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Solelhac G, Imler T, Strippoli MPF, Marchi NA, Berger M, Haba-Rubio J, Raffray T, Bayon V, Lombardi AS, Ranjbar S, Siclari F, Vollenweider P, Marques-Vidal P, Geoffroy PA, Léger D, Stephan A, Preisig M, Heinzer R. Sleep disturbances and incident risk of major depressive disorder in a population-based cohort. Psychiatry Res 2024; 338:115934. [PMID: 38833937 DOI: 10.1016/j.psychres.2024.115934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/25/2024] [Accepted: 04/27/2024] [Indexed: 06/06/2024]
Abstract
Sleep disturbances are well-known symptoms of major depressive disorder (MDD). However, the prospective risk of MDD in the presence of sleep disturbances in a general population-based cohort is not well known. This study investigated associations between both polysomnography (PSG)-based or subjective sleep features and incident MDD. Participants representative of the general population who had never had MDD completed sleep questionnaires (n = 2000) and/or underwent PSG (n = 717). Over 8 years' follow-up, participants completed psychiatric interviews enabling the diagnosis of MDD. Survival Cox models were used to analyze associations between sleep features and MDD incidence. A higher Epworth Sleepiness Scale and presence of insomnia symptoms were significantly associated with a higher incidence of MDD (hazard ratio [HR] [95 % confidence interval (CI)]: 1.062 [1.022-1.103], p = 0.002 and 1.437 [1.064-1.940], p = 0.018, respectively). Higher density of rapid eye movements in rapid eye movement (REM) sleep was associated with a higher incidence of MDD in men (HR 1.270 [95 % CI 1.064-1.516], p = 0.008). In women, higher delta power spectral density was associated with a lower MDD incidence (HR 0.674 [95 % CI 0.463-0.981], p = 0.039). This study confirmed the associations between subjective and objective sleep features and the incidence of MDD in a large community dwelling cohort.
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Affiliation(s)
- Geoffroy Solelhac
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland.
| | - Théo Imler
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Marie-Pierre F Strippoli
- Center for research in Psychiatric Epidemiology and Psychopathology (CEPP), Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Nicola Andrea Marchi
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Mathieu Berger
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Jose Haba-Rubio
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland; Florimont Sleep Center, Lausanne, Switzerland
| | - Tifenn Raffray
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland; Florimont Sleep Center, Lausanne, Switzerland
| | - Virginie Bayon
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Anne Sophie Lombardi
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Setareh Ranjbar
- Center for research in Psychiatric Epidemiology and Psychopathology (CEPP), Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Francesca Siclari
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland; Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands; The Sense Innovation and Research Center, Lausanne and Sion, Switzerland
| | - Peter Vollenweider
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pierre-Alexis Geoffroy
- GHU Paris - Psychiatry & Neurosciences, Paris, France; Université de Paris, NeuroDiderot, Inserm, Paris, France; Département de Psychiatrie et d'Addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
| | - Damien Léger
- Université Paris Cité, VIFASOM, AP-HP, Hôtel-Dieu, Centre du Sommeil et de la Vigilance, Paris, France
| | - Aurélie Stephan
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Martin Preisig
- Center for research in Psychiatric Epidemiology and Psychopathology (CEPP), Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Raphaël Heinzer
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
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Zhang Z, Zhang W, Fang Y, Wang N, Liu G, Zou N, Song Z, Liu H, Wang L, Xiao Q, Zhao J, Wang Y, Lei T, Zhang C, Liu X, Zhang B, Luo F, Xia J, He C, Hu Z, Ren S, Zhao H. A potentiation of REM sleep-active neurons in the lateral habenula may be responsible for the sleep disturbance in depression. Curr Biol 2024:S0960-9822(24)00752-8. [PMID: 38944036 DOI: 10.1016/j.cub.2024.05.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 03/25/2024] [Accepted: 05/31/2024] [Indexed: 07/01/2024]
Abstract
Psychiatric disorders with dysfunction of the lateral habenula (LHb) show sleep disturbance, especially a disinhibition of rapid eye movement (REM) sleep in major depression. However, the role of LHb in physiological sleep control and how LHb contributes to sleep disturbance in major depression remain elusive. Here, we found that functional manipulations of LHb glutamatergic neurons bidirectionally modulated both non-REM (NREM) sleep and REM sleep. Activity recording revealed heterogeneous activity patterns of LHb neurons across sleep/wakefulness cycles, but LHb neurons were preferentially active during REM sleep. Using an activity-dependent tagging method, we selectively labeled a population of REM sleep-active LHb neurons and demonstrated that these neurons specifically promoted REM sleep. Neural circuit studies showed that LHb neurons regulated REM sleep via projections to the ventral tegmental area but not to the rostromedial tegmental nucleus. Furthermore, we found that the increased REM sleep in a depression mouse model was associated with a potentiation of REM sleep-active LHb neurons, including an increased proportion, elevated spike firing, and altered activity mode. Importantly, inhibition of REM sleep-active LHb neurons not only attenuated the increased REM sleep but also alleviated depressive-like behaviors in a depression mouse model. Thus, our results demonstrated that REM sleep-active LHb neurons selectively promoted REM sleep, and a potentiation of these neurons contributed to depression-associated sleep disturbance.
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Affiliation(s)
- Zehui Zhang
- Department of Physiology, College of Basic Medical Sciences, Jilin University, Changchun 130021, China
| | - Wei Zhang
- Department of Physiology, College of Basic Medical Sciences, Army Medical University, Chongqing 400038, China
| | - Yuanyuan Fang
- Department of Physiology, College of Basic Medical Sciences, Army Medical University, Chongqing 400038, China; Department of Anaesthesiology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430071, China
| | - Na Wang
- Department of Physiology, College of Basic Medical Sciences, Army Medical University, Chongqing 400038, China
| | - Guoying Liu
- Chongqing Institute for Brain and Intelligence, Guangyang Bay Laboratory, Chongqing 400064, China
| | - Nan Zou
- Chongqing Institute for Brain and Intelligence, Guangyang Bay Laboratory, Chongqing 400064, China
| | - Zhenbo Song
- Department of Physiology, College of Basic Medical Sciences, Army Medical University, Chongqing 400038, China
| | - Hanshu Liu
- Department of Physiology, College of Basic Medical Sciences, Army Medical University, Chongqing 400038, China; Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Longshuo Wang
- Department of Physiology, College of Basic Medical Sciences, Jilin University, Changchun 130021, China
| | - Qin Xiao
- Department of Physiology, College of Basic Medical Sciences, Army Medical University, Chongqing 400038, China
| | - Juanjuan Zhao
- Department of Physiology, College of Basic Medical Sciences, Army Medical University, Chongqing 400038, China
| | - Yaling Wang
- Department of Physiology, College of Basic Medical Sciences, Army Medical University, Chongqing 400038, China
| | - Ting Lei
- Department of Physiology, College of Basic Medical Sciences, Jilin University, Changchun 130021, China
| | - Cai Zhang
- Department of Physiology, College of Basic Medical Sciences, Army Medical University, Chongqing 400038, China
| | - Xiaofeng Liu
- Department of Physiology, College of Basic Medical Sciences, Jilin University, Changchun 130021, China
| | - Beilin Zhang
- Department of Physiology, College of Basic Medical Sciences, Jilin University, Changchun 130021, China
| | - Fenlan Luo
- Department of Physiology, College of Basic Medical Sciences, Army Medical University, Chongqing 400038, China
| | - Jianxia Xia
- Department of Physiology, College of Basic Medical Sciences, Army Medical University, Chongqing 400038, China
| | - Chao He
- Department of Physiology, College of Basic Medical Sciences, Army Medical University, Chongqing 400038, China
| | - Zhian Hu
- Department of Physiology, College of Basic Medical Sciences, Army Medical University, Chongqing 400038, China; Chongqing Institute for Brain and Intelligence, Guangyang Bay Laboratory, Chongqing 400064, China.
| | - Shuancheng Ren
- Department of Physiology, College of Basic Medical Sciences, Army Medical University, Chongqing 400038, China.
| | - Hua Zhao
- Department of Physiology, College of Basic Medical Sciences, Jilin University, Changchun 130021, China.
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Xu YH, Wu F, Yu S, Guo YN, Zhao RR, Zhang RL. Therapeutic sleep deprivation for major depressive disorder: A randomized controlled trial. J Affect Disord 2024; 361:10-16. [PMID: 38844163 DOI: 10.1016/j.jad.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 04/01/2024] [Accepted: 06/02/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Major depressive disorder (MDD) is treated primarily using antidepressant drugs, but clinical effects may be delayed for weeks to months. This study investigated the efficacy of brief therapeutic sleep deprivation (TSD) for inducing rapid improvements in MDD symptoms. METHODS From November 2020 to February 2023, 54 inpatients with MDD were randomly allocated to TSD and Control groups. The TSD group (23 cases) remained awake for 36 h, while the Control group (31 cases) maintained regular sleep patterns. All participants continued regular drug therapy. Mood was assessed using the 24-item Hamilton Depression Scale (HAMD-24) at baseline and post-intervention in both groups. In the TSD group, the Visual Analogue Scale (VAS) was utilized to evaluate subjective mood during and after the intervention. Cognitive function was assessed at baseline and post-intervention using the Montreal Cognitive Assessment (MoCA). Objective sleep parameters were recorded in the TSD group by polysomnography. The follow-up period spanned one week. RESULTS HAMD-24 scores did not differ between groups at baseline or post-intervention. However, the clinical response rate was 34.8 % higher in the TSD group on day 3 post-intervention compared to the Control group (3.2 %), but not sustained by day 7. Moreover, responders demonstrated a faster improvement in the VAS score during TSD than non-responders (p = 0.047). There were no significant differences in MoCA scores or objective sleep parameters between the groups. LIMITATIONS Small sample size and notable attrition rate. CONCLUSIONS Therapeutic sleep deprivation can rapidly improve MDD symptoms without influencing sleep parameters or cognitive functions. Assessment of longer-term effects and identification of factors predictive of TSD response are warranted.
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Affiliation(s)
- Ya-Hui Xu
- Department of Sleep Medicine, Second Affiliated Hospital of Xinxiang Medical University; Henan Collaborative Innovation Center for Prevention and Treatment of Mental Disorders; Brain Institute, Henan Academy of Innovations in Medical Science, Xinxiang, China.
| | - Fang Wu
- Department of Sleep Medicine, Second Affiliated Hospital of Xinxiang Medical University; Henan Collaborative Innovation Center for Prevention and Treatment of Mental Disorders; Brain Institute, Henan Academy of Innovations in Medical Science, Xinxiang, China
| | - Shuai Yu
- Department of Sleep Medicine, Second Affiliated Hospital of Xinxiang Medical University; Henan Collaborative Innovation Center for Prevention and Treatment of Mental Disorders; Brain Institute, Henan Academy of Innovations in Medical Science, Xinxiang, China
| | - Ya-Nan Guo
- Department of Sleep Medicine, Second Affiliated Hospital of Xinxiang Medical University; Henan Collaborative Innovation Center for Prevention and Treatment of Mental Disorders; Brain Institute, Henan Academy of Innovations in Medical Science, Xinxiang, China
| | - Rong-Rong Zhao
- Psychiatry Department, First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
| | - Rui-Ling Zhang
- Department of Sleep Medicine, Second Affiliated Hospital of Xinxiang Medical University; Henan Collaborative Innovation Center for Prevention and Treatment of Mental Disorders; Brain Institute, Henan Academy of Innovations in Medical Science, Xinxiang, China
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Palatine E, Phillips ML, Soehner AM. The effect of slow wave sleep deprivation on mood in adolescents with depressive symptoms: A pilot study. J Affect Disord 2024; 354:347-355. [PMID: 38479512 DOI: 10.1016/j.jad.2024.03.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/13/2024] [Accepted: 03/09/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND There is an urgent need for safe, rapid-acting treatment strategies for adolescent depression. In depressed adults, slow wave sleep deprivation (SWSD) improved next-day mood without disrupting sleep duration, but SWSD has not been tested in adolescents. In a pilot study, the aim was to assess the effect of SWSD on sleep physiology and mood outcomes (depression, rumination, anhedonia) among adolescents with depressive symptoms. METHODS Sixteen adolescents (17.44 ± 1.46 yr, 12 female) completed three nights of polysomnographic sleep recording: Baseline, SWSD, and Recovery nights. Acoustic stimulation (tones of random pitch, duration, and volume) suppressed slow wave sleep (SWS) in real-time during SWSD. After each night, depression, rumination, and anhedonia severity were assessed. RESULTS SWSD successfully suppressed SWS, increased N2, and had minimal impact on Rapid Eye Movement (REM), nocturnal awakenings, and total sleep time. While SWSD did not improve depression or anhedonia severity overall, lower baseline non-REM alpha activity and greater SWS rebound during recovery sleep correlated with SWSD-related reduction in clinician-rated depression severity. Next-day rumination severity decreased after SWSD, with sustained improvements following recovery sleep. However, rumination improvement was not associated with SWS suppression, but rather reduction in total sleep time and REM in exploratory correlation models. LIMITATIONS Small sample size and large proportion of females. CONCLUSION SWSD did not improve depression in adolescents overall but a subset with low non-REM alpha activity and intact homeostatic sleep regulation may benefit from this approach. Findings from this pilot study also suggest that partial sleep deprivation may be a beneficial therapeutic strategy for rumination in adolescents.
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Affiliation(s)
- Elise Palatine
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mary L Phillips
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Adriane M Soehner
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Song SH, Cunningham TJ, Zhang Y, Lizano P, Keshavan MS. Neuroscience in pictures: 2. Sleep, wakefulness, and mental state biology. Asian J Psychiatr 2024; 98:104070. [PMID: 38838457 DOI: 10.1016/j.ajp.2024.104070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 05/09/2024] [Indexed: 06/07/2024]
Abstract
Sleep is a vital restorative process that has occupied our curiosity for millennia. Despite our longstanding research efforts, the biology of sleep and its connection to mental states remains enigmatic. Unsurprisingly, sleep and wakefulness, the fundamental processes between which our mental states oscillate, are inseparable from our physical and mental health. Thus, clinical consideration of sleep impairments warrants a transdiagnostic approach whilst appropriately acknowledging that certain individual disorders (e.g. depression, schizophrenia) may have somewhat distinct sleep disturbances. Moreover, our knowledge of the anatomy and physiology of sleep regulation-albeit limited-forms the foundation for current treatments for sleep difficulties. This pictorial article overviews the core concepts and future of sleep neuroscience and mental state biology for trainees and practitioners in psychiatry and related professions.
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Affiliation(s)
- Seo Ho Song
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Tony J Cunningham
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Yelu Zhang
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Paulo Lizano
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
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Jiang J, Li Z, Li H, Yang J, Ma X, Yan B. Sleep architecture and the incidence of depressive symptoms in middle-aged and older adults: A community-based study. J Affect Disord 2024; 352:222-228. [PMID: 38342319 DOI: 10.1016/j.jad.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 01/30/2024] [Accepted: 02/07/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Rapid eye movement (REM) sleep and three stages of non-REM (NREM) sleep comprise the full sleep cycle. The changes in sleep have been linked to depression risk. This study aimed to explore the association between sleep architecture and depressive symptoms. METHODS A total of 3247 participants from the Sleep Heart Health Study (SHHS) were included in this cohort study. REM and NREM sleep were monitored by in-home polysomnography at SHHS visit 1. Depressive symptoms was reported as the first occurrence between SHHS visits 1 and 2 (mean follow-up of 5.3 years). Multivariable logistic regression was used to investigate the relationship between sleep stages and depressive symptoms. RESULTS In total, 225 cases of depressive symptoms (6.9 %) were observed between SHHS visits 1 and 2. A significant linear association between NREM Stage 1 and depressive symptoms was found after adjusting for potential covariates. Multivariable logistic regression analysis showed that percentage in NREM Stage 1 was associated with the incidence of depressive symptoms (odds ratio [OR], 1.06; 95 % confidence interval [CI], 1.02-1.10; P = 0.001), as were time in NREM Stage 1 and depressive symptoms (OR, 1.02; 95 % CI, 1.01-1.03; P = 0.001). However, no significant association with depressive symptoms was found for other sleep stage. LIMITATIONS The specific follow-up time for depressive symptoms diagnosis was missing. CONCLUSIONS Increased time or percentage in NREM Stage 1 was associated with a higher risk of developing depressive symptoms. The early change in sleep architecture were important for incidence of depressive symptoms and warrants constant concerns.
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Affiliation(s)
- Jialu Jiang
- Department of Psychiatry, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Zhenyang Li
- Xi'an Jiaotong University Health Science Center, Xi'an, China; Department of Clinical Research Center, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Huimin Li
- Department of Psychiatry, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jian Yang
- Department of Psychiatry, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Department of Clinical Research Center, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Shaanxi Belt and Road Joint Laboratory of Precision Medicine in Psychiatry, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiancang Ma
- Department of Psychiatry, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Shaanxi Belt and Road Joint Laboratory of Precision Medicine in Psychiatry, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
| | - Bin Yan
- Department of Psychiatry, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Department of Clinical Research Center, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Shaanxi Belt and Road Joint Laboratory of Precision Medicine in Psychiatry, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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Ricciardiello A, McKinnon AC, Mowszowski L, LaMonica HM, Schrire ZM, Haroutonian C, Lam A, Hickie IB, D'Rozario A, Naismith SL. Assessing sleep architecture and cognition in older adults with depressive symptoms attending a memory clinic. J Affect Disord 2024; 348:35-43. [PMID: 38123073 DOI: 10.1016/j.jad.2023.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/28/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND While depression is intrinsically and bidirectionally linked with both sleep disturbance and cognition, the inter-relationships between sleep, cognition, and brain integrity in older people with depression, especially those with late-onset depression are undefined. METHODS One hundred and seventy-two older adults (mean age 64.3 ± 6.9 years, Depression: n = 66, Control: n = 106) attending a memory clinic underwent a neuropsychological battery of declarative memory, executive function tasks, cerebral magnetic resonance imaging and overnight polysomnography with quantitative electroencephalography. RESULTS The time spent in slow-wave sleep (SWS) and rapid eye movement (REM) sleep, slow-wave activity, sleep spindles, hippocampal volume and prefrontal cortex thickness did not differ between depression and control and depression onset groups. However, sleep onset latency (p = 0.005) and REM onset latency (p = 0.02) were later in the Depression group compared to controls. Less SWS was associated with poorer memory (r = 0.31, p = 0.023) in the depression group, and less SWS was related to better memory in the control group (r = -0.20, p = 0.043; Fishers r-to-z = -3.19). LIMITATIONS Longitudinal studies are needed to determine if changes in sleep in those with depressive symptoms predict cognitive decline and illness trajectory. CONCLUSION Older participants with depressive symptoms had delayed sleep initiation, suggestive of delayed sleep phase. The association between SWS and memory suggests SWS may be a useful target for cognitive intervention in older adults with depression symptoms. Reduced hippocampal volumes did not mediate this relationship, indicating a broader distributed neural network may underpin these associations.
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Affiliation(s)
- Andrea Ricciardiello
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia; CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Camperdown, NSW, Australia.
| | - Andrew C McKinnon
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia; CogSleep, Australian National Health and Medical Research Council Centre of Research Excellence, Australia
| | - Loren Mowszowski
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia; CogSleep, Australian National Health and Medical Research Council Centre of Research Excellence, Australia
| | - Haley M LaMonica
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Zoe Menczel Schrire
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia; CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Camperdown, NSW, Australia; CogSleep, Australian National Health and Medical Research Council Centre of Research Excellence, Australia
| | - Carla Haroutonian
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia; CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Camperdown, NSW, Australia
| | - Aaron Lam
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia; CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Camperdown, NSW, Australia; School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Ian B Hickie
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Angela D'Rozario
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia; CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Camperdown, NSW, Australia; CogSleep, Australian National Health and Medical Research Council Centre of Research Excellence, Australia; School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Sharon L Naismith
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia; Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia; CogSleep, Australian National Health and Medical Research Council Centre of Research Excellence, Australia
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8
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Arıkan MK, Uysal Ö, Gıca Ş, Orhan Ö, İlhan R, Esmeray MT, Bakay H, Metin B, Pogarell O, Turan Ş. REM parameters in drug-free major depressive disorder: A systematic review and meta-analysis. Sleep Med Rev 2024; 73:101876. [PMID: 37995418 DOI: 10.1016/j.smrv.2023.101876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/11/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023]
Abstract
Previous studies revealed that rapid eye movement (REM) parameters, such as REM latency (RL) and REM density (RD) could be used as electrophysiological markers of depression. Yet these finding should be re-tested in a comorbid-free and drug-free sample. The present systematic review and meta-analysis was conducted to investigate whether drug-free and comorbid-free patients with unipolar depression differentiate from controls with respect to the RL and RD. The PubMed and Web of Science databases were screened from inception to 23 January 2023 for case-control studies comparing RL and RD of patients with unipolar depression and controls. The primary outcome was the standard mean difference. The data were fitted with a random-effects model. Meta-regressions were conducted to investigate patient characteristics and effect size. Publication bias assessment was checked by Egger's Regression and funnel plot asymmetry. Among 43 articles accepted as eligible, 46 RL and 22 RD measurements were included in the meta-analysis. The results indicated shortened RL and increased RD in the patient group than controls. Neither Egger's regression nor funnel plot asymmetry were significant for publication bias. In conclusion, our results tested within drug-free and comorbid-free samples are in line with the literature.
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Affiliation(s)
| | - Ömer Uysal
- Istanbul University Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Biostatistics, Istanbul, Turkey
| | - Şakir Gıca
- Department of Mental Health and Disease, MERAM School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Özden Orhan
- Kemal Arıkan Psychiatry Clinic, Istanbul, Turkey
| | - Reyhan İlhan
- Kemal Arıkan Psychiatry Clinic, Istanbul, Turkey
| | | | - Hasan Bakay
- Department of Mental Health and Disease, MERAM School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Barış Metin
- Department of Neurology, Medical Faculty, Uskudar University, Istanbul, Turkey
| | - Oliver Pogarell
- Department of Psychiatry, Division of Clinical Neurophysiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Şenol Turan
- Istanbul University Cerrahpasa, Department of Psychiatry, Cerrahpasa Medical School, Istanbul, Turkey
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9
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Harrington MO, Reeve S, Bower JL, Renoult L. How do the sleep features that characterise depression impact memory? Emerg Top Life Sci 2023; 7:499-512. [PMID: 38054537 PMCID: PMC10754336 DOI: 10.1042/etls20230100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 12/07/2023]
Abstract
Depression is associated with general sleep disturbance and abnormalities in sleep physiology. For example, compared with control subjects, depressed patients exhibit lower sleep efficiency, longer rapid eye movement (REM) sleep duration, and diminished slow-wave activity during non-REM sleep. A separate literature indicates that depression is also associated with many distinguishing memory characteristics, including emotional memory bias, overgeneral autobiographical memory, and impaired memory suppression. The sleep and memory features that hallmark depression may both contribute to the onset and maintenance of the disorder. Despite our rapidly growing understanding of the intimate relationship between sleep and memory, our comprehension of how sleep and memory interact in the aetiology of depression remains poor. In this narrative review, we consider how the sleep signatures of depression could contribute to the accompanying memory characteristics.
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Affiliation(s)
| | - Sarah Reeve
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, U.K
| | - Joanne L. Bower
- School of Psychology, University of East Anglia, Norwich, U.K
| | - Louis Renoult
- School of Psychology, University of East Anglia, Norwich, U.K
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10
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Kishi TT, Andersen ML, Luciano YM, Kakazu VA, Tufik S, Pires GN. Methods for REM Sleep Density Analysis: A Scoping Review. Clocks Sleep 2023; 5:793-805. [PMID: 38131750 PMCID: PMC10742531 DOI: 10.3390/clockssleep5040051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/21/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023] Open
Abstract
Rapid eye movements (REM) sleep density is the parameter proposed to explain the variability in the amount of eye movements during REM sleep. Alterations in REM sleep density have been proposed as a screening criterion for individuals with depression and other mental health conditions, but its accuracy has not been properly evaluated. The lack of consensus and the variability of the methods used to score it reduces the external validity of the results, hindering an adequate analysis of its diagnostic accuracy and clinical applicability. This scoping review aimed to identify and quantify the methods used to score REM sleep density, describing their main characteristics. A literature search was conducted in PubMed, Scopus, PsycInfo, and Web of Science. Only studies with objective measures for REM sleep density analysis in individuals with depression were considered eligible. The final sample comprised 57 articles, covering 64 analyses of REM sleep density. The relative frequency methods were the predominant measurement parameter for analyzing REM sleep density across studies. The most frequently adopted REM estimation unit was the number of REM events followed by mini-epochs containing REM. The most common unit of measurement were frequency/time measures. The results demonstrate that there is no consistency in the methods used to calculate REM sleep density in the literature, and a high percentage of studies do not describe their methods in sufficient detail. The most used method was the number of REM episodes per minute of REM sleep, but its use is neither unanimous nor consensual. The methodological inconsistencies and omissions among studies limit the replicability, comparability, and clinical applicability of REM sleep density. Future guidelines should discuss and include a specific methodology for the scoring of REM sleep density, so it can be consensually implemented in clinical services and research.
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Affiliation(s)
- Tamires Tiemi Kishi
- Departamento de Psicobiologia, Federal University of São Paulo, São Paulo 04024-002, Brazil; (T.T.K.)
| | - Monica Levy Andersen
- Departamento de Psicobiologia, Federal University of São Paulo, São Paulo 04024-002, Brazil; (T.T.K.)
- Sleep Institute, São Paulo, 04020-060, Brazil
| | - Ygor Matos Luciano
- Departamento de Psicobiologia, Federal University of São Paulo, São Paulo 04024-002, Brazil; (T.T.K.)
| | - Viviane Akemi Kakazu
- Departamento de Psicobiologia, Federal University of São Paulo, São Paulo 04024-002, Brazil; (T.T.K.)
| | - Sergio Tufik
- Departamento de Psicobiologia, Federal University of São Paulo, São Paulo 04024-002, Brazil; (T.T.K.)
- Sleep Institute, São Paulo, 04020-060, Brazil
| | - Gabriel Natan Pires
- Departamento de Psicobiologia, Federal University of São Paulo, São Paulo 04024-002, Brazil; (T.T.K.)
- Sleep Institute, São Paulo, 04020-060, Brazil
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11
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Boolani A, Yager C, Reid J, Lackman J, Smith ML. Correlates of depressive mood among graduate-level allied health students: An exploratory study examining trait energy and fatigue. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:1685-1695. [PMID: 34379564 DOI: 10.1080/07448481.2021.1960843] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/28/2021] [Accepted: 07/22/2021] [Indexed: 06/13/2023]
Abstract
Objective: The objective of this study was to identify factors associated with the occurrence and severity of depressive mood states among graduate-level allied health students. Participants: Students (N = 77) completed this study. Methods: Participants completed a series of self-reported surveys measuring moods, lifestyle behaviors, trait mental and physical energy and fatigue, and objective assessments of Trail-Making Test Part-B, and muscle oxygen consumption. Multiple backwards linear regression models were fitted to identify factors associated with depressive mood states. Results: When accounting for all subjects, increased severity of depressive mood states was associated with worse sleep quality (SQ), increased sitting time (ST), and trait physical fatigue (TPF). When examining subjects reporting depressive mood states, increased severity of depressive mood states was associated with worse SQ, increased ST, decreased mental workload on non-school days, and trait physical energy (TPE). Conclusion: Adjustments in lifestyle factors such as sleep, mental workload, and ST, may ameliorate depressive mood states.
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Affiliation(s)
- Ali Boolani
- Department of Physical Therapy, Clarkson University, Potsdam, New York, USA
| | - Chelsea Yager
- Department of Neurology, St. Joseph's Hospital, Syracuse, New York, USA
| | - Jeri Reid
- Department of Neurology, St. Joseph's Hospital, Syracuse, New York, USA
| | - Jeremy Lackman
- Department of Health and Physical Education, Monmouth University, West Long Branch, New Jersey, USA
| | - Matthew Lee Smith
- Center for Population Health and Aging, Texas A&M University, College Station, Texas, USA
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, Texas, USA
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12
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Yasugaki S, Okamura H, Kaneko A, Hayashi Y. Bidirectional Relationship Between Sleep and Depression. Neurosci Res 2023:S0168-0102(23)00087-1. [PMID: 37116584 DOI: 10.1016/j.neures.2023.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 03/01/2023] [Accepted: 04/20/2023] [Indexed: 04/30/2023]
Abstract
Patients with depression almost inevitably exhibit abnormalities in sleep, such as shortened latency to enter rapid eye movement (REM) sleep and decrease in electroencephalogram delta power during non-REM sleep. Insufficient sleep can be stressful, and the accumulation of stress leads to the deterioration of mental health and contributes to the development of psychiatric disorders. Thus, it is likely that depression and sleep are bidirectionally related, i.e. development of depression contributes to sleep disturbances and vice versa. However, the relation between depression and sleep seems complicated. For example, acute sleep deprivation can paradoxically improve depressive symptoms. Thus, it is difficult to conclude whether sleep has beneficial or harmful effects in patients with depression. How antidepressants affect sleep in patients with depression might provide clues to understanding the effects of sleep, but caution is required considering that antidepressants have diverse effects other than sleep. Recent animal studies support the bidirectional relation between depression and sleep, and animal models of depression are expected to be beneficial for the identification of neuronal circuits that connect stress, sleep, and depression. This review provides a comprehensive overview regarding the current knowledge of the relationship between depression and sleep.
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Affiliation(s)
- Shinnosuke Yasugaki
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan; Biomedical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan; Department of Biological Sciences, Graduate School of Science, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan; Japan Society for the Promotion of Science (JSPS), Tokyo 102-0083, Japan.
| | - Hibiki Okamura
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan; Japan Society for the Promotion of Science (JSPS), Tokyo 102-0083, Japan; Program in Humanics, School of Integrative and Global Majors, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan.
| | - Ami Kaneko
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan; Program in Humanics, School of Integrative and Global Majors, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan.
| | - Yu Hayashi
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan; Department of Biological Sciences, Graduate School of Science, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan; Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto 603-8363, Japan.
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13
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Solelhac G, Berger M, Strippoli MPF, Marchi NA, Stephan A, Petit JM, Bayon V, Imler T, Haba-Rubio J, Raffray T, Vollenweider P, Marques-Vidal P, Waeber G, Léger D, Siclari F, Geoffroy PA, Preisig M, Heinzer R. Objective polysomnography-based sleep features and major depressive disorder subtypes in the general population. Psychiatry Res 2023; 324:115213. [PMID: 37098299 DOI: 10.1016/j.psychres.2023.115213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 04/27/2023]
Abstract
Insomnia and its opposite hypersomnia are part of the diagnostic criteria for major depressive disorder (MDD). However, no study has investigated whether the postulated sleep alterations in clinical subtypes of MDD are reflected in polysomnography (PSG)-derived objective sleep measures. The objective of this study was to establish associations between the melancholic, atypical and unspecified subtypes of MDD and objective PSG-based sleep features. This cross-sectional analysis included 1820 community-dwelling individuals who underwent PSG and a semi-structured psychiatric interview to elicit diagnostic criteria for MDD and its subtypes. Adjusted robust linear regression was used to assess associations between MDD subtypes and PSG-derived objective sleep measures. Current melancholic MDD was significantly associated with decreased absolute delta power and sleep efficiency and with increased wake after sleep onset. Remitted unspecified MDD was significantly associated with increased rapid eye movements density. No other significant associations were identified. Our findings reflect that some PSG-based sleep features differed in MDD subtypes compared with no MDD. The largest number of significant differences were observed for current melancholic MDD, whereas only rapid eye movements density could represent a risk factor for MDD as it was the only sleep measure that was also associated with MDD in remitted participants.
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Affiliation(s)
- Geoffroy Solelhac
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland.
| | - Mathieu Berger
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland.
| | - Marie-Pierre F Strippoli
- Center for research in Psychiatric Epidemiology and Psychopathology (CEPP), Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland.
| | - Nicola Andrea Marchi
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland.
| | - Aurélie Stephan
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Jean-Marie Petit
- Center for Psychiatric Neuroscience (CNP), Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Virginie Bayon
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland.
| | - Théo Imler
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Jose Haba-Rubio
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland; Florimont Sleep Center, Lausanne, Switzerland.
| | - Tifenn Raffray
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland; Florimont Sleep Center, Lausanne, Switzerland.
| | - Peter Vollenweider
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
| | - Gerard Waeber
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
| | - Damien Léger
- Université Paris Cité, VIFASOM, AP-HP, Hôtel-Dieu, Centre du Sommeil et de la Vigilance, Paris, France.
| | - Francesca Siclari
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland; The Sense Innovation and Research Center, Lausanne and Sion, Switzerland; Department of Clinical Neurosciences Lausanne University Hospital (CHUV), Lausanne, Switzerland; Netherlands Institute for Neuroscience, Amsterdam, Netherlands.
| | - Pierre A Geoffroy
- GHU Paris - Psychiatry & Neurosciences, Paris, France; Université de Paris, NeuroDiderot, Inserm, Paris, France; Département de Psychiatrie et d'Addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat - Claude Bernard, Paris, France
| | - Martin Preisig
- Center for research in Psychiatric Epidemiology and Psychopathology (CEPP), Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland.
| | - Raphaël Heinzer
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland.
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14
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Geoffroy PA, Schroder CM, Bourgin P, Maruani J, Lejoyeux M, d'Ortho MP, Couffignal C. Validation of a data collection set for the psychiatric, addiction, sleep and chronobiological assessments of patients with depression: A Delphi study for the SoPsy-depression French national cohort. L'ENCEPHALE 2023; 49:117-123. [PMID: 36257850 DOI: 10.1016/j.encep.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/08/2022] [Accepted: 07/15/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Despite international efforts to identify biomarkers of depression, none has been transferred to clinical practice, neither for diagnosis, evolution, nor therapeutic response. This led us to build a French national cohort (through the clinical and research network named SoPsy within the French biological psychiatry society (AFPBN) and sleep society (SFRMS)), to better identify markers of sleep and biological rhythms and validate more homogeneous subgroups of patients, but also to specify the manifestations and pathogeneses of depressive disorders. Before inclusions, we sought to provide a predefined, standardized, and robust set of data to be collected in all centers. METHODS A Delphi process was performed to achieve consensus through the independent rating of invited experts, the SoPsy-depression co-investigators (n=34). The initial set open for vote included 94 questionnaires targeting adult and child psychiatry, sleep and addiction. RESULTS Two questionnaire rounds were completed with 94% participation in the first round and 100% participation in the second round. The results of the Delphi survey incorporated the consensus opinion of the 32 members who completed both rounds. Nineteen of the 94 questionnaires achieved consensus at the first round and seventy of 75 at the second round. The five remaining questionnaires were submitted to three experts involved in the steering committee during a dedicated meeting. At the end, 24 questionnaires were retained in the mandatory and 26 in the optional questionnaire set. CONCLUSIONS A validated data collection set of questionnaires is now available to assess psychiatry, addiction, sleep and chronobiology dimensions of depressive disorders.
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Affiliation(s)
- P A Geoffroy
- Département de psychiatrie et d'addictologie, GHU Paris Nord, DMU neurosciences, hôpital Bichat - Claude Bernard, AP-HP, 75018 Paris, France; GHU Paris - psychiatry & neurosciences, 1, rue Cabanis, 75014 Paris, France; NeuroDiderot, Inserm, FHU I2-D2, université Paris Cité, 75019 Paris, France; CNRS UPR 3212, Institute for cellular and integrative neurosciences, 67000 Strasbourg, France.
| | - C M Schroder
- CNRS UPR 3212, Institute for cellular and integrative neurosciences, 67000 Strasbourg, France; Department of child and adolescent psychiatry, Strasbourg university and Strasbourg university hospitals, Strasbourg, France; Sleep disorders center & CIRCSom (International Research Center for ChronoSomnology), CHRU, Strasbourg, France
| | - P Bourgin
- CNRS UPR 3212, Institute for cellular and integrative neurosciences, 67000 Strasbourg, France; Sleep disorders center & CIRCSom (International Research Center for ChronoSomnology), CHRU, Strasbourg, France
| | - J Maruani
- Département de psychiatrie et d'addictologie, GHU Paris Nord, DMU neurosciences, hôpital Bichat - Claude Bernard, AP-HP, 75018 Paris, France; GHU Paris - psychiatry & neurosciences, 1, rue Cabanis, 75014 Paris, France; NeuroDiderot, Inserm, FHU I2-D2, université Paris Cité, 75019 Paris, France
| | - M Lejoyeux
- Département de psychiatrie et d'addictologie, GHU Paris Nord, DMU neurosciences, hôpital Bichat - Claude Bernard, AP-HP, 75018 Paris, France; GHU Paris - psychiatry & neurosciences, 1, rue Cabanis, 75014 Paris, France; NeuroDiderot, Inserm, FHU I2-D2, université Paris Cité, 75019 Paris, France
| | - M-P d'Ortho
- NeuroDiderot, Inserm, FHU I2-D2, université Paris Cité, 75019 Paris, France; Service de physiologie - explorations fonctionnelles, centre du sommeil, hôpital Bichat, AP-HP, 75018 Paris, France
| | - C Couffignal
- Département de biostatistique, épidémiologie et recherche clinique, Hôpital Bichat, université Paris Cité, AP-HP, 75018 Paris, France
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15
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Abnormal sleep features in adolescent MDD and its potential in diagnosis and prediction of early efficacy. Sleep Med 2023; 106:116-122. [PMID: 36740544 DOI: 10.1016/j.sleep.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 12/06/2022] [Accepted: 01/25/2023] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Previous studies have shown that abnormal sleep architectures are the important indicator for diagnosing MDD and predicting the efficacy of antidepressants. However, few studies have focused specifically on adolescents. OBJECTIVE To explore the relationship between abnormal sleep features, including PSG parameters and scale evaluation, and the onset of adolescent MDD, as well as early SSRIs efficacy. METHODS 102 adolescent MDD patients (age 12 to 19-year-old) and 41 similarly age-marched controls were recruited. Demographic data, the HAMD24 and the PSQI scale assessment scores were collected at baseline, latter two were also collected at follow-up. Part of the participants underwent a minimum 7-d medication-free period, and two consecutive night polysomnography. In the follow-up study, MDD patients were treated with standardized SSRIs. Treatment response was assessed every two weeks. RESULTS MDD subjects' parental marital status, REM-sleep latency, N2, N2%, N3, REM-sleep duration, REM % showed significant differences at baseline. REM-sleep latency showed significant prediction of the onset of MDD. The HAMD24 and PSQI scale assessment scores decreased over time in the follow-up study. Specifically, the sleep disorder factor score of HAMD24, the scores of PSQI sleep latency, sleep disorder, sleep efficiency and total score showed significantly differences between responder and non-responder groups. PSQI baseline moderate group showed significant prediction of the early efficacy of SSRIs. CONCLUSION Abnormal sleep PSG parameters and self-evaluation could be predictors for the adolescent MDD onset and early SSRIs efficacy.
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16
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Association analyses of the autosomal genome and mitochondrial DNA with accelerometry-derived sleep parameters in depressed UK biobank subjects. J Psychiatr Res 2023; 157:152-161. [PMID: 36463630 DOI: 10.1016/j.jpsychires.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 09/01/2022] [Accepted: 11/12/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The bidirectional relationship between sleep disturbances and depression is well documented, yet the biology of sleep is not fully understood. Mitochondria have become of interest not only because of the connection between sleep and metabolism but also because of mitochondria's involvement in the production of reactive oxygen species, which are largely scavenged during sleep. METHODS Genome-wide association studies (GWAS) of eight accelerometry-derived sleep measures were performed across both the autosomal and mitochondrial DNA (mtDNA) among two severity levels of depression in UK Biobank participants. We calculated SNP heritability for each of the sleep measures. Linear regression was performed to test associations and mitochondrial haplogroups. RESULTS Variants included in the GWAS accounted for moderate heritability of bedtime (19.6%, p = 4.75 × 10-7), sleep duration (16.6%, p = 8.58 × 10-6) and duration of longest sleep bout (22.6%, p = 4.64 × 10-4). No variants passed genome-wide significance in the autosomal genome. The top hit in the severe depression sample was rs145019802, near GOLGA8B, for sleep efficiency (p = 1.17 × 10-7), and the top hit in the broad depression sample was rs7100859, an intergenic SNP, and nap duration (p = 1.25 × 10-7). Top mtDNA loci were m.12633C > A of MT-ND5 with bedtime (p = 0.002) in the severe sample and m.16186C > T of the control region with nap duration (p = 0.002) in the broad sample. CONCLUSION SNP heritability estimates support the involvement of common SNPs in specific sleep measures among depressed individuals. This is the first study to analyze mtDNA variance in sleep measures in depressed individuals. Our mtDNA findings, although nominally significant, provide preliminary suggestion that mitochondria are involved in sleep.
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17
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Carpenter JS, Zmicerevska N, Crouse JJ, Nichles A, Garland A, Song YJC, Wilson C, Rohleder C, McHugh C, Leweke FM, Koethe D, Scott EM, Hickie IB. Effects of adjunctive brexpiprazole on sleep-wake and circadian parameters in youth with depressive disorders: study protocol for a clinical trial. BMJ Open 2022; 12:e056298. [PMID: 36691133 PMCID: PMC9454051 DOI: 10.1136/bmjopen-2021-056298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 08/09/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Sleep-wake and circadian disturbance is a key feature of mood disorders with a potential causal role and particular relevance to young people. Brexpiprazole is a second-generation antipsychotic medication with demonstrated efficacy as an adjunct to antidepressant treatment for major depressive disorder (MDD) in adults, with preliminary evidence suggesting greater effectiveness in subgroups of depressed patients with sleep disturbances. This clinical trial aims to evaluate the relationships between changes in sleep-wake and circadian parameters and changes in depressive symptoms following adjunctive brexpiprazole treatment in young adults with MDD and sleep-wake disturbance. METHODS AND ANALYSIS This study is designed as a 16 week (8 weeks active treatment, 8 weeks follow-up) mechanistic, open-label, single-arm, phase IV clinical trial and aims to recruit 50 young people aged 18-30 with MDD and sleep-wake cycle disturbance through an early intervention youth mental health clinic in Sydney, Australia. At baseline, participants will undergo multidimensional outcome assessment and subsequently receive 8 weeks of open-label treatment with brexpiprazole as adjunctive to their stable psychotropic medication. Following 4 weeks of treatment, clinical and self-report measures will be repeated. Ambulatory sleep-wake monitoring will be conducted continuously for the duration of treatment. After 8 weeks of treatment, all multidimensional outcome assessments will be repeated. Follow-up visits will be conducted 4 and 8 weeks after trial completion (including sleep-wake, clinical and self-report assessments). Circadian rhythm biomarkers including salivary melatonin, cortisol and core body temperature will be collected during an in-lab assessment. Additionally, metabolic, inflammatory and genetic risk markers will be collected at baseline and after 8 weeks of treatment. ETHICS AND DISSEMINATION This trial protocol has been approved by the Human Research Ethics Committee of the Sydney Local Health District (X19-0417 and 2019/ETH12986, Protocol Version 1-3, dated 25 February 2021). The results of this study, in deidentified form, will be disseminated through publication in peer-reviewed journals, scholarly book chapters, presentation at conferences and publication in conference proceedings. TRIAL REGISTRATION NUMBER ACTRN12619001456145.
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Affiliation(s)
- Joanne S Carpenter
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Natalia Zmicerevska
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jacob J Crouse
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Alissa Nichles
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Alexandra Garland
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Yun Ju Christine Song
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Chloe Wilson
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Cathrin Rohleder
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Catherine McHugh
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - F Markus Leweke
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Dagmar Koethe
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- The University of Notre Dame Australia School of Medicine Sydney Campus, Darlinghurst, New South Wales, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
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18
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Cognitive Computing in Mental Healthcare: a Review of Methods and Technologies for Detection of Mental Disorders. Cognit Comput 2022. [DOI: 10.1007/s12559-022-10042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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19
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A Weighted Error Distance Metrics (WEDM) for Performance Evaluation on Multiple Change-Point (MCP) Detection in Synthetic Time Series. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:6187110. [PMID: 35371237 PMCID: PMC8970941 DOI: 10.1155/2022/6187110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/16/2021] [Accepted: 01/22/2022] [Indexed: 11/18/2022]
Abstract
Change-point detection (CPD) is to find abrupt changes in time-series data. Various computational algorithms have been developed for CPD applications. To compare the different CPD models, many performance metrics have been introduced to evaluate the algorithms. Each of the previous evaluation methods measures the different aspects of the methods. Based on the existing weighted error distance (WED) method on single change-point (CP) detection, a novel WED metrics (WEDM) was proposed to evaluate the overall performance of a CPD model across not only repetitive tests on single CP detection, but also successive tests on multiple change-point (MCP) detection on synthetic time series under the random slide window (RSW) and fixed slide window (FSW) frameworks. In the proposed WEDM method, a concept of normalized error distance was introduced that allows comparisons of the distance between the estimated change-point (eCP) position and the target change point (tCP) in the synthetic time series. In the successive MCPs detection, the proposed WEDM method first divides the original time-series sample into a series of data segments in terms of the assigned tCPs set and then calculates a normalized error distance (NED) value for each segment. Next, our WEDM presents the frequency and WED distribution of the resultant eCPs from all data segments in the normalized positive-error distance (NPED) and the normalized negative-error distance (NNED) intervals in the same coordinates. Last, the mean WED (MWED) and MWTD (1-MWED) were obtained and then dealt with as important performance evaluation indexes. Based on the synthetic datasets in the Matlab platform, repetitive tests on single CP detection were executed by using different CPD models, including ternary search tree (TST), binary search tree (BST), Kolmogorov–Smirnov (KS) tests, t-tests (T), and singular spectrum analysis (SSA) algorithms. Meanwhile, successive tests on MCPs detection were implemented under the fixed slide window (FSW) and random slide window (RSW) frameworks. These CPD models mentioned above were evaluated in terms of our WED metrics, together with supplementary indexes for evaluating the convergence of different CPD models, including rates of hit, miss, error, and computing time, respectively. The experimental results showed the value of this WEDM method.
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Omichi C, Kadotani H, Sumi Y, Ubara A, Nishikawa K, Matsuda A, Ozeki Y. Prolonged Sleep Latency and Reduced REM Latency Are Associated with Depressive Symptoms in a Japanese Working Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042112. [PMID: 35206296 PMCID: PMC8872621 DOI: 10.3390/ijerph19042112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/01/2022] [Accepted: 02/10/2022] [Indexed: 12/26/2022]
Abstract
Background: Examining the relationship between sleep and depression may be important for understanding the aetiology of affective disorders. Most studies that use electroencephalography (EEG) to objectively assess sleep have been conducted using polysomnography in the laboratory. Impaired sleep continuity, including prolonged sleep latency and changes in rapid eye movement (REM) sleep, have been reported to be associated with depression in clinical settings. Here, we aimed to use home EEG to analyse the association between sleep and depressive symptoms. Methods: We performed a cross-sectional epidemiological study in a large Japanese working population to identify the EEG parameters associated with depressive symptoms based on the results of a questionnaire survey and home EEG measurements using 1-channel (1-Ch) EEG. Results: The study included 650 Japanese patients (41.2% male, 44.7 ± 11.5 years) who underwent home EEG monitoring along with the Patient Health Questionnaire-9 (PHQ-9) to assess depressive symptoms. Logistic regression analysis revealed that depressive symptoms (PHQ-9 ≥ 10) were associated with sleep latency (odds ratio (OR) 1.02; 95% confidence interval (CI): 1.00–1.04) and REM latency (OR, 0.99; 95% CI: 0.99–1.00). Conclusions: Our results suggest that depressive symptoms are associated with prolonged sleep latency and reduced REM latency in a Japanese working population. The 1-Ch EEG may be a useful tool to monitor sleep and screen depression/depressive symptoms in non-clinical settings.
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Affiliation(s)
- Chie Omichi
- Department of Psychiatry, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu City 520-2192, Japan; (C.O.); (Y.S.); (A.U.); (K.N.); (A.M.); (Y.O.)
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan
- Department of Hygiene and Public Health, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-machi, Takatsuki 569-8686, Japan
| | - Hiroshi Kadotani
- Department of Psychiatry, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu City 520-2192, Japan; (C.O.); (Y.S.); (A.U.); (K.N.); (A.M.); (Y.O.)
- Correspondence: or ; Tel.: +81-77-548-2291
| | - Yukiyoshi Sumi
- Department of Psychiatry, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu City 520-2192, Japan; (C.O.); (Y.S.); (A.U.); (K.N.); (A.M.); (Y.O.)
| | - Ayaka Ubara
- Department of Psychiatry, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu City 520-2192, Japan; (C.O.); (Y.S.); (A.U.); (K.N.); (A.M.); (Y.O.)
- Graduate School of Psychology, Doshisha University, Kyoto 610-0394, Japan
- Japan Society for the Promotion of Science, Research Fellowships, Tokyo 102-0083, Japan
| | - Kohei Nishikawa
- Department of Psychiatry, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu City 520-2192, Japan; (C.O.); (Y.S.); (A.U.); (K.N.); (A.M.); (Y.O.)
- Japan CBT Center, CG Building F4, 3-12 Chuo-cho, Hikone 522-0063, Japan
| | - Arichika Matsuda
- Department of Psychiatry, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu City 520-2192, Japan; (C.O.); (Y.S.); (A.U.); (K.N.); (A.M.); (Y.O.)
| | - Yuji Ozeki
- Department of Psychiatry, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu City 520-2192, Japan; (C.O.); (Y.S.); (A.U.); (K.N.); (A.M.); (Y.O.)
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Maranci JB, Nigam M, Masset L, Msika EF, Vionnet MC, Chaumereil C, Vidailhet M, Leu-Semenescu S, Arnulf I. Eye movement patterns correlate with overt emotional behaviours in rapid eye movement sleep. Sci Rep 2022; 12:1770. [PMID: 35110651 PMCID: PMC8810754 DOI: 10.1038/s41598-022-05905-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/12/2022] [Indexed: 11/09/2022] Open
Abstract
Growing evidence suggests that sleep plays a key role in regulating emotions. Rapid eye movements (REMs) in REM sleep could be associated with dreams emotions, but supporting evidence is indirect. To highlight this association, we studied the REM sleep during video-polysomnography of 20 subjects with REM sleep behaviour disorder (RBD), a model of enacted dreams offering direct access to the emotional content of the sleeper (face expression, speeches, behaviour). Video and the electro-oculography recordings were divided into 3 s time intervals and classified as non-behavioural, or behavioural (neutral, positive or negative emotions), and as containing no eye movements (EMs), slow eye movements (SEMs) or REMs (isolated or bursts). Compared to the absence of EMs, neutral behaviours successively increased in the presence of SEMs (odd ratio, OR = 1.4), then isolated REMs (OR = 2.8) and then REM bursts (OR = 4.6). Positive behaviours increased with SEMs (OR = 2.8) but did not increase further with isolated REMs (OR = 2.8) and REM bursts (OR = 3). Negative behaviours were absent with SEMs, increased with isolated REMs (OR = 2.6) and further with REM bursts (OR = 10.1). These results support an association between REMs and SEMs, and dream emotions.
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Affiliation(s)
- Jean-Baptiste Maranci
- Sleep Disorder Unit, Pitie-Salpetriere University Hospital, APHP, Paris, France.,Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montréal, Canada.,Paris Brain Institute, Paris, France
| | - Milan Nigam
- Sleep Disorder Unit, Pitie-Salpetriere University Hospital, APHP, Paris, France.,Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montréal, Canada
| | - Luc Masset
- Sleep Disorder Unit, Pitie-Salpetriere University Hospital, APHP, Paris, France
| | - Eva-Flore Msika
- Sleep Disorder Unit, Pitie-Salpetriere University Hospital, APHP, Paris, France
| | | | | | - Marie Vidailhet
- Paris Brain Institute, Paris, France.,Sorbonne University, Paris, France
| | - Smaranda Leu-Semenescu
- Sleep Disorder Unit, Pitie-Salpetriere University Hospital, APHP, Paris, France.,Paris Brain Institute, Paris, France
| | - Isabelle Arnulf
- Sleep Disorder Unit, Pitie-Salpetriere University Hospital, APHP, Paris, France. .,Paris Brain Institute, Paris, France. .,Sorbonne University, Paris, France.
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22
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Hickman AR, Hang Y, Pauly R, Feltus FA. Identification of condition-specific biomarker systems in uterine cancer. G3 GENES|GENOMES|GENETICS 2022; 12:6427626. [PMID: 34791179 PMCID: PMC8727964 DOI: 10.1093/g3journal/jkab392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/30/2021] [Indexed: 11/23/2022]
Abstract
Uterine cancer is the fourth most common cancer among women, projected to affect 66,000 US women in 2021. Uterine cancer often arises in the inner lining of the uterus, known as the endometrium, but can present as several different types of cancer, including endometrioid cancer, serous adenocarcinoma, and uterine carcinosarcoma. Previous studies have analyzed the genetic changes between normal and cancerous uterine tissue to identify specific genes of interest, including TP53 and PTEN. Here we used Gaussian Mixture Models to build condition-specific gene coexpression networks for endometrial cancer, uterine carcinosarcoma, and normal uterine tissue. We then incorporated uterine regulatory edges and investigated potential coregulation relationships. These networks were further validated using differential expression analysis, functional enrichment, and a statistical analysis comparing the expression of transcription factors and their target genes across cancerous and normal uterine samples. These networks allow for a more comprehensive look into the biological networks and pathways affected in uterine cancer compared with previous singular gene analyses. We hope this study can be incorporated into existing knowledge surrounding the genetics of uterine cancer and soon become clinical biomarkers as a tool for better prognosis and treatment.
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Affiliation(s)
- Allison R Hickman
- Department of Genetics and Biochemistry, Clemson University, Clemson, SC 29634, USA
| | - Yuqing Hang
- Department of Genetics and Biochemistry, Clemson University, Clemson, SC 29634, USA
| | - Rini Pauly
- Biomedical Data Science and Informatics Program, Clemson University, Clemson, SC 29634, USA
| | - Frank A Feltus
- Department of Genetics and Biochemistry, Clemson University, Clemson, SC 29634, USA
- Biomedical Data Science and Informatics Program, Clemson University, Clemson, SC 29634, USA
- College of Science, Center for Human Genetics, Clemson University, Clemson, SC 29634, USA
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23
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MacLellan A, Fureix C, Polanco A, Mason G. Can animals develop depression? An overview and assessment of ‘depression-like’ states. BEHAVIOUR 2021. [DOI: 10.1163/1568539x-bja10132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract
Describing certain animal behaviours as ‘depression-like’ or ‘depressive’ has become common across several fields of research. These typically involve unusually low activity or unresponsiveness and/or reduced interest in pleasure (anhedonia). While the term ‘depression-like’ carefully avoids directly claiming that animals are depressed, this narrative review asks whether stronger conclusions can be legitimate, with animals developing the clinical disorder as seen in humans (cf., DSM-V/ICD-10). Here, we examine evidence from animal models of depression (especially chronically stressed rats) and animals experiencing poor welfare in conventional captive conditions (e.g., laboratory mice and production pigs in barren environments). We find troubling evidence that animals are indeed capable of experiencing clinical depression, but demonstrate that a true diagnosis has yet to be confirmed in any case. We thus highlight the importance of investigating the co-occurrence of depressive criteria and discuss the potential welfare and ethical implications of animal depression.
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Affiliation(s)
- Aileen MacLellan
- Department of Integrative Biology, University of Guelph, Guelph, ON, Canada N1G 2W1
| | - Carole Fureix
- Bristol Veterinary School, University of Bristol, Langford, UK
| | - Andrea Polanco
- Department of Integrative Biology, University of Guelph, Guelph, ON, Canada N1G 2W1
| | - Georgia Mason
- Department of Integrative Biology, University of Guelph, Guelph, ON, Canada N1G 2W1
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Bertrand L, d'Ortho MP, Reynaud E, Lejoyeux M, Bourgin P, Geoffroy PA. Polysomnography in seasonal affective disorder: A systematic review and meta-analysis. J Affect Disord 2021; 292:405-415. [PMID: 34144365 DOI: 10.1016/j.jad.2021.05.080] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 04/26/2021] [Accepted: 05/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND . Although sleep disturbances are ubiquitous in depression, studies assessing sleep architecture lead to conflicting results, possibly because of the heterogeneity in this disorder. We aimed to focus on Seasonal Affective Disorder (SAD), which is directly associated with circadian and sleep homeostasis impairments. METHODS . A systematic search was conducted in July 2019. Original papers reporting data about night sleep architecture using polysomnography (PSG), in SAD or remitted-SAD and controls, were included. RESULTS . Seven studies were retained and included 183 individuals, including 109 patients with SAD and 74 healthy controls. The random-effects meta-analysis showed that rapid eye movement sleep (REM) was significantly increased in SAD compared to controls (REM amount: SMD=1[0.11,1.88], p = 0.027; REM percentage: SMD=0.71[0.02,1.40], p = 0.045). Remitted SAD patients, compared to controls, also had a significantly increased REM sleep (REM amount: SMD=1.84[0.78,2.90], p<0.001; REM percentage: SMD=1.27[0.51,2.03], p = 0.001) and a significantly decreased REM latency (SMD=-0.93[-1.73,-0.13], p = 0.022). No differences were observed for total sleep time, sleep efficiency, and slow-wave-sleep. LIMITATIONS . Most studies had small sample size, with no placebo group and with open designs. CONCLUSIONS . REM sleep amount and latency appear altered both during the acute and remitted phase of SAD, representing trait markers with interesting diagnosis and therapeutic implications.
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Affiliation(s)
- Léa Bertrand
- Department of Psychiatry and Addictive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hospital Bichat - Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France
| | - Marie-Pia d'Ortho
- Université de Paris, NeuroDiderot, Inserm, F-75019 Paris, France; Department of Sleep Disorders, Physiology and Functionnal Explorations, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France
| | - Eve Reynaud
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, 5 rue Blaise Pascal, 67000, Strasbourg, France
| | - Michel Lejoyeux
- Department of Psychiatry and Addictive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hospital Bichat - Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France
| | - Patrice Bourgin
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, 5 rue Blaise Pascal, 67000, Strasbourg, France; Sleep Disorders Center & CIRCSom (International Research Center for ChronoSomnology), Strasbourg University Hospital, 1 place de l'hôpital, 67000, Strasbourg, France
| | - Pierre A Geoffroy
- Department of Psychiatry and Addictive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hospital Bichat - Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France; Université de Paris, NeuroDiderot, Inserm, F-75019 Paris, France; CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, 5 rue Blaise Pascal, 67000, Strasbourg, France.
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A wake-up call: Sleep physiology and related translational discrepancies in studies of rapid-acting antidepressants. Prog Neurobiol 2021; 206:102140. [PMID: 34403718 PMCID: PMC9583188 DOI: 10.1016/j.pneurobio.2021.102140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/04/2021] [Accepted: 08/09/2021] [Indexed: 11/21/2022]
Abstract
Depression is frequently associated with sleep problems, and clinical improvement often coincides with the normalization of sleep architecture and realignment of circadian rhythm. The effectiveness of treatments targeting sleep in depressed patients, such as sleep deprivation, further demonstrates the confluence of sleep and mood. Moreover, recent studies showing that the rapid-acting antidepressant ketamine influences processes related to sleep-wake neurobiology have led to novel hypotheses explaining rapid and sustained antidepressant effects. Despite the available evidence, studies addressing ketamine’s antidepressant effects have focused on pharmacology and often overlooked the role of physiology. To explore this discrepancy in research on rapid-acting antidepressants, we examined articles published between 2009–2019. A keyword search algorithm indicated that vast majority of the articles completely ignored sleep. Out of the 100 most frequently cited preclinical and clinical research papers, 89 % and 71 %, respectively, did not mention sleep at all. Furthermore, only a handful of these articles disclosed key experimental variables, such as the times of treatment administration or behavioral testing, let alone considered the potential association between these variables and experimental observations. Notably, in preclinical studies, treatments were preferentially administered during the inactive period, which is the polar opposite of clinical practice and research. We discuss the potential impact of this practice on the results in the field. Our hope is that this perspective will serve as a wake-up call to (re)-examine rapid-acting antidepressant effects with more appreciation for the role of sleep and chronobiology.
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26
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Chronic antidepressant treatment rescues abnormally reduced REM sleep theta power in socially defeated rats. Sci Rep 2021; 11:16713. [PMID: 34408180 PMCID: PMC8373914 DOI: 10.1038/s41598-021-96094-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 08/02/2021] [Indexed: 11/08/2022] Open
Abstract
The effects of chronic antidepressant (AD) treatment on sleep disturbances in rodent chronic stress models have not been thoroughly investigated. Here, we show that chronic social defeat stress (SDS) in rats induces prolonged social avoidance, alterations in sleep architecture (increased total rapid eye movement [REM] sleep duration, bout, and shortened REM latency), and contextual but not cued fear memory deficits, even 1 month after the last SDS. These abnormalities were associated with changes in electroencephalography (EEG) spectral powers, including reduced REM sleep theta power during the light phase. Chronic treatment with two different classes of antidepressants (ADs), imipramine and fluoxetine, significantly ameliorated these behavioral, sleep, and EEG abnormalities. Interestingly, REM theta power was normalized by chronic (1 month) but not 1 week AD administration and solely correlated with the ratio (an objective indicator) of social interaction 1 month after the last SDS. These data suggest that reductions in REM sleep theta power, an EEG parameter that has never been directly investigated in humans, is a core sleep symptom in socially defeated rats, and, potentially, also in patients with stress-related psychiatric disorders, including major depressive and posttraumatic stress disorders.
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Bowers SJ, Lambert S, He S, Lowry CA, Fleshner M, Wright KP, Turek FW, Vitaterna MH. Immunization with a heat-killed bacterium, Mycobacterium vaccae NCTC 11659, prevents the development of cortical hyperarousal and a PTSD-like sleep phenotype after sleep disruption and acute stress in mice. Sleep 2021; 44:6025170. [PMID: 33283862 DOI: 10.1093/sleep/zsaa271] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/20/2020] [Indexed: 12/27/2022] Open
Abstract
STUDY OBJECTIVES Sleep deprivation induces systemic inflammation that may contribute to stress vulnerability and other pathologies. We tested the hypothesis that immunization with heat-killed Mycobacterium vaccae NCTC 11659 (MV), an environmental bacterium with immunoregulatory and anti-inflammatory properties, prevents the negative impacts of 5 days of sleep disruption on stress-induced changes in sleep, behavior, and physiology in mice. METHODS In a 2 × 2 × 2 experimental design, male C57BL/6N mice were given injections of either MV or vehicle on days -17, -10, and -3. On days 1-5, mice were exposed to intermittent sleep disruption, whereby sleep was disrupted for 20 h per day. Immediately following sleep disruption, mice were exposed to 1-h social defeat stress or novel cage (control) conditions. Object location memory (OLM) testing was conducted 24 h after social defeat, and tissues were collected 6 days later to measure inflammatory markers. Sleep was recorded using electroencephalography (EEG) and electromyography (EMG) throughout the experiment. RESULTS In vehicle-treated mice, only the combination of sleep disruption followed by social defeat (double hit): (1) increased brief arousals and NREM beta (15-30 Hz) EEG power in sleep immediately post-social defeat compared to baseline; (2) induced an increase in the proportion of rapid-eye-movement (REM) sleep and number of state shifts for at least 5 days post-social defeat; and (3) induced hyperlocomotion and lack of habituation in the OLM task. Immunization with MV prevented most of these sleep and behavioral changes. CONCLUSIONS Immunization with MV ameliorates a stress-induced sleep and behavioral phenotype that shares features with human posttraumatic stress disorder.
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Affiliation(s)
- Samuel J Bowers
- Center for Sleep and Circadian Biology, Northwestern University, Evanston, IL.,Department of Neurobiology, Northwestern University, Evanston, IL
| | - Sophie Lambert
- Department of Neurobiology, Northwestern University, Evanston, IL
| | - Shannon He
- Center for Sleep and Circadian Biology, Northwestern University, Evanston, IL.,Department of Neurobiology, Northwestern University, Evanston, IL
| | - Christopher A Lowry
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO.,Center for Neuroscience, University of Colorado Boulder, Boulder, CO
| | - Monika Fleshner
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO.,Center for Neuroscience, University of Colorado Boulder, Boulder, CO
| | - Kenneth P Wright
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO.,Center for Neuroscience, University of Colorado Boulder, Boulder, CO.,Sleep and Chronobiology Laboratory, University of Colorado Boulder, Boulder, CO
| | - Fred W Turek
- Center for Sleep and Circadian Biology, Northwestern University, Evanston, IL.,Department of Neurobiology, Northwestern University, Evanston, IL.,The Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Martha H Vitaterna
- Center for Sleep and Circadian Biology, Northwestern University, Evanston, IL.,Department of Neurobiology, Northwestern University, Evanston, IL
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Melhuish Beaupre LM, Brown GM, Gonçalves VF, Kennedy JL. Melatonin's neuroprotective role in mitochondria and its potential as a biomarker in aging, cognition and psychiatric disorders. Transl Psychiatry 2021; 11:339. [PMID: 34078880 PMCID: PMC8172874 DOI: 10.1038/s41398-021-01464-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 04/16/2021] [Accepted: 05/14/2021] [Indexed: 02/05/2023] Open
Abstract
Melatonin is an ancient molecule that is evident in high concentrations in various tissues throughout the body. It can be separated into two pools; one of which is synthesized by the pineal and can be found in blood, and the second by various tissues and is present in these tissues. Pineal melatonin levels display a circadian rhythm while tissue melatonin does not. For decades now, melatonin has been implicated in promoting and maintaining sleep. More recently, evidence indicates that it also plays an important role in neuroprotection. The beginning of our review will summarize this literature. As an amphiphilic, pleiotropic indoleamine, melatonin has both direct actions and receptor-mediated effects. For example, melatonin has established effects as an antioxidant and free radical scavenger both in vitro and in animal models. This is also evident in melatonin's prominent role in mitochondria, which is reviewed in the next section. Melatonin is synthesized in, taken up by, and concentrated in mitochondria, the powerhouse of the cell. Mitochondria are also the major source of reactive oxygen species as a byproduct of mitochondrial oxidative metabolism. The final section of our review summarizes melatonin's potential role in aging and psychiatric disorders. Pineal and tissue melatonin levels both decline with age. Pineal melatonin declines in individuals suffering from psychiatric disorders. Melatonin's ability to act as a neuroprotectant opens new avenues of exploration for the molecule as it may be a potential treatment for cases with neurodegenerative disease.
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Affiliation(s)
- Lindsay M Melhuish Beaupre
- Molecular Brain Science Research Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Gregory M Brown
- Molecular Brain Science Research Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Vanessa F Gonçalves
- Molecular Brain Science Research Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - James L Kennedy
- Molecular Brain Science Research Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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29
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Geoffroy PA, Oquendo MA, Courtet P, Blanco C, Olfson M, Peyre H, Lejoyeux M, Limosin F, Hoertel N. Sleep complaints are associated with increased suicide risk independently of psychiatric disorders: results from a national 3-year prospective study. Mol Psychiatry 2021; 26:2126-2136. [PMID: 32355334 DOI: 10.1038/s41380-020-0735-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/06/2020] [Accepted: 04/14/2020] [Indexed: 12/21/2022]
Abstract
Prior research suggests that sleep disturbances are associated with increased risk of suicide. However, sleep disturbances are associated with a wide range of psychiatric disorders, and it is unknown whether this association is independent of psychopathology. In a large nationally representative prospective survey, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), we used structural equation modeling to examine the shared and specific effects of three sleep complaints (i.e., trouble falling asleep, early morning awakening, and hypersomnia) on the 3-year occurrence of attempting suicide. Because psychiatric disorders increase the risk of suicide attempt almost exclusively through a general psychopathology factor representing their shared effect, covariates included that factor, prior history of suicide attempt, and a wide range of sociodemographic and clinical characteristics. The 3-year prevalence rate of suicide attempt was 0.6% (n = 241). Compared with participants who did not attempt suicide between the two waves, those who did reported significantly more frequently having trouble falling asleep (44.6% vs. 16.6%), early morning awakening (38.9% vs. 12.7%), and hypersomnia (35.0% vs. 10.7%). Following adjustments, effects of sleep complaints on this risk were significant and exerted almost exclusively through a general sleep complaints factor representing the shared effect across all sleep complaints. There were no residual associations of any individual sleep complaint with attempting suicide above that association. Sleep complaints are associated with an increased risk of attempting suicide independently of psychopathology, and should be included in suicide risk assessments as these symptoms may provide targets for reducing the risks of suicidal behaviors.
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Affiliation(s)
- Pierre A Geoffroy
- Paris Diderot University-Paris VII, 5 Rue Thomas Mann, 75013, Paris, France. .,Université de Paris, NeuroDiderot, Inserm, F-75019, Paris, France. .,University Hospital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018, Paris, France.
| | - Maria A Oquendo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Philippe Courtet
- INSERM, U1061, Neuropsychiatry, University Montpellier, Montpellier, France.,Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, Montpellier, France
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Mark Olfson
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY, 10032, USA
| | - Hugo Peyre
- Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France.,Cognitive Sciences and Psycholinguistic Laboratory, Ecole Normale Supérieure, Paris, France
| | - Michel Lejoyeux
- Paris Diderot University-Paris VII, 5 Rue Thomas Mann, 75013, Paris, France.,University Hospital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018, Paris, France
| | - Frédéric Limosin
- Cognitive Sciences and Psycholinguistic Laboratory, Ecole Normale Supérieure, Paris, France.,Centre Ressource Régional de Psychiatrie du Sujet Agé (CRRPSA), Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris, Paris, France.,Faculté de médecine Paris Descartes, Université de Paris, Paris, France.,Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Nicolas Hoertel
- Cognitive Sciences and Psycholinguistic Laboratory, Ecole Normale Supérieure, Paris, France.,Centre Ressource Régional de Psychiatrie du Sujet Agé (CRRPSA), Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris, Paris, France.,Faculté de médecine Paris Descartes, Université de Paris, Paris, France.,Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
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Lai CH. Fronto-limbic neuroimaging biomarkers for diagnosis and prediction of treatment responses in major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2021; 107:110234. [PMID: 33370569 DOI: 10.1016/j.pnpbp.2020.110234] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 12/02/2020] [Accepted: 12/21/2020] [Indexed: 12/23/2022]
Abstract
The neuroimaging is an important tool for understanding the biomarkers and predicting treatment responses in major depressive disorder (MDD). The potential biomarkers and prediction of treatment response in MDD will be addressed in the review article. The brain regions of cognitive control and emotion regulation, such as the frontal and limbic regions, might represent the potential targets for MDD biomarkers. The potential targets of frontal lobes might include anterior cingulate cortex (ACC), dorsolateral prefrontal cortex (DLPFC) and orbitofrontal cortex (OFC). For the limbic system, hippocampus and amygdala might be the potentially promising targets for MDD. The potential targets of fronto-limbic regions have been found in the studies of several major neuroimaging modalities, such as the magnetic resonance imaging, near-infrared spectroscopy, electroencephalography, positron emission tomography, and single-photon emission computed tomography. Additional regions, such as brainstem and midbrain, might also play a part in the MDD biomarkers. For the prediction of treatment response, the gray matter volumes, white matter tracts, functional representations and receptor bindings of ACC, DLPFC, OFC, amygdala, and hippocampus might play a role in the prediction of antidepressant responses in MDD. For the response prediction of psychotherapies, the fronto-limbic, reward regions, and insula will be the potential targets. For the repetitive transcranial magnetic stimulation, the DLPFC, ACC, limbic, and visuospatial regions might represent the predictive targets for treatment. The neuroimaging targets of MDD might be focused in the fronto-limbic regions. However, the neuroimaging targets for the prediction of treatment responses might be inconclusive and beyond the fronto-limbic regions.
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Affiliation(s)
- Chien-Han Lai
- Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan; PhD Psychiatry & Neuroscience Clinic, Taoyuan, Taiwan.
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Geoffroy PA, Palagini L. Biological rhythms and chronotherapeutics in depression. Prog Neuropsychopharmacol Biol Psychiatry 2021; 106:110158. [PMID: 33152388 DOI: 10.1016/j.pnpbp.2020.110158] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/14/2020] [Accepted: 10/27/2020] [Indexed: 12/28/2022]
Abstract
Depressive syndromes are frequent and heterogeneous brain conditions with more than 90% of patients suffering from sleep complaints. Better characterizing this "sleep" domain may allow to both better treat acute episodes with existing chronotherapeutics, but also to prevent the manifestation or recurrences of mood disorders. This work aims to i) review theoretical and fundamental data of chronotherapeutics, and ii) provide practical recommendations. Light therapy (LT) can be used as a first-line monotherapy of moderate to severe depression of all subtypes. LT can be also used as a combination with antidepressant to maximize patients' response rates, which has a clear superiority to antidepressant alone. Sleep deprivation (SD) is a rapid and powerful chronotherapeutic with antidepressant responses within hours in 45-60% of patients with unipolar or bipolar depression. Different strategies should be combined to stabilize the SD antidepressant effect, including concomitant medications, repeated SD, combination with sleep phase advance and/or LT (triple chronotherapy). Melatonin treatment is of interest in remitted patients with mood disorder to prevent relapses or recurrences, if a complaint of insomnia, poor sleep quality or phase delay syndrome is associated. During the acute phase, melatonin could be used as an adjuvant treatment for symptoms of insomnia associated with depression. The cognitive behavioral therapy for insomnia (CBT-I) can be recommend to treat insomnia during euthymic phases. The Interpersonal and social rhythm therapy (IPSRT) is indicated for the acute treatment of bipolar depression and for the prevention of mood episodes. Chronotherapeutics should always be associated with behavioral measures for healthy sleep.
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Affiliation(s)
- Pierre A Geoffroy
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat - Claude Bernard, F-75018 Paris, France; GHU Paris - Psychiatry & Neurosciences, 1 rue Cabanis, 75014 Paris, France; Université de Paris, NeuroDiderot, Inserm, F-75019 Paris, France.
| | - Laura Palagini
- Department of Clinical and Experimental Medicine, Psychiatric Section, University of Pisa; Azienda Ospedaliera Universitaria Pisana (AUOP), Pisa, Italy
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O'Callaghan VS, Couvy-Duchesne B, Strike LT, McMahon KL, Byrne EM, Wright MJ. A meta-analysis of the relationship between subjective sleep and depressive symptoms in adolescence. Sleep Med 2021; 79:134-144. [PMID: 33524839 DOI: 10.1016/j.sleep.2021.01.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Adolescence is a risk period for the development of mental illness, as well as a time for pronounced change in sleep behaviour. While prior studies, including several meta-analyses show a relationship between sleep and depressive symptoms, there were many inconsistences found in the literature. OBJECTIVE To investigate the relationship between subjective sleep and depressive symptoms. METHODS Following PRISMA guidelines, we conducted a literature search that yielded forty-nine recent studies (2014-2020) with adolescent samples aged 9 to 25-year-olds, and more than double the sample size of previous meta-analyses (N = 318,256). RESULTS In a series of meta-analyses, we show that while several common categories of subjective sleep are associated with depressive symptoms in adolescents, the strength of this relationship varies. Measures of sleep perception: poor sleep quality (r = 0.41), insomnia (r = 0.37), sleep disturbances (r = 0.36), wake after sleep onset (r = 0.31), and daytime sleepiness (r = 0.30) correlated more strongly with depressive symptoms, than measures of sleep behaviour: sleep latency (r = 0.22), and sleep duration (r = -0.19). CONCLUSIONS These findings suggest that in studies of depressive symptoms it may be important to assess an adolescent's perception about their sleep, in addition to their sleep/wake behaviours.
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Affiliation(s)
| | - Baptiste Couvy-Duchesne
- Institute of Molecular Bioscience, University of Queensland, Brisbane, Australia; Paris Brain Institute, ARAMIS INRIA Team, Paris, France
| | - Lachlan T Strike
- Queensland Brain Institute, University of Queensland, Brisbane, Australia
| | - Katie L McMahon
- Queensland University of Technology, Faculty of Health, School of Clinical Science and Institute of Health and Biomedical Innovation, Brisbane, Australia
| | - Enda M Byrne
- Institute of Molecular Bioscience, University of Queensland, Brisbane, Australia
| | - Margaret J Wright
- Queensland Brain Institute, University of Queensland, Brisbane, Australia; Centre for Advanced Imaging, University of Queensland, Brisbane, Australia
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Mengistu N, Azale T, Yimer S, Fikreyesus M, Melaku E, Shumye S. Quality of sleep and associated factors among people living with HIV/AIDS on follow up at Ethiopian Zewditu memorial hospital, 2018. SLEEP SCIENCE AND PRACTICE 2021. [DOI: 10.1186/s41606-020-00056-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Sleep disturbance is a common complaint in people living with HIV/AIDS. Despite the influence of sleep disturbance on treatment adherence, quality of life, work productivity, risk of chronic illness, it remains under-recognized and under-studied in Ethiopia. Therefore it is necessary to produce scientific evidence to fill the knowledge gap and areas of management. The current study aimed to assess sleep quality and its associated factors among people living with HIV/AIDS.
Methods
An institution-based cross-sectional study was utilized among 408 participants who were selected by a systematic random sampling technique at Zewditu memorial hospital from April to May 2018. The Pittsburgh Sleep Quality Index questionnaire was used to measure sleep quality. Ethical clearance was obtained from the joint ethics committee of the University of Gondar and Amanuel Mental Specialized Hospital. Oral informed consent was obtained from each participant. Binary and multivariable logistic regression models were fitted. Odds ratios (OR) with the corresponding 95% confidence interval (95%CI) was computed.
Results
The magnitude of poor sleep quality was 55.6%. Being female [AOR = 3.40, 95% CI: (1.80, 6.41)], depression [AOR =3.52, 95% CI: (1.95, 6.32)], CD4count ≤ 200 cells/mm3 [AOR = 3.18,95%CI: (1.65,6.13)], duration of HIV/AIDS diagnosis [AOR = 3.43,95% CI: (1.61,7.29)], current use of tobacco [AOR = 5.69, 95% CI: (2.04,15.9)] and chat or caffeinated drinks [AOR = 2.65, 95% CI: (1.06,6.64)] and poor sleep hygiene [AOR = 3.55, 95% CI: (1.85, 6.78)] were significantly associated with poor sleep quality.
Conclusions
More than half of the study participants were found to have poor sleep quality. A range factors influence quality of sleep of people with HIV/AIDS. Routine screening of sleep condition among people living with HIV/AIDS and early intervention based on the findings is suggested.
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Sasidharan S, Dhillon H. A pilot study of antidepressant therapy on sleep architecture in patients with depression in Congo. TAIWANESE JOURNAL OF PSYCHIATRY 2021. [DOI: 10.4103/tpsy.tpsy_17_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Simon L, Blay M, Galvao F, Brunelin J. Using EEG to Predict Clinical Response to Electroconvulsive Therapy in Patients With Major Depression: A Comprehensive Review. Front Psychiatry 2021; 12:643710. [PMID: 34248695 PMCID: PMC8264052 DOI: 10.3389/fpsyt.2021.643710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/18/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: An important approach to improve the therapeutic effect of electroconvulsive therapy (ECT) may be to early characterize patients who are more likely to respond. Our objective was to explore whether baseline electroencephalography (EEG) settings before the beginning of ECT treatment can predict future clinical response to ECT in patients with depressive disorder. Methods: We conducted a systematic search in the MEDLINE, EMBASE, PsycINFO, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases to identify studies using EEG in adults with depressive disorder treated by ECT. To investigate the predictive value of baseline EEG on clinical outcomes of ECT, we extracted from the retrieved studies and qualitatively described the association between the baseline EEG markers characteristics and the rates of future responders and/or remitters to ECT. Results: The primary search yielded 2,531 potentially relevant citations, and 12 articles were selected according to inclusion criteria. Most of the studies were prospective studies with small sample size. Sociodemographic and clinical characteristics of patients, ECT settings, EEG settings, and outcomes were heterogeneous. Event-related potential (ERP) paradigms were used in three studies, polysomnography was used in three studies, and the six other studies used EEG to measure cerebral connectivity and activity. Conclusions: P300 amplitude, coherence, and connectivity measures were correlated with remission in patients with depression treated by ECT. Sleep EEG recordings seemed not to be correlated with remission after ECT. Further prospective studies with large sample size are needed to determine optimal EEG parameters associated with clinical response to ECT in depressive disorder. Systematic Review Registration: PROSPERO CRD42020181978.
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Affiliation(s)
- Louis Simon
- Centre Hospitalier Le Vinatier, Bron, France.,INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, PSYR2 Team, Lyon, France.,Lyon University, Université Lyon 1, Villeurbanne, France
| | - Martin Blay
- Centre Hospitalier Le Vinatier, Bron, France.,Lyon University, Université Lyon 1, Villeurbanne, France
| | | | - Jerome Brunelin
- Centre Hospitalier Le Vinatier, Bron, France.,INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, PSYR2 Team, Lyon, France.,Lyon University, Université Lyon 1, Villeurbanne, France
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Harlev D, Ravona-Springer R, Nuriel Y, Fruchter E. Sleep Monitoring Using WatchPAT Device to Predict Recurrence of Major Depression in Patients at High Risk for Major Depression Disorder Recurrence: A Case Report. Front Psychiatry 2021; 12:572660. [PMID: 34248688 PMCID: PMC8268003 DOI: 10.3389/fpsyt.2021.572660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 05/31/2021] [Indexed: 12/01/2022] Open
Abstract
Background: Major depressive disorders are strongly correlated with alterations in sleep pattern and architecture, including changes in the Rapid Eye Movement (REM) phase. However, it is still unknown whether sleep alterations precede other depression-related symptoms, particularly in patients with recurrent depressive episodes at relapse risk. Case Presentation: We initiated a study aimed at examining the value of ambulatory sleep monitoring using a WatchPAT device, in predicting recurrence of Major depression. Depression was assessed monthly with the Beck Depression Inventory version II (BDI-II). Here we present the case of a 63 years old woman, with a history of recurrent depressive episodes. AT the time of recruitment, she was asymptomatic, she experienced recurrence of Major depression 3 months into the study. We observed a significant reduction of the Rem Latency parameters 5 weeks prior to BDI-II score increase, reflecting major depressive episode recurrence. Conclusion: Though our results are preliminary, they suggest that ambulatory sleep monitoring can be used as a simple and accessible tool, predicting recurrence of Major Depressive episodes in patients at high risk, thus enabling early treatment intervention.
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Lechinger J, Koch J, Weinhold SL, Seeck-Hirschner M, Stingele K, Kropp-Näf C, Braun M, Drews HJ, Aldenhoff J, Huchzermeier C, Göder R. REM density is associated with treatment response in major depression: Antidepressant pharmacotherapy vs. psychotherapy. J Psychiatr Res 2021; 133:67-72. [PMID: 33310502 DOI: 10.1016/j.jpsychires.2020.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 01/04/2023]
Abstract
Major depression is one of the most common psychiatric illnesses. Interestingly, a few studies have indicated the existence of depression subgroups, which respond differently to the available treatment options. Previously, sleep abnormalities have been suggested to indicate amenability to different treatment regimens. Thereby, especially REM-sleep parameters seem to play a prominent role, and REM-sleep dysregulation has been repeatedly discussed as a potential endophenotype of depression. With that said, estimating therapy outcome in order to choose the best line of treatment is of utmost importance to patients suffering from depression. The present study looks deeper into these clues by investigating the capability of polysomnographic sleep parameters to predict treatment response in depressed patients to either pharmacotherapy or psychotherapy. Moderately to severely depressed patients (n = 38) were randomly assigned to either psychotherapy (i.e. interpersonal psychotherapy) or pharmacotherapy (i.e., monotherapy with selective serotonin reuptake inhibitors, SSRI, or selective serotonin noradrenalin reuptake inhibitors, SSNRI). Prior to treatment, all patients underwent polysomnography in the sleep laboratory. After treatment, responders and non-responders of both treatment groups were compared regarding their baseline sleep parameters. Higher baseline REM density, i.e. the amount of rapid eye movements during REM sleep, predicted better response to antidepressant pharmacotherapy. In the psychotherapy group, the effect seemed reversed but was not statistically significant. No other sleep parameter predicted treatment response. Our findings support the notion that REM-sleep dysregulation is indeed indicative of a distinct endophenotype of depression and that pharmacotherapy with SSRI/SSNRI might be superior to psychotherapy in these patients.
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Affiliation(s)
- Julia Lechinger
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany.
| | - Jakob Koch
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany
| | - Sara Lena Weinhold
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany
| | - Mareen Seeck-Hirschner
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany
| | - Karoline Stingele
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany
| | - Cornelia Kropp-Näf
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany
| | - Milena Braun
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany
| | - Henning Johannes Drews
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany
| | - Josef Aldenhoff
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany
| | - Christian Huchzermeier
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany
| | - Robert Göder
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany.
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D'Agostino A, Ferrara P, Terzoni S, Ostinelli EG, Carrara C, Prunas C, Gambini O, Destrebecq A. Efficacy of Triple Chronotherapy in unipolar and bipolar depression: A systematic review of the available evidence. J Affect Disord 2020; 276:297-304. [PMID: 32697712 DOI: 10.1016/j.jad.2020.07.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/03/2020] [Accepted: 07/01/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Given the strong relationship between circadian rhythm disruption and mood regulation, combined chronotherapeutic approaches have been proposed for mood disorders. However, a comprehensive review of the available evidence on the efficacy of such interventions for depression is lacking. AIM To systematically review available literature on Triple Chronotherapy (Sleep Deprivation - Sleep Phase Advance - Bright Light Therapy) for depressive symptoms in Major Depression and Bipolar Depression. METHODS We followed the PRISMA statement for systematic reviews to conduct a web-based search on PubMed, Scopus and Embase using a list of selected keywords relevant to depression and chronotherapy. RESULTS After title and abstract screening of the 321 records retrieved, 25 potentially eligible studies were assessed at full-text screening. Nineteen studies were excluded for failure to match inclusion criteria. Six records of Triple Chronotherapy in addition to conventional treatment, published between 2009 and 2019, were included in the revision. All studies reported significant improvements on HAM-D scores at the end of treatment, with 50% to 84% response rates. Efficacy of treatment was confirmed on follow-up by three studies, with 58% to 61% response rates. Remission rates varied from 33,3% to 77%. Reported side effects were negligible across studies. LIMITATIONS Available trials are very few and only one included a control group treated with a daily exercise program. CONCLUSIONS The limited literature suggests that Triple chronotherapy might be a safe and effective addition to conventional antidepressant interventions, although well-designed, randomized controlled trials are needed.
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Affiliation(s)
- Armando D'Agostino
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.
| | - Paolo Ferrara
- Università degli Studi di Roma "Tor Vergata", Rome, Italy; San Paolo Bachelor School of Nursing, San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Stefano Terzoni
- San Paolo Bachelor School of Nursing, San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | | | - Claudia Carrara
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Cecilia Prunas
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Orsola Gambini
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy; "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milan, Italy
| | - Anne Destrebecq
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
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Barateau L, Lopez R, Chenini S, Pesenti C, Rassu AL, Jaussent I, Dauvilliers Y. Depression and suicidal thoughts in untreated and treated narcolepsy: Systematic analysis. Neurology 2020; 95:e2755-e2768. [PMID: 32963102 DOI: 10.1212/wnl.0000000000010737] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/12/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To assess the frequency and determinants of depressive symptoms and suicidal thoughts in adults with narcolepsy type 1 (NT1) and controls, as well as the changes after NT1 management and the risk factors of major depressive episode (MDE) and suicide risk (SR) in NT1. METHODS Two hundred ninety-seven patients with NT1 (age 39 ± 17 years, 172 drug-free) and 346 controls (age 38 ± 16 years) underwent a comprehensive clinical evaluation including the Beck Depression Inventory-II (BDI-II) self-questionnaire, with 1 item on suicidal thoughts. One hundred one drug-free patients with NT1 completed the BDI-II a second time during treatment. In 162 patients with NT1, the face-to-face Mini International Neuropsychiatric Interview was performed to formally diagnose current MDE and SR. RESULTS BDI-II total scores were higher in patients with NT1 than controls and in untreated than treated patients. Patients with moderate to severe BDI-II scores (24.9%) were less educated, were more frequently obese, and had more severe narcolepsy symptoms, more autonomic dysfunctions, and poorer quality of life. Results were unchanged in models adjusted for NT1 medication intake. Suicidal thoughts were more frequent in untreated patients than controls (22.7% vs 12.4%). Patients with suicidal thoughts were more likely to be men and to have more severe narcolepsy symptoms. After narcolepsy management, BDI-II total score and suicidal thoughts decreased. MDE was diagnosed in 29 (18.1%) and SR in 27 (16.9%) patients. CONCLUSIONS Depression, depressive symptoms, suicidal thoughts, and SR were frequent in patients with NT1, especially those without treatment, and were associated with NT1 severity. Depressive symptoms and suicidal thoughts improved after NT1 management.
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Affiliation(s)
- Lucie Barateau
- From the Sleep-Wake Disorders Unit (L.B., R.L., S.C., A.L.R., Y.D.), Department of Neurology, Gui-de-Chauliac Hospital, and National Reference Network for Narcolepsy (L.B., R.L., S.C., C.P., A.L.R., Y.D.), CHU Montpellier; and PSNREC (L.B., R.L., I.J., Y.D.), Université de Montpellier, INSERM, France.
| | - Régis Lopez
- From the Sleep-Wake Disorders Unit (L.B., R.L., S.C., A.L.R., Y.D.), Department of Neurology, Gui-de-Chauliac Hospital, and National Reference Network for Narcolepsy (L.B., R.L., S.C., C.P., A.L.R., Y.D.), CHU Montpellier; and PSNREC (L.B., R.L., I.J., Y.D.), Université de Montpellier, INSERM, France
| | - Sofiene Chenini
- From the Sleep-Wake Disorders Unit (L.B., R.L., S.C., A.L.R., Y.D.), Department of Neurology, Gui-de-Chauliac Hospital, and National Reference Network for Narcolepsy (L.B., R.L., S.C., C.P., A.L.R., Y.D.), CHU Montpellier; and PSNREC (L.B., R.L., I.J., Y.D.), Université de Montpellier, INSERM, France
| | - Carole Pesenti
- From the Sleep-Wake Disorders Unit (L.B., R.L., S.C., A.L.R., Y.D.), Department of Neurology, Gui-de-Chauliac Hospital, and National Reference Network for Narcolepsy (L.B., R.L., S.C., C.P., A.L.R., Y.D.), CHU Montpellier; and PSNREC (L.B., R.L., I.J., Y.D.), Université de Montpellier, INSERM, France
| | - Anna Laura Rassu
- From the Sleep-Wake Disorders Unit (L.B., R.L., S.C., A.L.R., Y.D.), Department of Neurology, Gui-de-Chauliac Hospital, and National Reference Network for Narcolepsy (L.B., R.L., S.C., C.P., A.L.R., Y.D.), CHU Montpellier; and PSNREC (L.B., R.L., I.J., Y.D.), Université de Montpellier, INSERM, France
| | - Isabelle Jaussent
- From the Sleep-Wake Disorders Unit (L.B., R.L., S.C., A.L.R., Y.D.), Department of Neurology, Gui-de-Chauliac Hospital, and National Reference Network for Narcolepsy (L.B., R.L., S.C., C.P., A.L.R., Y.D.), CHU Montpellier; and PSNREC (L.B., R.L., I.J., Y.D.), Université de Montpellier, INSERM, France
| | - Yves Dauvilliers
- From the Sleep-Wake Disorders Unit (L.B., R.L., S.C., A.L.R., Y.D.), Department of Neurology, Gui-de-Chauliac Hospital, and National Reference Network for Narcolepsy (L.B., R.L., S.C., C.P., A.L.R., Y.D.), CHU Montpellier; and PSNREC (L.B., R.L., I.J., Y.D.), Université de Montpellier, INSERM, France.
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Associations between sex hormones, sleep problems and depression: A systematic review. Neurosci Biobehav Rev 2020; 118:669-680. [PMID: 32882313 DOI: 10.1016/j.neubiorev.2020.08.006] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/30/2020] [Accepted: 08/11/2020] [Indexed: 01/14/2023]
Abstract
Sleep problems and depression are both common and have a high impact on quality of life. They are also strongly associated and commonly occur together. During the reproductive age, both sleep problems and depression are almost twice as common in women than men. Epidemiological studies show that women experience more sleep problems and depressive symptoms around times when sex hormones change, such as puberty and menopause, but it is unclear what effect sex hormones have on sleep problems and depression. This systematic review aims to summarize and evaluate studies that investigated the relationship between sex hormones, sleep and depression. Systematic search resulted in 2895 articles, of which 13 met inclusion criteria. Depressed patients showed worse sleep than controls, but no significant difference in endogenous hormone levels was found. Additionally, higher endogenous estrogen was associated with better sleep in controls, but associations between endogenous sex hormones and depressive symptoms were inconclusive. More research on the effect of sex hormones on sleep and depression is necessary.
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Pandi-Perumal SR, Monti JM, Burman D, Karthikeyan R, BaHammam AS, Spence DW, Brown GM, Narashimhan M. Clarifying the role of sleep in depression: A narrative review. Psychiatry Res 2020; 291:113239. [PMID: 32593854 DOI: 10.1016/j.psychres.2020.113239] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 06/14/2020] [Accepted: 06/14/2020] [Indexed: 01/13/2023]
Abstract
It has been established that 4.4 to 20% of the general population suffers from a major depressive disorder (MDD), which is frequently associated with a dysregulation of normal sleep-wake mechanisms. Disturbances of circadian rhythms are a cardinal feature of psychiatric dysfunctions, including MDD, which tends to indicate that biological clocks may play a role in their pathophysiology. Thus, episodes of depression and mania or hypomania can arise as a consequence of the disruption of zeitgebers (time cues). In addition, the habit of sleeping at a time that is out of phase with the body's other biological rhythms is a common finding in depressed patients. In this review, we have covered a vast area, emerging from human and animal studies, which supports the link between sleep and depression. In doing so, this paper covers a broad range of distinct mechanisms that may underlie the link between sleep and depression. This review further highlights the mechanisms that may underlie such link (e.g. circadian rhythm alterations, melatonin, and neuroinflammatory dysregulation), as well as evidence for a link between sleep and depression (e.g. objective findings of sleep during depressive episodes, effects of pharmacotherapy, chronotherapy, comorbidity of obstructive sleep apnea and depression), are presented.
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Affiliation(s)
| | - Jaime M Monti
- Department of Pharmacology and Therapeutics, School of Medicine Clinics Hospital, University of the Republic, Montevideo 11600, Uruguay
| | - Deepa Burman
- Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Palestine, State of, United States
| | | | - Ahmed S BaHammam
- University of Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia; The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation, Saudi Arabia
| | | | - Gregory M Brown
- Centre for Addiction and Mental Health, University of Toronto, 250 College St, Toronto, ON, Canada
| | - Meera Narashimhan
- Department of Medicine, University of South Carolina, Columbia, SC, United States; Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC, United States
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Van Someren EJW. Brain mechanisms of insomnia: new perspectives on causes and consequences. Physiol Rev 2020; 101:995-1046. [PMID: 32790576 DOI: 10.1152/physrev.00046.2019] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
While insomnia is the second most common mental disorder, progress in our understanding of underlying neurobiological mechanisms has been limited. The present review addresses the definition and prevalence of insomnia and explores its subjective and objective characteristics across the 24-hour day. Subsequently, the review extensively addresses how the vulnerability to develop insomnia is affected by genetic variants, early life stress, major life events, and brain structure and function. Further supported by the clear mental health risks conveyed by insomnia, the integrated findings suggest that the vulnerability to develop insomnia could rather be found in brain circuits regulating emotion and arousal than in circuits involved in circadian and homeostatic sleep regulation. Finally, a testable model is presented. The model proposes that in people with a vulnerability to develop insomnia, the locus coeruleus is more sensitive to-or receives more input from-the salience network and related circuits, even during rapid eye movement sleep, when it should normally be sound asleep. This vulnerability may ignite a downward spiral of insufficient overnight adaptation to distress, resulting in accumulating hyperarousal, which, in turn, impedes restful sleep and moreover increases the risk of other mental health adversity. Sensitized brain circuits are likely to be subjectively experienced as "sleeping with one eye open". The proposed model opens up the possibility for novel intervention studies and animal studies, thus accelerating the ignition of a neuroscience of insomnia, which is direly needed for better treatment.
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Affiliation(s)
- Eus J W Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands; Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, Vrije Universiteit University Amsterdam, Amsterdam, The Netherlands; and Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands
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43
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Kirlioglu SS, Balcioglu YH. Chronobiology Revisited in Psychiatric Disorders: From a Translational Perspective. Psychiatry Investig 2020; 17:725-743. [PMID: 32750762 PMCID: PMC7449842 DOI: 10.30773/pi.2020.0129] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/15/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Several lines of evidence support a relationship between circadian rhythms disruption in the onset, course, and maintenance of mental disorders. Despite the study of circadian phenotypes promising a decent understanding of the pathophysiologic or etiologic mechanisms of psychiatric entities, several questions still need to be addressed. In this review, we aimed to synthesize the literature investigating chronobiologic theories and their associations with psychiatric entities. METHODS The Medline, Embase, PsycInfo, and Scopus databases were comprehensively and systematically searched and articles published between January 1990 and October 2019 were reviewed. Different combinations of the relevant keywords were polled. We first introduced molecular elements and mechanisms of the circadian system to promote a better understanding of the chronobiologic implications of mental disorders. Then, we comprehensively and systematically reviewed circadian system studies in mood disorders, schizophrenia, and anxiety disorders. RESULTS Although subject characteristics and study designs vary across studies, current research has demonstrated that circadian pathologies, including genetic and neurohumoral alterations, represent the neural substrates of the pathophysiology of many psychiatric disorders. Impaired HPA-axis function-related glucocorticoid rhythm and disrupted melatonin homeostasis have been prominently demonstrated in schizophrenia and other psychotic disorders, while alterations of molecular expressions of circadian rhythm genes including CLOCK, PER, and CRY have been reported to be involved in the pathogenesis of mood disorders. CONCLUSION Further translational work is needed to identify the causal relationship between circadian physiology abnormalities and mental disorders and related psychopathology, and to develop sound pharmacologic interventions.
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Affiliation(s)
- Simge Seren Kirlioglu
- Department of Psychiatry, Bakirkoy Prof Mazhar Osman Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Yasin Hasan Balcioglu
- Department of Psychiatry, Bakirkoy Prof Mazhar Osman Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
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Cox RC, Parmar AM, Olatunji BO. Sleep in obsessive-compulsive and related disorders: a selective review and synthesis. Curr Opin Psychol 2020; 34:23-26. [DOI: 10.1016/j.copsyc.2019.08.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/07/2019] [Accepted: 08/16/2019] [Indexed: 02/07/2023]
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Sunwoo JS, Kim YJ, Byun JI, Kim TJ, Jun JS, Lee ST, Jung KH, Park KI, Chu K, Kim M, Lee SK, Kim HJ, Schenck CH, Jung KY. Comorbid Depression Is Associated with a Negative Treatment Response in Idiopathic REM Sleep Behavior Disorder. J Clin Neurol 2020; 16:261-269. [PMID: 32319243 PMCID: PMC7174129 DOI: 10.3988/jcn.2020.16.2.261] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 01/16/2023] Open
Abstract
Background and Purpose The first-line medications for the symptomatic treatment of rapid eye movement sleep behavior disorder (RBD) are clonazepam and melatonin taken at bedtime. We aimed to identify the association between depression and treatment response in patients with idiopathic RBD (iRBD). Methods We reviewed the medical records of 123 consecutive patients (76 males; age, 66.0±7.7 years; and symptom duration, 4.1±4.0 years) with iRBD who were treated with clonazepam and/or melatonin. Clonazepam and melatonin were initially administered at 0.25–0.50 and 2 mg/day, respectively, at bedtime, and the doses were subsequently titrated according to the response of individual patients. Treatment response was defined according to the presence or absence of any improvement in dream-enacting behaviors or unpleasant dreams after treatment. Results Forty (32.5%) patients were treated with clonazepam, 56 (45.5%) with melatonin, and 27 (22.0%) with combination therapy. The doses of clonazepam and melatonin at followup were 0.5±0.3 and 2.3±0.7 mg, respectively. Ninety-six (78.0%) patients reported improvement in their RBD symptoms during a mean follow-up period of 17.7 months. After adjusting for potential confounders, depression was significantly associated with a negative treatment response (odds ratio=3.76, 95% confidence interval=1.15–12.32, p=0.029). Conclusions We found that comorbid depression is significantly associated with a negative response to clonazepam and/or melatonin in patients with iRBD. Further research with larger numbers of patients is needed to verify our observations and to determine the clinical implications of comorbid depression in the pathophysiology of iRBD.
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Affiliation(s)
- Jun Sang Sunwoo
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Young Ji Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Jung Ick Byun
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Tae Joon Kim
- Department of Neurology, Ajou University School of Medicine, Suwon, Korea
| | - Jin Sun Jun
- Department of Neurology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Soon Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Keun Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Kyung Il Park
- Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Manho Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea.,Protein Metabolism and Dementia Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea.,Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Han Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Carlos H Schenck
- Minnesota Regional Sleep Disorders Center and Department of Psychiatry, Hennepin County Medical Center, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Ki Young Jung
- Department of Neurology, Seoul National University Hospital, Seoul, Korea.,Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Korea.
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Wilckens KA, Kline CE, Bowman MA, Brindle RC, Cribbet MR, Thayer JF, Hall MH. Does objectively-assessed sleep moderate the association between history of major depressive disorder and task-switching? J Affect Disord 2020; 265:216-223. [PMID: 32090744 DOI: 10.1016/j.jad.2020.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 08/08/2019] [Accepted: 01/02/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Executive function and psychomotor speed are consistently impaired in patients with major depressive disorder (MDD). Persistent cognitive impairments after depression remission are thought to reflect "scarring" from the neurotoxic effects of hypothalamic-pituitary-adrenal axis activity during a depressive episode. As sleep also deteriorates with depression and restores daytime executive functions, we examined whether adequate sleep could be protective against task-switching and psychomotor impairments associated with a history of MDD. METHODS This cross-sectional study tested task-switching associations with MDD history, sleep, and their interaction to determine whether sleep continuity and sleep duration moderate the relationship between MDD history and task-switching performance. RESULTS After adjusting for age, sex, education, current depressive symptoms, and use of anti-depressants, a history of MDD, particularly recurrent MDD, was associated with slower response speed and disproportionately lower accuracy on repetition trials compared to switch trials, reflecting impaired adoption of a task-set. Regardless of MDD history, higher wake after sleep onset and shorter total sleep time were associated with slower response times, but neither sleep measure moderated the association between depression history and task-switching performance. LIMITATIONS This cross-sectional study cannot assess the causal direction of associations. One night of sleep in the laboratory was used to assess sleep and a single task-switching paradigm was used to assess executive function. CONCLUSIONS These results suggest that longer, more continuous sleep is associated with greater psychomotor speed across healthy controls and those with a history of MDD, but MDD-task-switching associations are not mitigated by longer or more continuous sleep.
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Affiliation(s)
- Kristine A Wilckens
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3801 O'Hara Street E-1124, Pittsburgh 15213, PA, United States.
| | - Christopher E Kline
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA, United States
| | - Marissa A Bowman
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ryan C Brindle
- Department of Cognitive and Behavioral Science & Neuroscience Program, Washington and Lee University, Lexington, VA, United States
| | - Matthew R Cribbet
- Department of Psychology, University of Alabama, Tuscaloosa, AL, United States
| | - Julian F Thayer
- Department of Psychological Science, University of California at Irvine, Irvine, CA, United States
| | - Martica H Hall
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3801 O'Hara Street E-1124, Pittsburgh 15213, PA, United States
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47
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Updating Internal Cognitive Models during Sleep. J Neurosci 2020; 39:1966-1968. [PMID: 30867280 DOI: 10.1523/jneurosci.2926-18.2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/02/2019] [Accepted: 01/06/2019] [Indexed: 11/21/2022] Open
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48
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Cox RC, Olatunji BO. Sleep in the anxiety-related disorders: A meta-analysis of subjective and objective research. Sleep Med Rev 2020; 51:101282. [PMID: 32109832 DOI: 10.1016/j.smrv.2020.101282] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 02/04/2023]
Abstract
Although sleep disturbance is implicated in psychopathology, its role in anxiety-related disorders remains unclear. The present meta-analysis characterizes sleep disturbance in anxiety-related disorders collectively and individually. Subjective measures of total sleep time and sleep continuity were included with objective measures. Results indicate a large effect for increased subjective sleep disturbance (g = 2.16), medium effects for decreased total sleep time (g = -.40) and sleep continuity (g = -.49), and a small effect for decreased sleep depth (g = -.20) in anxiety-related disorders compared to healthy controls. Each anxiety-related disorder exhibited a distinct sleep disturbance pattern, suggesting that sleep may facilitate identification of unique biopsychological underpinnings. Effects were not moderated by comorbid depression and were similar in magnitude to those found for depression. Sleep disturbances, particularly decreased sleep continuity, may be a key pathology in the anxiety-related disorders that could highlight novel etiological mechanisms and intervention targets.
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Affiliation(s)
- Rebecca C Cox
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN 37240, USA.
| | - Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN 37240, USA
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49
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Hein M, Lanquart JP, Mungo A, Hubain P, Loas G. Impact of number of sleep ultradian cycles on polysomnographic parameters related to REM sleep in major depression: Implications for future sleep research in psychiatry. Psychiatry Res 2020; 285:112818. [PMID: 32035377 DOI: 10.1016/j.psychres.2020.112818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/18/2020] [Accepted: 01/25/2020] [Indexed: 12/22/2022]
Abstract
Given the contradictory data on REMS alterations in major depression, the aim of this study was to empirically demonstrate that based on the number of sleep ultradian cycles, it was possible to highlight different subtypes of major depression characterized by specific patterns of REMS alterations. Demographic and polysomnographic data from 211 individuals (30 healthy controls and 181 untreated major depressed individuals) recruited from the sleep laboratory database were analyzed. Major depressed individuals with sleep ultradian cycles <4 showed alterations consistent with REMS deficiency (non-shortened REM latency as well as decrease in REMS percentage, REMS duration and REMS/NREMS ratio) whereas major depressed individuals with sleep ultradian cycles >4 showed alterations consistent with REMS disinhibition (shortened REM latency as well as increase in REMS percentage, REMS duration and REMS/NREMS ratio). Regarding major depressed individuals with 4 sleep ultradian cycles, their REMS alterations were intermediate to those present in major depressed individuals with sleep ultradian cycles <4 and >4. Thus, in major depressed individuals, the highlighting of this heterogeneity of REMS alterations based on the number of sleep ultradian cycles seems to suggest the involvement of distinct pathophysiological mechanisms and could open new perspectives for future sleep research in psychiatry.
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Affiliation(s)
- Matthieu Hein
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium.
| | - Jean-Pol Lanquart
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium
| | - Anaïs Mungo
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium
| | - Philippe Hubain
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium
| | - Gwenolé Loas
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium
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50
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Liu RQ, Bloom MS, Wu QZ, He ZZ, Qian Z, Stamatakis KA, Liu E, Vaughn M, Lawrence WR, Yang M, Lu T, Hu QS, Dong GH. Association between depressive symptoms and poor sleep quality among Han and Manchu ethnicities in a large, rural, Chinese population. PLoS One 2019; 14:e0226562. [PMID: 31856188 PMCID: PMC6922383 DOI: 10.1371/journal.pone.0226562] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 11/28/2019] [Indexed: 02/07/2023] Open
Abstract
Objectives To estimate the relationship between sleep quality and depression, among Han and Manchu ethnicities, in a rural Chinese population. Methods A sample of 8,888 adults was selected using a multistage cluster and random sampling method. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Depressive symptoms were assessed via the Center for Epidemiological Survey, Depression Scale (CES-D). Logistic regression was conducted to assess associations between sleep quality and depression. Results The prevalence of poor sleep quality and depression in the Manchus (20.74% and 22.65%) was significantly lower than that in the Hans (29.57% and 26.25%), respectively. Depressive participants had higher odds ratios of global and all sub PSQI elements than non-depressive participants, both among the Hans and the Manchus. Additive interactions were identified between depressive symptoms and ethnicity with global and four sub-PSQI elements, including subjective sleep quality, sleep disturbance, use of sleep medication and daytime dysfunction. Conclusions The findings revealed that the prevalence of poor sleep quality and depression among the Hans was greater than among the Manchus. Depression was associated with higher odds of poor sleep quality.
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Affiliation(s)
- Ru-Qing Liu
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Michael S. Bloom
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
- Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, New York, United States of America
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Rensselaer, New York, United States of America
| | - Qi-Zhen Wu
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhi-Zhou He
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhengmin Qian
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Katherine A. Stamatakis
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Echu Liu
- Department of Health Management & Policy, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Michael Vaughn
- School of Social Work, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Wayne R. Lawrence
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Rensselaer, New York, United States of America
| | - Mingan Yang
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, San Diego State University, San Diego, California, United States of America
| | - Tao Lu
- Department of Mathematics and Statistics, University of Nevada, Reno, Nevada, United States of America
| | - Qian-Sheng Hu
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
- * E-mail: (GD); (QH)
| | - Guang-Hui Dong
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
- * E-mail: (GD); (QH)
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