;retest and inter-rater reliability&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0050" class="elsevierStylePara elsevierViewall">The Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime &#40;K-SADS-PL&#41;&#44; version 5&#44; is a diagnostic interview that includes data on psychiatric disorders both in the present and over the course of one&#39;s life&#46; It enables coding the number and duration of previous episodes&#44; evaluating functional abnormalities related to specific diagnoses and assessing the interviewee&#39;s overall functioning through the Children&#39;s Global Assessment Scale &#40;C-GAS&#41;&#46; It also provides information on the subject&#39;s developmental history as well as family and medical history&#46; Furthermore&#44; it can determine the presence of subthreshold symptoms&#44; considered a set of symptoms that create discomfort and disability but do not meet all the criteria that they must meet to be labelled with a diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> The version in Spanish has good inter-rater reliability&#44; as its validation yielded kappa coefficients &#62;0&#46;7 for more than half of disorders&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0055" class="elsevierStylePara elsevierViewall">The C-GAS is a numerical scale used to classify the general functioning of subjects under 18 years of age&#46; It is scored from 1 to 100 points&#58; the higher the score&#44; the better the functioning&#46; Scores &#60;30 are interpreted as an inability to function in most areas&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> The translation into Spanish showed acceptable reliability&#44; with an intra-class correlation coefficient of 0&#46;61-0&#46;91 for test&#8211;retest and inter-rater reliability&#44; as well as suitable construct validity&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#44;25</span></a></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Sleep diaries are designed to collect information on daily sleep patterns in individuals in order to subjectively detect sleep abnormalities&#46; Ideally&#44; diary entries are prepared within one hour of waking up&#46; The following items are recorded in the diary&#58; bedtime&#44; time of sleep onset&#44; sleep latency time&#44; number of episodes of waking up during the night and how long these episodes last &#40;not counting getting out of bed&#41;&#44; wake-up time and time of getting out of bed&#44; rating of sleep quality and any additional comments that the subject deems pertinent&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0065" class="elsevierStylePara elsevierViewall">The sleep evaluation questionnaire is a screening instrument filled in by parents&#44; proposed by Owens et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;27</span></a> The items reflect a number of key sleep domains that translate to clinical sleep complaints&#46; Its internal consistency&#44; measured by Cronbach&#39;s alpha coefficient for each subscale&#44; is 0&#46;36 to 0&#46;70 in a population sample of children 4 to 10 years of age&#46; An abbreviated version of this scale expressly designed for research studies consists of 22 items with a response scale from 1 &#40;always&#41; to 5 &#40;never&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0070" class="elsevierStylePara elsevierViewall">The survey on sleep habits in schoolchildren is an interview designed to evaluate sleep habits and behaviours in schoolchildren in the two weeks prior to the interview&#46; Major variables include total sleep time&#44; bedtime and time of getting out of bed on school days&#47;nights and non-school days&#47;nights&#46; It also covers school performance and scales of daytime sleepiness&#44; problems with sleep&#8211;wake behaviour and presence of symptoms of depression&#44; with suitable internal consistency&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Procedures</span><p id="par0075" class="elsevierStylePara elsevierViewall">The research protocol was approved by the Independent Ethics Committees of the Universidad de Antioquia Faculty of Medicine and the Hospital Universitario de San Vicente Fundaci&#243;n &#91;San Vicente Fundaci&#243;n University Hospital&#93; &#40;HUSVF&#41;&#46; Before data collection began&#44; parents and their children had to sign the informed consent form and the informed assent form&#44; respectively&#46; The study was conducted according to the guidelines of the declaration of Helsinki in relation to ethical principles for medical research in human beings&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The participants were contacted by telephone by a social worker from the research group&#46; Once the inclusion criteria were met&#44; clinical interviews were conducted and scales completed in a HUSVF office&#46; The interview was prepared by a psychiatry resident&#44; child psychiatry resident or psychiatrist&#46; The evaluators were unaware of the presence or absence of a family history of BD&#46; After the interview was held&#44; two expert psychiatrists completed a &#34;best estimate&#34; diagnosis procedure in order to corroborate the psychiatric diagnosis&#46; In case of discrepancy&#44; the opinion of a third psychiatrist was sought&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The DIGS was applied to each parent to verify the presence of BD and other psychiatric disorders&#46; Their children under 18 years of age were assessed using the K-SADS-PL&#44; the sleep evaluation questionnaire and the survey of sleep habits in schoolchildren&#44; which required the presence of one of the parents to aid in the application of the scales and the interview process&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">After parents and children received an explanation of and training in how to complete the sleep diaries&#44; the actigraph unit was placed on the non-dominant hand to be used for 14 days according to international standards&#59;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30&#44;31</span></a> in addition&#44; the parent in charge of supervision was sent an instructional video on actigraph unit use and sleep diary recording&#46; Sleep was monitored by means of an actigraph unit in subjects who were willing to use the device on a continuous basis and whose parents agreed to its placement&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Philips Actiwatch Spectrum PRO &#40;Philips&#41; actigraph wristwatches were used&#59;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">32&#44;33</span></a> actigraph data were processed using the Actiware software program&#44; provided by the actigraph manufacturer&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical analysis</span><p id="par0100" class="elsevierStylePara elsevierViewall">The SPSS 22&#46;0 and STATA 14 statistics software programs were used for analyses&#46; To describe the subjects&#44; measure of central tendency and dispersion were used for quantitative variables&#44; and frequencies and percentages were used for qualitative variables&#46; Differences between COCP and COPBD were determined using Pearson&#39;s &#967;<span class="elsevierStyleSup">2</span> test for qualitative variables and the Mann&#8211;Whitney U test for quantitative variables&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">A mixed-effects model was used in which the average of the variables was estimated&#44; taking into account the random effect of the participant and the fixed effect of being COPBD or not&#46; The model adjusted for the age variable was evaluated&#59; however&#44; given that no variations were found&#44; the unadjusted model was preferred&#46; For all tests&#44; a threshold for significance was set at p&#8239;&#60;&#8239;0&#46;05&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Clinical and demographic variables</span><p id="par0110" class="elsevierStylePara elsevierViewall">One hundred participants were included and evaluated for psychiatric disease using the DIGS or K-SADS-PL and assessed using the sleep scales&#46; Of them&#44; 42 underwent sleep monitoring using an actigraph unit&#46; The actigraphy subgroup was similar to the non-actigraphy subgroup in relation to age&#44; sex&#44; education and C-GAS functioning scale&#46; The groups only showed differences with regard to origin and having separated parents&#46; In addition&#44; a larger number of subjects who had repeated more than one year of school was found in the group of children without actigraphy &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Comparison of the groups revealed that a higher proportion of COPBD lived with separated parents and that 13 subjects &#40;72&#46;2&#37;&#41; from that same group lived in the same house as the parent with BD&#46; No differences were found with regard to age&#44; education&#44; C-GAS&#44; urban or rural residence&#44; or repeated years of school &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Psychiatric disease in COPBD and COCP</span><p id="par0120" class="elsevierStylePara elsevierViewall">Compared to the COCP group&#44; the COPBD group was found to have higher rates of mood disorders and subthreshold symptoms&#44; specifically major depressive disorder &#40;MDD&#41; &#40;p&#8239;&#61;&#8239;0&#46;04&#41; and disruptive mood dysregulation disorder &#40;DMDD&#41; &#40;p&#8239;&#61;&#8239;0&#46;04&#41;&#46; No differences were seen between the groups in anxiety disorders&#44; neurodevelopmental or behavioural disorders&#44; or in internalised or externalised disorders&#46; Some differences in the prevalence of some psychiatric disorders should be noted as they were of clinical&#44; although not statistical&#44; significance&#58; in the COPBD group&#44; there was a higher rate of oppositional defiant disorder &#40;ODD&#41; or subthreshold symptoms thereof &#40;61&#46;1&#37;&#41;&#44; and in the COCP group&#44; there were higher rates of attention deficit&#47;hyperactivity disorder &#40;ADHD&#41; &#40;45&#46;8&#37;&#41; and separation anxiety disorder &#40;SAD&#41; &#40;66&#46;7&#37;&#41; as well as subthreshold symptoms of those disorders &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Sleep scales</span><p id="par0125" class="elsevierStylePara elsevierViewall">COPBD were found to have higher rates of poor perceived sleep quality&#44; nightmares and coffee consumption&#46; Regarding quantitative measures of sleep reported on scales&#44; it was found that COPBD tended to report shorter overall sleep times on school days and non-school days&#44; although the difference was not statistically significant&#46; It was also found that the COPBD group had longer sleep latency on school days and non-school days&#44; as indicated by the wider corresponding interquartile range&#59; however&#44; when medians were compared&#44; no statistically significant differences were seen &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Actigraphy</span><p id="par0130" class="elsevierStylePara elsevierViewall">No significant differences were found in the actigraphy measurements between the COCP and COPBD groups&#46; However&#44; total sleep time was seen to be lower in the COPBD group than in the COCP group &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discussion</span><p id="par0135" class="elsevierStylePara elsevierViewall">This study was conducted with the objective of comparing an evaluation of psychiatric disease and sleep characteristics in an at-risk population furthermore belonging to a genetic isolate in which certain distinctive characteristics have been identified in previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;34&#44;35</span></a></p><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Changes in sleep by subjective measures</span><p id="par0140" class="elsevierStylePara elsevierViewall">Differences were found between the groups in sleep characteristics&#44; especially on subjective measures such as scales&#46; COPBD were seen to have worse sleep quality than COCP&#44; higher numbers of nightmares and higher rates of coffee consumption&#46; Sleep abnormalities have been studied as precursors to mood disorders&#46; In this regard&#44; Fredriksen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> observed a relationship between sleep abnormalities&#44; symptoms of depression and a decrease in self-esteem in a group of middle school-aged children&#46; Another study demonstrated the relationship between nightmares and a higher rate of behavioural difficulties&#44; which&#44; when chronic&#44; led to increased stressors&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">36&#44;37</span></a> These studies back the explanation that this COPBD group may have sleep abnormalities corresponding to symptoms of a depressive condition or precursors to other psychiatric disorders&#46; They would also support the notion that this at-risk group is showing a BD endophenotype&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Subjective abnormalities in sleep quality have also been reported in other studies in at-risk populations&#46; Sebela et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> evaluated 42 COCP without psychiatric disease and 42 COPBD using self-administered scales filled in by parents&#44; finding higher rates of nightmares and daytime sleepiness in the COPBD group&#46; Scott et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> for their part&#44; compared 12 COPBD and 48 COCP and found no significant differences with respect to reported sleep quality&#44; though the subjects were experiencing an episode of major depression at the time of the study&#46; Perceived sleep quality appears to be related to cultural factors and sleep hygiene&#46; Some studies have indicated a correlation between sleep hygiene practices and perceived sleep quality in healthy adolescents&#44; with differences between cultures&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> This would point to a need to evaluate sleep practices in COPBD as well as in their homes&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">In this&#44; a higher rate of coffee consumption was reported in the COPBD group&#46; This consumption may stem from sleep abnormalities&#44; creating a vicious cycle in which poor sleep quality leads to coffee consumption and abstaining from coffee leads to a feeling of fatigue and low mood&#46; In this regard&#44; Whalen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> reported a relationship between symptoms of depression&#44; sleep abnormalities and coffee consumption as self-medication for fatigue and sleepiness&#46; They also reported that abstaining from coffee caused these symptoms to recur&#44; leading subjects to resume coffee consumption&#46; This could account for the association between coffee consumption&#44; symptoms of depression and poor sleep quality in our COPBD population&#46; One repercussion of substantial coffee consumption is poorer performance in school&#46; One study in this vein demonstrated the role of environmental factors in sleep patterns&#44; finding a shorter overall sleep time to be associated with worse academic performance&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Coffee and other caffeinated beverages&#44; such as fizzy drinks and energy drinks&#44; have become more widely distributed and available to a young population&#46; Various studies have focused on the existing relationship between caffeine consumption in children and adolescents and its association with academic performance&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> On the one hand&#44; Tennant et al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> conducted a study with 1&#44;354 subjects in the United States army&#44; reporting that those who used illicit drugs and alcohol had started to use alcohol&#44; cigarettes and caffeine before they turned 12&#46; On the other hand&#44; Jin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> studied 308 adolescents 15-17 years of age&#44; and found higher caffeine consumption and higher alcohol consumption to be associated with worse academic performance and higher scores for depression&#44; anxiety&#44; insomnia and stress&#46; These two studies emphasised that the younger one&#39;s age&#44; the higher their risk of addiction&#59; they also stressed the relationship between caffeine and alcohol use and future mood and anxiety disorders&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Changes in sleep by objective measures</span><p id="par0160" class="elsevierStylePara elsevierViewall">Analysis of actigraphy data did not reveal differences between the two groups&#46; One possible explanation is the limited power of this study given its small sample size&#44; pointing to a possible type II error&#46; However&#44; in the field of actigraphy&#44; the differences between the COPBD and COCP groups reported by other authors were not consistent&#46; Regarding sleep latency&#44; Jones et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> found it to be longer in COCP &#40;mean&#58; 28&#46;31&#8239;min&#41;&#44; whereas according to Sebela et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> sleep latency was longer in COPBD &#40;mean&#58; 17&#8239;min&#41;&#46; Studies in adults with BD have indeed demonstrated consistent findings&#44; indicating longer sleep latency&#46; There is also total sleep time&#59; Jones et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> reported that it was longer in COPBD than in COCP &#40;mean&#58; 31&#46;67&#8239;min&#41;&#44; while Sebela et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> found a difference of just two minutes between the groups&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Psychiatric disorders</span><p id="par0165" class="elsevierStylePara elsevierViewall">This study found higher rates of MDD and DMDD as well as higher rates of subthreshold symptoms of these disorders in the COPBD group&#46; This was consistent with similar studies having found a predominance of affective disorders in COPBD compared to COCP&#46; For example&#44; in a systematic review of the literature conducted by Raouna et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> COPBD were a group at high risk of affective and non-affective psychiatric disease in childhood&#44; adolescence and adulthood&#46; Specifically&#44; Birmaher et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a> found a 13 times higher risk of mental disorders in COPBD versus COCP&#46; The findings of this study pointed in the same direction as others indicating a higher risk of mood disorders in this population&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;47&#44;48</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">In addition&#44; a higher rate of ODD was found in the COPBD group&#46; Aronen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> compared sleep in 30 children with ODD and 30 children with psychiatric disease and confirmed that the patients in the former group had greater sleep problems&#44; based on both reports and actigraphy measurements&#59; specifically&#44; they had shorter sleep times and lower sleep efficiency related to externalised symptoms reported by their parents&#46; This might in some way explain the reports of poor sleep quality in the COPBD group&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">High prevalences of SAD and ADHD were found in the COCP group&#44; and although there was no difference between the groups&#44; this must be treated in light of sleep abnormalities&#46; Becker et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> in a study in 181 subjects with ADHD&#44; reported difficulties in several aspects of sleep&#44; such as sleep anxiety&#44; bedtime resistance and waking up during the night&#46; These findings suggest that&#44; in the current sample&#44; various participants with ADHD in both groups could have sleep abnormalities&#44; and for this reason no differences were seen in some subjective parameters and objective measures&#46; It should be borne in mind that the comparator group was selected based on a control parent who did not have BD&#44; but whose offspring might have had certain psychiatric disorders based on the K-SADS evaluation&#44; except for intellectual disabilities or autism spectrum disorders&#46; Other studies have already reported COCP to have anxiety disorders&#44; ADHD and ODD&#44; and some effects on their results for sleep variables have been found&#44; though at lower rates than the COPBD group&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a> In addition&#44; anxiety disorders may be associated with sleep abnormalities&#46; For example&#44; Iwadare et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a> reported abnormalities such as bedtime resistance&#44; sleep anxiety&#44; waking up during the night and abnormalities in total sleep in children with generalised anxiety disorder &#40;GAD&#41;&#44; SAD&#44; social phobia and obsessive-compulsive disorder&#46; In addition&#44; Alfano et al&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a> evaluated sleep-related problems associated with GAD&#44; SAD and social phobia&#44; and found bedtime resistance&#44; delayed sleep onset&#44; daytime sleepiness and abnormalities in total sleep&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">In summary&#44; in the population studied&#44; COPBD were found to have higher rates of ODD and anxiety disorders in general&#44; and COCP were found to have higher rates of SAD in particular&#44; which could explain why the populations showed no differences in terms of presentation of sleep variables&#46; These variables should be controlled in future studies&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Clinical implications</span><p id="par0185" class="elsevierStylePara elsevierViewall">Based on these findings&#44; it can be affirmed that COPBD are a population at higher risk of experiencing affective symptoms and disorders than COCP&#46; In addition to this&#44; COPBD have worse perceived sleep quality and more nightmares&#46; This may be tied to higher rates of coffee consumption in this group&#46; Therefore&#44; we wish to propose not only that active efforts be made to detect psychiatric disease in this age group&#44; but also that sleep hygiene regimens be promoted among relatives of adult patients with BD&#44; especially COPBD&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Sleep hygiene measures are&#44; in reality&#44; among the most important recommendations for children and adolescents in the treatment of sleep abnormalities&#44; regardless of whether or not they are associated with psychiatric disease&#46; A lack of such measures leads to sleep abnormalities&#44; as already demonstrated by Mindell et al&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">54</span></a> in an analysis of reports from 1&#44;473 parents on the sleep of their children &#40;0 to 10 years of age&#41;&#46; They reported that using screens in bed&#44; consuming caffeine at night and getting out of bed before dawn were significantly associated with sleep abnormalities&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Limitations and future studies</span><p id="par0195" class="elsevierStylePara elsevierViewall">The limitations of this study included its sample size&#44; which might have been too small to find the differences cited in prior studies&#44; corresponding in that case to a type II error&#46; In addition&#44; the subjects selected may have struggled to use diaries and manage the actigraph unit given their youth&#44; which might have led to measurement bias&#46; Finally&#44; although various control parents were invited&#44; it is difficult to know whether those who agreed to take part did so in order to have their children evaluated or out of some particular interest such as detection of a psychiatric disorder&#46; This might have been a source of bias&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">To our knowledge&#44; this was the first study on sleep conducted in Latin America in this at-risk population&#46; It is essential to conduct further research in this area with larger sample sizes that would enable analysis of differences in actigraphy&#46; In addition&#44; measures of school performance that would identify the impact of sleep abnormalities on subjects&#39; daily lives should be included&#46; BD largely begins in adolescence&#44; meaning it is essential to perform subgroup analyses to characterise this at-risk population and to evaluate differences due to expected normal changes and differences due to possible developing or established psychiatric disease&#46;</p></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Conclusions</span><p id="par0205" class="elsevierStylePara elsevierViewall">This study confirmed higher rates of affective disorders and symptoms in the COPBD group&#46; It also identified some subjective measures that show sleep abnormalities&#44; such as poor perceived sleep quality&#44; more reported nightmares and higher rates of coffee consumption in this group&#46; Affective symptoms may be associated with sleep abnormalities and coffee consumption&#44; which should continue to be investigated as potential early markers of BD onset&#46; No differences were found between the groups in actigraphy recording&#59; however&#44; the study&#39;s limited statistical power should be borne in mind&#46; Studies with larger sample sizes are needed to confirm sleep abnormalities with objective measures such as actigraphy in the population at risk of BD&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Funding</span><p id="par0210" class="elsevierStylePara elsevierViewall">This study was funded by <span class="elsevierStyleGrantSponsor" id="gs0005">COLCIENCIAS</span>&#44; Code No&#46; 1115 7114 9700&#44; and by the <span class="elsevierStyleGrantSponsor" id="gs0010">Colciencias PRISMA Project</span>&#44; Code No&#46; 99059634&#44; in collaboration with the Universidad de Antioquia Faculty of Medicine and the Universidad de Antioquia Research Development Committee &#40;CODI&#41;&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Conflicts of interest</span><p id="par0215" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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    "fechaRecibido" => "2019-12-01"
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            0 => "Sleep"
            1 => "Actigraphy"
            2 => "Children"
            3 => "Bipolar disorder"
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            5 => "Major depressive disorder"
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            0 => "Sue&#241;o"
            1 => "Actigraf&#237;a"
            2 => "Hijos"
            3 => "Trastorno Bipolar"
            4 => "Psicopatolog&#237;a"
            5 => "Trastorno Depresivo Mayor"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">The offspring of bipolar parents &#40;BO&#41; is a high-risk population for inheriting the bipolar disorder &#40;BD&#41; and other early clinical manifestations&#44; such as sleep disturbances&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">To compare the presence of psychiatric disorders and sleep disturbances of BO versus offspring of control parents &#40;OCP&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional analytical study was conducted that compared BO versus OCP&#46; The participants were assessed using valid tools to determine the presence of psychiatric symptoms or disorders&#46; The &#8220;Sleep Evaluation Questionnaire&#8221; and &#8220;School Sleep Habits Survey&#8221; were used to determine sleep characteristics and associated factors&#46; Sleep records &#40;7-21 days&#41; were also obtained by using an actigraphy watch&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">A sample of 42 participants &#40;18 BO and 24 OCP&#41; was recruited&#46; Differences were found in the presentation of the psychiatric disorder&#46; The BO group showed a higher frequency of major depression disorder &#40;MDD&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;04&#41; and Disruptive Mood Dysregulation Disorder &#40;DMDD&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;04&#41;&#46; The OCP group showed a higher frequency of Attention Deficit and Hyperactivity Disorder &#40;ADHD&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;65&#41;&#44; and Separation Anxiety Disorder &#40;SAD&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;46&#41;&#46; Differences were also found in sleep by using subjective measurements&#46; Compared to the OCP group&#44; BO had a worse perception of quality of sleep &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;02&#41;&#44; a higher frequency of nightmares &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;01&#41;&#44; a shorter total sleep time&#44; and a higher sleep latency&#46; Nevertheless&#44; no differences were found between groups in the actigraphy measurements&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">The BO group had a higher frequency of Mood Disorders&#44; and at the same time a higher number of sleep disturbances in the subjective measurements&#46; It is possible that there is an association between mood symptoms&#44; sleep disturbances&#44; and coffee intake&#46; No differences were found in the sleep profile by using actigraphy&#46;</p></span>"
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            "titulo" => "Introduction"
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            "titulo" => "Objective"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Methods"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">los Hijos de Padres con Trastorno Bipolar &#40;HPTB&#41; constituyen una poblaci&#243;n de riesgo ya que pueden heredar el Trastorno Bipolar &#40;TB&#41; como tambi&#233;n manifestaciones cl&#237;nicas tempranas como seria la alteraciones en el sue&#241;o&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">comparar la presencia de trastornos psiqui&#225;tricos y las alteraciones en el sue&#241;o de los HPTB con los Hijos de Padres Control &#40;HPC&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio anal&#237;tico de corte transversal&#44; que compar&#243; HPTB versus HPC&#46; Se entrevistaron con instrumentos validados para determinar la existencia de s&#237;ntomas y trastornos psiqui&#225;tricos&#46; Utilizamos las escalas&#58; &#8220;Cuestionario de evaluaci&#243;n de sue&#241;o&#8221; y &#8220;Encuesta sobre h&#225;bitos de sue&#241;o en escolares&#8221; para determinar las caracter&#237;sticas del sue&#241;o y factores asociados con el mismo&#46; Adicionalmente se obtuvo el registro de sue&#241;o &#40;7-21 d&#237;as&#41; por medio de un reloj de act&#237;grafia&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Se reuni&#243; una muestra con 42 sujetos &#40;18 HPTB y 24 HPC&#41;&#46; Se encontraron diferencias en la presentaci&#243;n de los trastornos psiqui&#225;tricos&#46; El grupo de HPTB presento mayor frecuencia del trastorno depresivo mayor &#40;TDM&#59; p &#61; 0&#44;04&#41; y el trastorno disruptivo de la regulaci&#243;n emocional &#40;TDRE&#44; p &#61; 0&#44;04&#41;&#46; En el grupo de HPC por su parte se present&#243; una mayor frecuencia de Trastorno por D&#233;ficit de Atenci&#243;n e Hiperactividad &#40;TDAH&#59; p &#61; 0&#44;65&#41; y de Trastorno de Ansiedad por Separaci&#243;n &#40;TAS&#59; p &#61; 0&#44;46&#41;&#46; Tambi&#233;n se encontraron diferencias a nivel del sue&#241;o en las medidas subjetivas&#46; En comparaci&#243;n con el HPC&#44; el grupo de HPTB presento una peor percepci&#243;n de la calidad de sue&#241;o &#40;p &#61; 0&#44;02&#41;&#44; una mayor presencia de pesadillas &#40;p &#61; 0&#44;01&#41;&#44; un menor tiempo total de sue&#241;o y una mayor latencia de sue&#241;o&#46; Sin embargo&#44; no se encontraron diferencias entre los dos grupos en las mediciones de actigraf&#237;as&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">el grupo de HPTB presenta mayor frecuencia de trastornos del estado de &#225;nimo&#44; y a su vez una mayor presencia de alteraciones del sue&#241;o en las medidas subjetivas&#46; Es posible que exista una asociaci&#243;n entre los s&#237;ntomas afectivos&#44; las alteraciones en el sue&#241;o y el consumo de caf&#233;&#46; No se encontraron diferencias en el perfil de sue&#241;o por act&#237;graf&#237;a&#46;</p></span>"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0075">Please cite this article as&#58; Estrada-Jaramillo S&#44; Quintero-Cadavid CP&#44; Andrade-Carrillo R&#44; G&#243;mez-Cano S&#44; Erazo-Osorio JJ&#44; Zapata-Ospina JP&#44; et al&#46; &#191;Los hijos de pacientes con trastorno bipolar tienen una peor percepci&#243;n de la calidad de sue&#241;o&#63; Rev Colomb Psiquiat&#46; 2022&#59;51&#58;25&#8211;34&#46;</p>"
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Education &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Current C-GAS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;92<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lives in urban area&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;01<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Lives with separated parents&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;0&#46;01<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;07<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sociodemographic and clinical characteristics&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Children of parents with bipolar disorder &#40;n&#8239;&#61;&#8239;18&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;84a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&#46;83&#8239;&#177;&#8239;2&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;56<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Current C-GAS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">83&#46;2&#8239;&#177;&#8239;14&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;03<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Lives in urban area&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16 &#40;69&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;10<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lives with separated parents&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;38&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;12&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;05<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Has repeated at least one school year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;22&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;20&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">ADHD&#58; attention deficit&#47;hyperactivity disorder&#59; BD&#58; bipolar disorder&#59; DMDD&#58; disruptive mood dysregulation disorder&#59; MDD&#58; major depressive disorder&#59; ODD&#58; oppositional defiant disorder&#59; SAD&#58; separation anxiety disorder&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Values are expressed in terms of n &#40;&#37;&#41;&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sociodemographic and clinical characteristics&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Children of parents with bipolar disorder &#40;n&#8239;&#61;&#8239;18&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Children of control parents &#40;n&#8239;&#61;&#8239;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Mood disorders</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MDD or subthreshold symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10 &#40;55&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6 &#40;25&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;04<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">BD or subthreshold symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;11&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;8&#46;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;58<a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DMDD or subthreshold symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">5 &#40;27&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1 &#40;4&#46;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;04<a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Anxiety disorders</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">SAD or subthreshold symptoms&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10 &#40;55&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16 &#40;66&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;46<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Other anxiety disorders or subthreshold symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14 &#40;77&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16 &#40;66&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;43<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Neurodevelopmental and behavioural disorders</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">ADHD or subthreshold symptoms&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7 &#40;38&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;45&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;65<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">ODD or subthreshold symptoms&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">11 &#40;61&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Internalised and externalised disorders</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Any internalised disorder&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10 &#40;55&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14 &#40;58&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sleep characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Children of parents with bipolar disorder &#40;n&#8239;&#61;&#8239;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Children of control parents &#40;n&#8239;&#61;&#8239;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Quantitative measures of sleep</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sleep time on school days &#40;h&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;17 &#91;7&#46;0-8&#46;0&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;17 &#91;7&#46;0-9&#46;0&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;08<a class="elsevierStyleCrossRef" href="#tblfn0050"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sleep latency on school days &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#91;5&#8211;25&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#91;5-10&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;40<a class="elsevierStyleCrossRef" href="#tblfn0050"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sleep time on non-school days &#40;h&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#91;8&#46;11-9&#46;75&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#91;9-10&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;10<a class="elsevierStyleCrossRef" href="#tblfn0050"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sleep latency on non-school days &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#91;5-22&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#91;10-15&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;41<a class="elsevierStyleCrossRef" href="#tblfn0050"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Perceived need for sleep &#40;h&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#91;8-9&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#91;9-9&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;30<a class="elsevierStyleCrossRef" href="#tblfn0050"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Qualitative measures of sleep</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">At least one episode of waking up during the night&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;43&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;69<a class="elsevierStyleCrossRef" href="#tblfn0055"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Problems with daytime sleepiness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;12&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;21&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;38<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Need to take naps&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;56&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;65&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;57<a class="elsevierStyleCrossRef" href="#tblfn0055"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Perceived amount of sleep</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Too much&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;6&#46;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;4&#46;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;06<a class="elsevierStyleCrossRef" href="#tblfn0055"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enough&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;75&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;95&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Too little&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;18&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Poor perceived sleep quality</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;02<a class="elsevierStyleCrossRef" href="#tblfn0055"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Nightmares</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;56&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;17&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;01<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sleepwalking</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;6&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;4&#46;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;65<a class="elsevierStyleCrossRef" href="#tblfn0055"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sleep talking</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;27<a class="elsevierStyleCrossRef" href="#tblfn0055"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;6&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Children of parents with bipolar disorder &#40;n&#8239;&#61;&#8239;18&#41;<a class="elsevierStyleCrossRef" href="#tblfn0065"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Children of control parents &#40;n&#8239;&#61;&#8239;24&#41;<a class="elsevierStyleCrossRef" href="#tblfn0065"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p<a class="elsevierStyleCrossRef" href="#tblfn0070"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Mean&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#174; &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;0&#46;09 &#40;&#8211;0&#46;43 to 0&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#46;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sleep latency &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;1&#46;12 &#40;&#8211;4&#46;5 to 2&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Time of getting out of bed&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;0&#46;11 &#40;&#8211;0&#46;55 to 0&#46;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total sleep time &#40;h&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;0&#46;47 &#40;&#8211;1&#46;3 to 1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Time in bed &#40;h&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;21&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Episodes of waking up during the night&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Sleep characteristics according to the actigraph unit&#46;</p>"
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                      "titulo" => "Developmental aspects of sleep hygiene&#58; Findings from the 2004 National Sleep Foundation Sleep in America Poll"
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                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;A&#46; Mindell"
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                      "doi" => "10.1016/j.sleep.2008.07.016"
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                        "tituloSerie" => "Sleep Med"
                        "fecha" => "2009"
                        "volumen" => "10"
                        "paginaInicial" => "771"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19285450"
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        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0220" class="elsevierStylePara elsevierViewall">We would like to thank the families who took part in this study&#59; Mar&#237;a Cecilia L&#243;pez&#44; Patricia Montoya&#44; Aurora Gallo and all the members of the GIPSI for their help and support in contacting the participating families&#59; the Universidad de Antioquia CODI&#59; and the Universidad de Antioquia Sustainability Strategy&#46;</p>"
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Article information
ISSN: 25303120
Original language: English
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