Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies

Insomnia and sleep duration for kidney function: Mendelian randomization study

OBJECTIVES

Extensive researches highlight the detrimental impact of sleep disorders such as insomnia and insufficient sleep duration on kidney function. However, establishing a clear causal relationship between insomnia, sleep duration, and kidney function remains challenging. This study aims to estimate this relationship using Mendelian randomization (MR).

METHODS

Independent genetic variants strongly associated with insomnia (N = 462,341) and sleep duration (N = 460,099) were selected as instrumental variables from corresponding genome-wide association studies (GWAS). Kidney function parameters, including serum creatinine, estimated glomerular filtration rate by cystatin C (eGFRcys), acute renal failure (ARF), chronic renal failure (CRF), kidney injury molecule-1, neutrophil gelatinase associated lipocalin, microalbuminuria, cystatin C, and β2 microglobulin, were derived from GWAS databases. A two-sample MR study was conducted to assess the causal relationship between sleep disorders and kidney function, and multivariable MR was used to identify potential mediators. The inverse-variance weighted was used as the primary estimate.

RESULTS

MR analysis found robust evidence indicating that insomnia and short sleep duration were associated with an increased risk of elevated serum creatinine, regardless of adjusting for obesity. Causal links between sleep duration and eGFRcys or cystatin C were also identified. While genetically predicted insomnia and sleep duration were found to potentially impact ARF, CRF, microalbuminuria, and β2 microglobulin, the p-values in multivariable MR analysis became nonsignificant. No pleiotropy was detected.

CONCLUSIONS

This study demonstrates a causal impact of insomnia on the risk of elevated serum creatinine and a positive effect of sleep duration on serum creatinine, eGFRcys, and cystatin C. Our findings also suggest their potential indirect effects on ARF, CRF, microalbuminuria, and β2 microglobulin mediated by obesity.

Effects of Sleep Deficiency on Risk, Course, and Treatment of Psychopathology

This article reviews the literature on the relationship between sleep deficiency and unipolar and bipolar depression, anxiety disorders, and posttraumatic stress disorder. We consider the evidence for sleep as a contributory causal factor in the development of psychiatric disorders, as well as sleep as an influential factor related to the outcome and recurrence of psychopathology. A case for sleep deficiency being an important treatment target when sleep and psychiatric disorders are comorbid is also made. Our recommendation is that sleep deficiency is recognized as a means to positively impact the development and course of psychopathology and, as such, is routinely assessed and treated in clinical practice.

Development, validation, and visualization of a novel nomogram to predict depression risk in patients with stroke

BACKGROUND

This study aimed to develop and validate a predictive nomogram model applicable to depression risk in stroke patients.

METHODS

Participants from the NHANES database (n = 1097) were enrolled from 2005 to 2018; 767 subjects were randomly assigned to the training cohort, and the remaining subjects composed the testing cohort. A nomogram containing the optimal predictors identified by the least absolute shrinkage and selection operator (LASSO) and logistic regression methods was constructed to estimate the probability of depression in stroke patients. To evaluate the performance of the nomogram, the area under the receiver operating characteristic curve (AUC), calibration plot, decision curve analysis (DCA) and internal validation were utilized.

RESULTS

Age, family income, trouble sleeping, coronary heart disease, and total cholesterol were included in the nomogram after filtering predictive variables. The AUCs of the nomogram for the training and testing cohorts were 0.782 (95 % CI = 0.742-0.821) and 0.755 (95 % CI = 0.675-0.834), respectively. The calibration plot revealed that the predicted probability was extremely close to the actual probability of depression occurrence in both the training and testing cohorts. DCA revealed that the nomogram model in the training and testing cohorts had a net benefit when the risk thresholds were 0-0.59 and 0-0.375, respectively.

LIMITATIONS

This study was limited by the absence of clinical external validation, which hindered the estimation of the nomogram's external applicability. In addition, this study has a cross-sectional design.

CONCLUSIONS

A novel nomogram was successfully constructed and proven to be beneficial for identifying individuals at high risk for depression among stroke patients.

Sleep disturbance as a poor prognostic predictor in patients with advanced non-small-cell lung cancer treated with immune checkpoint inhibitors: A prospective study

BACKGROUND

Sleep disturbances are highly prevalent in oncology and often exacerbate symptoms, leading to reduced quality of life, which in turn may further affect the tolerability and efficacy of oncological treatments. Sleep disturbance and cancer have an intimate and complicated relationship, and may be a negative predictor of cancer treatment. The present study aimed to characterize the relationship between sleep disturbance and immune checkpoint inhibitor (ICI) therapy in patients with advanced non-small cell lung cancer (NSCLC).

METHODS

Data from 171 patients with advanced NSCLC, who underwent ICI treatment between December 2020 and October 2022, were analysed in our prospective study. Sleep disturbances were evaluated according to the Pittsburgh Sleep Quality Index (PSQI), with a cut-off value of 5, to investigate the impact of sleep disturbance on the survival of patients with NSCLC and the efficacy of ICI treatment.

RESULTS

The median progression-free survival (PFS) was10.4 months (9 5% confidence interval [CI]:9.84-10.97). Univariate and multivariate analyses revealed that sleep disturbance and depressive symptom predicted worse prognosis with shortened PFS. Patients who experienced sleep disturbance exhibited a significant reduction in PFS (9.2 vs. 11.8 months; HR: 1.83 [9 5% CI 1.27-2.6 5]; p = 0.001), as did those with depressive states (HR 1.5 5 [9 5% CI 1.06-2.28]; p = 0.02 5). Additionally, patients with sleep disturbance and depressive symptoms exhibited significantly lower objective response rates and disease control rates.

CONCLUSION

Sleep disturbance could be a factor for prognosis in patients with advanced NSCLC undergoing first- or second-line treatment with ICIs, including shorter PFS and reduced efficacy.

Sleep Problems in Adults With ADHD: Prevalences and Their Relationship With Psychiatric Comorbidity

BACKGROUND

Sleep problems are common in adults with ADHD and may be bidirectionally associated with ADHD severity and other psychiatric symptoms. We investigated the prevalence of positive screenings for various sleep disorders, and their association with psychiatric comorbidities in a large sample of adults with ADHD from a specialized outpatient clinic.

METHODS

We included data of 3,691 adult patients diagnosed with ADHD, who had filled out a screener for sleep disorders (Holland Sleep Disorders Questionnaire (HSDQ)) as part of routine diagnostic assessment. The HSDQ screens for the sleep disorders insomnia, parasomnia, hypersomnia, circadian rhythm sleep disorders (CRSD), restless legs syndrome (RLS)/periodic limb movement disorder (PLMD), and sleep-related breathing disorders (SBD). As delayed sleep phase syndrome (DSPS) is very frequent in ADHD, we additionally screened for DSPS. Psychiatric comorbidities were diagnosed through clinical assessment and the Mini International Neuropsychiatric Interview (M.I.N.I.) Plus, which assesses 26 psychiatric disorders following the classification of the DSM-5. All data were retrieved from the electronic patient files.

RESULTS

Mean age was 35.4 and 49.4% of the patients were female. About 60% of the adults with ADHD screened positive for any sleep disorder. Highest prevalences were found for symptoms of DSPS (36%), insomnia (30%), and RLS/PLMD (29%). Sleep problems in adults with ADHD were associated with comorbid depression, anxiety, substance use disorder, personality disorder, and post-traumatic stress disorder.

CONCLUSION

Adults with ADHD often report sleep problems, which are associated with specific psychiatric comorbidities. Systematic screening for sleep disorders in adult patients with ADHD can contribute to a better understanding of their complaints and may aid improved and integrated treatment for the sleep and psychiatric problems.

Investigation of risk factors associated with the development of depressive symptoms in healthy subjects exposed to long-term stress: A prospective study of the Japanese Antarctic research expedition wintering party

BACKGROUND

Stressors induce depression together with parenting experienced in childhood, personality traits, and sleep. In this study, we investigated factors associated with the development of depression in a long-term stressful environment, namely, the Antarctic Research Expedition wintering party, by comparing 2 groups, the depression and nondepression groups.

METHODS

A self-administered questionnaire was used to survey 91 members of the Japanese Antarctic Research Expedition who spent winters in the Antarctic base. Psychological evaluations of depression, anxiety, and sleep were performed using a questionnaire every 3 months during the participants' stay in Antarctica. The primary endpoint was the occurrence of minor or major depression, as evaluated by the PHQ-9 score.

RESULTS

Participants with a PHQ-9 score of 5 or more during their stay in Antarctica were defined as the depression group (25 subjects), and participants with a PHQ score of 4 or less were defined as the nondepression group (43 subjects). Compared with the nondepression group, the depression group had significantly higher scores for predeparture PHQ-9, state and trait anxiety, sleep disturbance, and neuroticism. Multivariable logistic regression analyses showed that higher predeparture scores of subthreshold depressive symptoms and neuroticism were found to be significant predictors of the occurrence of depression during their stay in Antarctica.

CONCLUSIONS

This study prospectively showed that subthreshold depressive symptoms and neuroticism, which were suggested as risk factors in previous studies, were confirmed to be risk factors for depression. The results of our study are expected to contribute to the understanding of depression in harsh environments.

Safety and effectiveness of weighted blankets for symptom management in patients with mental disorders: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

The current practice guideline regarding treatment for insomnia and sleep disturbances among children and adolescents with autism spectrum disorder (ASD) has been published and it suggests that the use of weighted blankets might not be an evidence-informed practice. However, limited guidance and evidence synthesis exist on the overall effectiveness of a weighted blanket for symptom management among patients with mental disorders, although it has been routinely recommended and prescribed for this population in many mental health care settings.

OBJECTIVE

To systematically evaluate and synthesize existing data on the safety and effectiveness of weighted blankets for symptom management among patients with mental disorders.

METHODS

Comprehensive retrieval of published, unpublished, or ongoing studies was carried out across a series of bibliographic databases, grey literature sources, and clinical trial registry platforms, along with manual screening of the reference lists of the included studies or relevant reviews. Randomized controlled trials (RCTs) were included if they compared a weighted blanket intervention and a control condition among patients with mental disorders. Two reviewers independently extracted the data using a pre-specified form and assessed the methodological quality of the included studies with the revised Cochrane 'Risk of Bias' (RoB 2) tool. Review Manager (RevMan) 5.3 software was used to conduct the meta-analysis when possible. Subgroup and sensitivity analyses, where appropriate, were conducted to explore the robustness of the pooled effect estimates.

RESULTS

Eight studies involving a total of 426 patients were included in this review. Half of the included studies were rated as having a high risk of bias, primarily due to the failure to blind participants for participant-reported measures. No serious adverse events were reported with the application of weighted blankets. The meta-analysis of five studies revealed that the use of weighted blankets induced a small magnitude decrease (standardized mean difference within studies [SMD]= 0.40) in anxiety management. The pooled estimate of three studies reporting the effect of weighted blankets on insomnia revealed a nonsignificant difference between the two groups (mean difference [MD] = -1.92, 95 % confidence interval [CI] = -3.92-0.09, p = 0.06). However, the leave-one-out sensitivity analysis of the two remaining homogeneous studies revealed that patients who used weighted blankets had reduced insomnia severity index (ISI) scores (MD = -2.78, 95 % CI = -4.44 to -1.12, p = 0.001). Additionally, a study without available data for inclusion in the meta-analysis also reported a positive effect in reducing the ISI score. Due to the heterogeneity across studies, summary estimates for the effects of weighted blankets on fatigue and depression were not computed. However, primary studies reporting these two outcomes demonstrated that the application of weighted blankets had a positive effect.

CONCLUSION

Weighted blankets may be a safe and effective add-on treatment for managing common symptoms such as anxiety, insomnia, depression, and fatigue among psychiatric patients. However, these results need to be further confirmed due to the limited number of studies included in this review, the small sample size and the significant heterogeneity across these primary studies. To gain a better understanding of the effect and mechanism of weight blankets, future trials should preferably integrate more objective measures.

Sleep disturbances and psychomotor retardation in the prediction of cognitive impairments in patients with major depressive disorder

BACKGROUND

Symptoms of depression and comorbid anxiety are known risk factors for cognitive impairment in major depressive disorder (MDD). Understanding their relationships is crucial for developing targeted interventions to mitigate cognitive impairments in MDD patients. We expect that the severity of sleep disturbances and other depressive symptoms will be positively correlated with the degree of cognitive impairments. We also hypothesize that anxiety symptoms, especially psychic anxiety, is a key factor in predicting cognitive performance in MDD patients and may indirectly contribute to cognitive impairment by affecting sleep disturbances and other potential factors.

AIM

To determine which dimension of the depressive and anxiety symptoms predicts cognitive impairment during a depressive episode.

METHODS

A comprehensive neurocognitive test battery assessed executive function, attention, processing speed, and memory in 162 medication-free MDD patients and 142 matched healthy controls. The 24-item Hamilton Depression Rating Scale was used to assess depressive symptoms, and the 14-item Hamilton Anxiety Scale was used to assess anxiety symptoms. Linear regression analyses and mediation analyses were conducted to evaluate the impact of depressive and anxiety symptoms, as well as their interactions, on cognitive impairments.

RESULTS

Among the depressive symptoms, sleep disturbances were associated with poorer executive function (P = 0.004), lower processing speed (P = 0.047), and memory impairments (P < 0.001), and psychomotor retardation (PR) was associated with lower processing speed in patients with MDD (P = 0.019). Notably, PR was found to mediate the impact of sleep disturbances on the processing speed. Regarding anxiety symptoms, psychic anxiety, rather than somatic anxiety, was associated with cognitive impairments in all aspects. Sleep disturbances mediated the effect of psychic anxiety on executive function [β = -0.013, BC CI (-0.027, -0.001)] and memory [β = -0.149, BC CI (-0.237, -0.063)], while PR mediated its effect on processing speed (β = -0.023, BC CI (-0.045, -0.004)].

CONCLUSION

Sleep disturbances may be a key predictor of poorer executive function, lower processing speed, and memory loss, while PR is crucial for lower processing speed during a depressive episode. Psychic anxiety contributes to all aspects of cognitive impairments, mediated by sleep disturbances and PR.

Sleep disorders in younger and middle-older age adults with newly diagnosed type 2 diabetes mellitus: A retrospective cohort study in >1million individuals

AIMS

To explore the 5-year incidence and relative rates of sleep disorders in younger (16-≤40 years) and middle-older (=>40 years) age adults with and without newly diagnosed type 2 diabetes.

METHODS

This retrospective, observational cohort study utilised data from the US Collaborative Network within the TriNetX database. We compared 5-year cumulative incidence of sleep disorders in younger (n = 110,088) and middle-older populations (n = 1,185,961).

RESULTS

The absolute risk of developing any type of sleep disorder was greater in individuals with type 2 diabetes vs. those without. Over the 5-year follow-up period, 14.2 % of younger adults and 18.5 % of middle-older age adults with newly diagnosed type 2 diabetes developed any form of sleep disorder, compared to 4.5 % and 7.9 % propensity matched individuals without diabetes. We observed a more pronounced relative rate across the observed sleep disorders in younger adults.

CONCLUSIONS

The 5-year risk of sleep disorders is higher in those with newly diagnosed type 2 diabetes vs. those without. A higher absolute risk was seen in middle-older adults, but relative rates were consistently higher in younger adults with type 2 diabetes. Sleep should be regularly discussed as part of a holistic approach to diabetes care, particularly in those aged ≤40.

Sleep Awareness of Japanese Outpatients: A Survey at a Psychiatry Department of a University Hospital

Background: Insomnia is common in patients with psychiatric disorders. However, patients' awareness of sleep has seldom been examined in detail. In this study, we investigated sleep awareness in outpatients at the psychiatry department of a university hospital. Methods: The participants (n = 241) were recruited at the psychiatry department of Ehime University Hospital between 11 October and 5 November 2021. The following questionnaires were used: Clinical Global Impression Scale of Severity (CGI-S), Global Assessment of Functioning (GAF), General Health Questionnaire (GHQ-30), Athens Insomnia Scale (AIS), and Epworth Sleepiness Scale (ESS). Psychiatric disorders were diagnosed by certified psychiatrists using the International Statistical Classification of Diseases and Related Health Problems 10. Participants with an AIS score of ≥6 were allocated to the insomnia group for statistical analysis. A logistic regression analysis was conducted to identify which items of sleep hygiene the patients with insomnia practiced using the Sleep Guidelines for Health Promotion. Results: Of 241 participants, 133 (55.2%) were allocated to the insomnia group. The mean scores for the CGI were significantly higher and the GAF scores were significantly lower in the insomnia group than in the healthy sleep group (p < 0.01). Of the 12 sleep guidelines proposed by the Japanese Government, "Do not go to bed until you are sleepful, do not delay getting up", was the item that maximally influenced insomnia. Conclusions: The insomnia group had worse scores on various medical assessment scales compared to the healthy sleep group. Based on a survey of outpatients at the psychiatry department of the university hospital, appropriate stimulus control techniques may help clinicians to treat outpatients with insomnia.

Heart Rate Variability and Interoception in Periodic Limb Movements in Sleep: Interference with Psychiatric Disorders?

Periodic limb movements in sleep (PLMS) are a prevalent disorder characterized by rhythmic, involuntary movements of the lower limbs, such as dorsiflexion of the ankle and extension of the big toe, occurring in periodic intervals during sleep. These movements are often linked to disrupted autonomic nervous system (ANS) activity and altered interoception. Interoception involves perceiving internal bodily states, like heartbeat, breathing, hunger, and temperature, and plays a crucial role in maintaining homeostasis and the mind-body connection. This review explores the complex relationships between PLMS, heart rate variability (HRV), ANS dysregulation, and their impact on psychiatric disorders. By synthesizing the existing literature, it provides insights into how ANS dysregulation and altered interoceptive processes, alongside PLMS, contribute to psychiatric conditions. The review highlights the potential for integrated diagnostic and therapeutic approaches and presents a cause-and-effect model illustrating the mutual influence of psychiatric disorders, ANS dysregulation, PLMS, and interoception.

Chronotype, sleep quality, depression and pre-sleep rumination: A diary and actigraphy study

Eveningness has been associated with both disturbed sleep and depression. It is unclear, however, if deprived sleep explains evening types' vulnerability to depression. The role of pre-sleep rumination in these associations also remains understudied. The present study assessed the relationship between eveningness and sleep quality, as well as the possible mediating effect of pre-sleep rumination and the moderating effect of a history of depression, under naturalistic conditions. Eighty-eight Dutch-speaking participants (87.5% females, 21.4 ± 3.7 years) were selected on the basis of their non-intermediate chronotype using the Morningness Eveningness Questionnaire (evening types (n = 53); morning types (n = 35)). Depression status was assessed through a diagnostic interview (healthy (n = 61); remitted depressed (n = 27)). Participants' sleep characteristics were monitored via actigraphy and sleep diaries for seven consecutive days and nights. Pre-sleep rumination was measured via a self-report questionnaire. Evening types had longer subjective and actigraphic sleep onset latency than morning types. Pre-sleep rumination did not mediate the former associations but predicted longer subjective sleep onset latency. Furthermore, the relationship between chronotype and subjective sleep onset latency was moderated by depression history. Remitted depressed evening types reported longer sleep onset latency than healthy evening and morning types, possibly posing the former at a higher risk for depressive relapse. Overall, the current findings address the need to further investigate the physiological signature of circadian rhythms and sleep latency. This could serve as a foundation for the development of prevention and early intervention programs, tailored for mood and sleep disorders.

Evaluation of a Brief Three-Item Insomnia Severity Index (ISI-3) Among Healthcare Workers

OBJECTIVES

Sleep disorder is a growing public health concern that requires attentive assessment and treatment. However, the length of assessment tools for sleep disorders, including insomnia, hinders their use in both research and clinical settings. Brief assessment measures expedite assessment time, reducing respondent burden, and save resources, especially in resource-limited settings.

METHODS

This study investigated the validity and reliability of a short three-item insomnia scale, the Insomnia Severity Index-3 (ISI-3) and established two cutoff scores in a sample of 238 healthcare providers in Oman (45.8% physicians and 54.2% nurses).

RESULTS

The ISI-3 demonstrated good convergent and divergent validity. The receiver operator characteristic recommended two cutoff scores of > 4 (a sensitivity of 0.87.3 and a specificity of 0.96.4) and > 6 (a sensitivity of 0.96.9 and a specificity of 0.97.1).

CONCLUSIONS

The ISI-3 is a good assessment index of insomnia, especially when the utilization of the full insomnia index is unfeasible.

The Relationship Between Epidemic Perception and Cyberbullying Behaviors of Chinese Adolescents During the COVID-19 Pandemic: Cross-Sectional Study

Background

In response to the COVID-19 outbreak, the government initiated measures for social distancing, leading to a gradual transition of adolescents' social interactions toward web-based platforms. Consequently, web-based behaviors, particularly cyberbullying, have become a prominent concern. Considering that adolescents experience more intense feelings, the widely increased negative emotions and strains perceived from the COVID-19 pandemic may end up engaging in cyberbullying behaviors. In addition, during the COVID-19 pandemic, adolescents experiencing insomnia and negative affect are more prone to diminished self-control, which is associated with cyberbullying behaviors.

Objective

This study aims to investigate the relationship between epidemic perception and cyberbullying behaviors, while also examining the serial mediating roles of insomnia and negative affect on the relationship between epidemic perception and cyberbullying behaviors.

Methods

This study presents a large-scale web-based survey conducted during the period of concentrated COVID-19 outbreaks, encompassing 20,000 Chinese adolescents. A total of 274 submitted questionnaires were discarded because of high levels of missing data or their answers were clearly fictitious or inconsistent. The final count of valid participants amounted to 19,726 (10,371 boys, age range: 12-18 years; mean 14.80, SD 1.63 years). The Perceptions of COVID-19 Scale, Negative Affect Scale, Insomnia Scale, and Cyberbullying Behavior Scale were used to assess participants' responses on the Questionnaire Star platform.

Results

The results show that epidemic perception is positively correlated with cyberbullying behaviors (r=0.13; P<.001), insomnia (r=0.19; P<.001), and negative affect (r=0.25; P<.001). Insomnia is positively correlated with negative affect (r=0.44; P<.001) and cyberbullying behaviors (r=0.30; P<.001). Negative affect is positively correlated with cyberbullying behaviors (r=0.25; P<.001). And insomnia and negative affect play independent mediating and serial mediating roles in epidemic perception and cyberbullying behaviors.

Conclusions

This study provides additional empirical evidence on the relationship between the perception of COVID-19 pandemic and cyberbullying in adolescents. In addition, the study offers recommendations for implementing interventions targeted at mitigating cyberbullying in adolescents during the COVID-19 pandemic.

Adolescent suicide: a major mental health issue in pediatric care

Adolescent suicide is a major public health problem, as suicide is one of the leading causes of death for adolescents. Predicting and preventing suicide represent very difficult challenges for clinicians. Youth suicide might be prevented by identifying risk factors for adolescent suicidal behavior. Diagnostic assessment involves identification of multiple factors including gender differences, psychopathology, comorbidity, interpersonal problems, family discord, family psychopathology, accessibility of lethal suicide methods, exposure to suicide, previous attempt, social support, life stressors, and protective factors. The literature clearly indicates a need for suicide awareness and prevention programs and for early identification of adolescents at risk for suicidal behaviors. However, many health care professionals who have frequent contact with adolescents are not sufficiently trained in suicide evaluation techniques and approaches to adolescents with suicidal behavior. Pediatricians and other health professionals involved in adolescents' care need more in-depth information about the characteristics and the warning signs for suicide.

Prediction of depressive symptoms severity based on sleep quality, anxiety, and gray matter volume: a generalizable machine learning approach across three datasets

BACKGROUND

Depressive symptoms are rising in the general population, but their associated factors are unclear. Although the link between sleep disturbances and depressive symptoms severity (DSS) is reported, the predictive role of sleep on DSS and the impact of anxiety and the brain on their relationship remained obscure.

METHODS

Using three population-based datasets (N = 1813), we trained the machine learning models in the primary dataset (N = 1101) to assess the predictive role of sleep quality, anxiety problems, and brain structural (and functional) measurements on DSS, then we tested our models' performance in two independent datasets (N = 378, N = 334) to test the generalizability of our findings. Furthermore, we applied our model to a smaller longitudinal subsample (N = 66). In addition, we performed a mediation analysis to identify the role of anxiety and brain measurements on the sleep quality and DSS association.

FINDINGS

Sleep quality could predict individual DSS (r = 0.43, R2 = 0.18, rMSE = 2.73), and adding anxiety, contrary to brain measurements, strengthened its prediction performance (r = 0.67, R2 = 0.45, rMSE = 2.25). Importantly, out-of-cohort validations in other cross-sectional datasets and a longitudinal subsample provided robust similar results. Furthermore, anxiety scores, contrary to brain measurements, mediated the association between sleep quality and DSS.

INTERPRETATION

Poor sleep quality could predict DSS at the individual subject level across three datasets. Anxiety scores not only increased the predictive model's performance but also mediated the link between sleep quality and DSS.

FUNDING

The study is supported by Helmholtz Imaging Platform grant (NimRLS, ZTI-PF-4-010), the Deutsche Forschungsgemeinschaft (DFG, GE 2835/2-1, GE 2835/4-1), the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation)-Project-ID 431549029-SFB 1451, the programme "Profilbildung 2020" (grant no. PROFILNRW-2020-107-A), an initiative of the Ministry of Culture and Science of the State of Northrhine Westphalia.

Sleep disorders and Parkinson's disease: is there a right direction?

In the last years, the hypothesis of a close relationship between sleep disorders (SDs) and Parkinson's disease (PD) has significantly strengthened. Whether this association is causal has been also highlighted by recent evidence demonstrating a neurobiological link between SDs and PD. Thus, the question is not whether these two chronic conditions are mutually connected, but rather how and when this relationship is expressed. Supporting this, not all SDs manifest with the same temporal sequence in PD patients. Indeed, SDs can precede or occur concomitantly with the onset of the clinical manifestation of PD. This review discusses the existing literature, putting under a magnifying glass the timing of occurrence of SDs in PD-neurodegeneration. Based on this, here, we propose two possible directions for studying the SDs-PD relationship: the first direction, from SDs to PD, considers SDs as potential biomarker/precursor of future PD-neurodegeneration; the second direction, from PD to SDs, considers SDs as concomitant symptoms in manifest PD, mainly related to primary PD-neuropathology and/or parkinsonian drugs. Furthermore, for each direction, we questioned SDs-PD relationship in terms of risk factors, neuronal circuits/mechanisms, and impact on the clinical phenotype and disease progression. Future research is needed to investigate whether targeting sleep may be the winning strategy to treat PD, in the context of a personalized precision medicine.

The Role of Sleep Effort as a Mediator Between Anxiety and Depression

Depression, anxiety, and insomnia are all conditions that share a complex bidirectional relationship. Sleep effort is a construct with cognitive and behavioral components that perpetuates insomnia. Although many studies have examined the associations between these three variables, no studies have yet examined sleep effort as a mediating variable between anxiety and depression and vice versa. Online versions of the Hospital Anxiety and Depression Scale and the Glasgow Sleep Effort Scale were administered to a sample of 1927 higher education students aged 18-40 years (75.9% women and 76% from 18 to 23 years old). As part of the survey, participants also completed a sociodemographic questionnaire. Mediation analysis indicated that sleep effort mediates the relationship between depression and anxiety, when the former was the predictor and the latter was the criterion. Moreover, sleep effort also mediated the relationship between anxiety and depression when the former was the predictor and the latter was the criterion, albeit in a lesser extent. Sleep effort appears to play a bidirectional mediational role between depression and anxiety, being a potential target for intervention.

Erectile dysfunction and sleep related bruxism: An exploratory review of an improbable association

The World Health Organization recognizes sexual health as not merely the absence of disease, but a state of physical, mental, and social well-being in relation to one's sexuality. Achieving sexual satisfaction is pivotal for many individuals, as it significantly contributes to their quality of life. Among various sexual disorders, erectile dysfunction (ED) is notably prevalent, affecting an estimated 10-20 million men in the United States alone. This condition impacts not just the person experiencing it but also significantly influences their intimate connections with partners. Although the causes of ED are multifactorial, recent research highlights a compelling association between sleep disorders, such as sleep deprivation, obstructive sleep apnea (OSA), and insomnia, and the incidence of ED. Furthermore, engaging in night work has been observed to exacerbate the risk of developing ED. One common sleep disorder, sleep related bruxism (SRB), despite its prevalence, has not generally been associated with ED. However, there is some interesting evidence hinting at a potential relationship, including a few studies reporting a high prevalence of ED in individuals with SRB. This review delves into the epidemiological, etiological, and mechanistic links between ED and SRB, aiming to uncover potential intersections between these two conditions. These insights could pave the way for innovative research avenues, possibly exploring treatments like vasodilation medication, that might concurrently address both ED and SRB.

Depressive symptoms' trajectories since adolescence and sleep quality in early adulthood: results from the EPITeen cohort

OBJECTIVES

We aimed to estimate the association between depressive symptoms' trajectories during adolescence and young adulthood and sleep quality in early adulthood.

METHODS

Data from 802 participants of the EPITeen study, evaluated at 13, 17 and 21 years of age, were analysed. Depressive symptoms were assessed using the Beck Depression Inventory-II and three trajectory classes from adolescence to adulthood were previously identified (High, Moderate, Low). The prevalences of poor sleep quality, overall (score>5) and in its specific dimensions: subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleep drugs and daytime dysfunction (score≥2), at 21 years of age were evaluated using the Pittsburgh Sleep Quality Index. Associations were estimated using adjusted odds ratio (OR) and the respective 95 % confidence intervals (CI).

RESULTS

At 21 years of age, 29.8 % young adults presented poor sleep quality, which was significantly different between those in the Low and High depressive trajectories (14.3 and 53.1 %, respectively, p<0.001). Compared with participants in the Low trajectory, those in the High trajectory were more likely to present poorer sleep quality at 21 years of age (OR=6.34 95 % CI: 3.94-10.21), particularly worse levels of sleep disturbance (OR=5.89 95 % CI: 2.84-12.21), daytime dysfunction (OR=7.63 95 % CI: 3.63-16.06) and subjective sleep quality (OR=6.61 95 % CI: 3.69-11.85).

CONCLUSIONS

Poor sleep quality in early adulthood was more frequent among individuals who had high levels of depressive symptoms since adolescence. Monitoring depression until adulthood may help to identify those at higher risk of sleep problems which, in turn, can lead to worse health outcomes over time.

Construction and evaluation of two nomograms for screening major depressive disorder and subthreshold depression individuals based on anxiety, depression, and sleep items

BACKGROUND

Current evidence is insufficient to support specific tools for screening Major Depressive Disorder (MDD). Early detection of subthreshold depression (SD) is crucial in preventing its progression to MDD. This study aims to develop nomograms that visualize the weights of predictors to improve the performance of screening tools.

METHODS

Participants were recruited from Peking University Sixth Hospital and Beijing Physical Examination Center between October 2022 and April 2024. The Mini-International Neuropsychiatric Interview (MINI) 5.0.0 was employed as the diagnostic gold standard, and Generalized Anxiety Disorder questionnaire-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Pittsburgh Sleep Quality Index (PSQI) were employed to assess anxiety, depression, and sleep state. The nomograms were constructed by incorporating optimal predictors, selected through the Least Absolute Shrinkage and Selection Operator (LASSO), into a multivariate logistic regression model to estimate the probability of MDD and SD.

RESULTS

After matching age and education, 164 participants were included in each group for analysis. Both nomograms demonstrated superior discrimination, calibration, and clinical applicability compared to PHQ-9. Anxiety emerged as a most significant predictor for SD, while sleep problems exhibited high rankings for both SD and MDD. The two predictors subsequently affect concentration and daytime functioning.

LIMITATIONS

With a lack of external validation data, the performance of nomograms may be overestimated.

CONCLUSIONS

This study is the first attempt to develop a nomogram for predicting SD, while also providing a nomogram for MDD. The crucial predictors offer valuable insights into potential variables for clinical intervention.

Environmental study and stress-related biomarkers modifications in a crew during analog astronaut mission EMMPOL 6

PURPOSE

Human presence in space is increasingly frequent, but we must not forget that it is a hostile environment. We aimed to study the characteristics of experimental scenarios, to obtain data on human response to isolation, disruption of circadian rhythm and high levels of psychophysical stress.

METHODS

In these experiments, we evaluated stress response in five young healthy subjects inside an earth-based moon-settlement-like habitat during a 1-week long analog astronaut mission. Wearable devices were used to monitor daily step count of the subjects, physical activity, heart rate during physical exercise and at rest, and sleep parameters. From saliva and urine samples collected every day at awakening, we studied oxy-inflammation biomarkers and hormones (stress and appetite) were studied too.

RESULTS

At the end of the week, all subjects revealed an increase in oxidative stress and cortisol levels but no inflammation biomarkers variations, in conjunction with increasing time/daily exercise. Furthermore, a significant decrease in hours of sleep/day, sleep quality, and REM phase of sleep was recorded and correlated with the increase of reactive oxygen species.

CONCLUSION

Oxidative stress increased in a short period of time and may be attributed to the influence of psychological stress during confinement, as well as increased exercise and decreased amount of sleep. On a long-term basis, this could impact performance.

Clinical associations with treatment resistance in depression: An electronic health record study

Treatment resistance is common in major depressive disorder (MDD), yet clinical risk factors are not well understood. Using a discovery-replication design, we conducted phenome-wide association studies (PheWASs) of MDD treatment resistance in two electronic health record (EHR)-linked biobanks. The PheWAS included participants with an MDD diagnosis in the EHR and at least one antidepressant (AD) prescription. Participant lifetime diagnoses were mapped to phecodes. PheWASs were conducted for three treatment resistance outcomes based on AD prescription data: number of unique ADs prescribed, ≥1 and ≥2 CE switches. Of the 180 phecodes significantly associated with these outcomes in the discovery cohort (n = 12,558), 71 replicated (n = 8,206). In addition to identifying known clinical factors for treatment resistance in MDD, the total unique AD prescriptions was associated with additional clinical variables including irritable bowel syndrome, gastroesophageal reflux disease, symptomatic menopause, and spondylosis. We calculated polygenic risk of specific-associated conditions and tested their association with AD outcomes revealing that genetic risk for many of these conditions is also associated with the total unique AD prescriptions. The number of unique ADs prescribed, which is easily assessed in EHRs, provides a more nuanced measure of treatment resistance, and may facilitate future research and clinical application in this area.

Actigraphic monitoring of sleep and circadian rest-activity rhythm in individuals with major depressive disorder or depressive symptoms: A meta-analysis

BACKGROUND

Disrupted sleep and rest-activity pattern are common clinical features in depressed individuals. This meta-analysis compared sleep and circadian rest-activity rhythms in people with major depressive disorder (MDD) or depressive symptoms and healthy controls.

METHODS

Eligible studies were identified in five databases up to December 2023. The search yielded 53 studies with a total of 11,115 participants, including 4000 depressed participants and 7115 healthy controls.

RESULTS

Pooled meta-analyses demonstrated that depressed individuals have significantly longer sleep latency (SMD = 0.23, 95 % CI: 0.12 to 0.33) and wake time after sleep onset (SMD = 0.37, 95 % CI: 0.22 to 0.52), lower sleep efficiency (SMD = -0.41, 95 % CI: -0.56 to -0.25), more nocturnal awakenings (SMD = 0.58, 95 % CI: 0.29 to 0.88), lower MESOR (SMD = -0.54, 95 % CI: -0.81 to -0.28), amplitude (SMD = -0.33, 95 % CI: -0.57 to -0.09), and interdaily stability (SMD = -0.17, 95 % CI: -0.28 to -0.05), less daytime (SMD = -0.79, 95 % CI: -1.08 to -0.49) and total activities (SMD = -0.89, 95 % CI: -1.28 to -0.50) when compared with healthy controls.

LIMITATIONS

Most of the included studies reported separate sleep and activity parameters instead of 24-hour rest-activity rhythms. The variabilities among actigraphy devices and the types of participants recruited also impede precise comparisons.

CONCLUSIONS

The findings emerging from this study offered a better understanding of sleep and rest-activity rhythm in individuals with MDD or depressive symptoms. Future studies could advocate for deriving objective, distinctive 24-hour rest-activity profiles contributing to the risk of depression.

PROSPERO REGISTRATION NUMBER

CRD42021259780.

Visual analysis of research hotspots and trends of external therapies in traditional Chinese medicine for depression

Objective

Based on the visualization and analysis of the CiteSpace software, we aimed to explore the current research status and development trend of depression caused by external therapies in traditional Chinese medicine (TCM) and to provide a reference for further research in this field.

Methods

In the China National Knowledge Infrastructure, Wanfang, Web of Science, and PubMed databases, relevant articles on external therapies in TCM for depression were selected as the research objects, and CiteSpace performed the bibliometric analysis.

Results

In total, 1672 Chinese and 441 English articles were included after CiteSpace was used to remove duplicate articles and perform manual screening. The Chinese articles were analyzed, and the overall issuance showed an upward trend; the core author was Tu Ya, and the institution with the highest article production was Heilongjiang University of Traditional Chinese Medicine. The English articles were analyzed, and the overall issuance showed an upward trend; the core author was Macpherson, Hugh, and the institution with the highest article production was Guangzhou University of Traditional Chinese Medicine. China ranked first in terms of number and centrality of publications, followed by the United States. The keywords of Chinese and English articles were analyzed to conclude that the research trends in this field were an exploration of therapeutic mechanisms, acupoint application therapy, and assessment of sleep quality, and the research hotspots were the clinical application of external therapies in TCM and the types of underlying diseases.

Conclusion

This study comprehensively and objectively summarized the relevant literature on external therapies in TCM for depression. It highlights the direction for further exploration by revealing and analyzing the research hotspots and trends in this field.

Mechanisms of change in digital interventions for depression: A systematic review and meta-analysis of six mediator domains

BACKGROUND

While the efficacy of digital interventions for the treatment of depression is well established, comprehensive knowledge on how therapeutic changes come about is still limited. This systematic review aimed to provide an overview of research on change mechanisms in digital interventions for depression and meta-analytically evaluate indirect effects of potential mediators.

METHODS

The databases CENTRAL, Embase, MEDLINE, and PsycINFO were systematically searched for randomized controlled trials investigating mediators of digital interventions for adults with depression. Two reviewers independently screened studies for inclusion, assessed study quality and categorized potential mediators. Indirect effects were synthesized with a two-stage structural equation modeling approach (TSSEM).

RESULTS

Overall, 25 trials (8110 participants) investigating 84 potential mediators were identified, of which attentional (8 %), self-related (6 %), biophysiological (6 %), affective (5 %), socio-cultural (2 %) and motivational (1 %) variables were the scope of this study. TSSEM revealed significant mediation effects for combined self-related variables (ab = -0.098; 95 %-CI: [-0.150, -0.051]), combined biophysiological variables (ab = -0.073; 95 %-CI: [-0.119, -0.025]) and mindfulness (ab = -0.042; 95 %-CI: [-0.080, -0.015]). Meta-analytical evaluations of the other three domains were not feasible.

LIMITATIONS

Methodological shortcomings of the included studies, the considerable heterogeneity and the small number of investigated variables within domains limit the generalizability of the results.

CONCLUSION

The findings further the understanding of potential change mechanisms in digital interventions for depression and highlight recommendations for future process research, such as the consideration of temporal precedence and experimental manipulation of potential mediators, as well as the application of network approaches.

Association of inadequate sleep with mortality among persons who inject drugs

BACKGROUND

Inadequate sleep is associated with all-cause mortality in the general population. Substance use has adverse effects on sleep, and insomnia symptoms are common among people with HIV. Therefore, persons who inject drugs may face a heightened risk of adverse outcomes from inadequate sleep. We evaluated the association of inadequate sleep with mortality among persons who inject drugs in a long-standing community cohort.

METHODS

Participants were from the AIDS Linked to the IntraVenous Experience (ALIVE) study, a cohort of persons who inject drugs in Baltimore, Maryland, USA. From 2005-2020, perceived sleep adequacy and duration were assessed semiannually using survey. Mortality data were obtained through linkage to the National Death Index-Plus. Cause of death was independently characterized and validated by three physicians. Hazards of all-cause and cause-specific mortality were evaluated using Cox regression accounting for repeated measurements.

RESULTS

A total of 2633 participants were included, with a median age at entry of 45.8years; 32.5% were female, and 75% were Black. After adjustment for demographics, mental health, and comorbidities, inadequate sleep was associated with a 32% greater hazard of all-cause mortality (hazard ratio: 1.32, 95% confidence interval: 1.12-1.55) and a 67% greater hazard of HIV/infectious disease-related deaths (hazard ratio: 1.67, 95% confidence interval: 1.15-2.42). Short (<6 hours) and long (≥8 hours) duration of sleep were both associated with higher hazard of all-cause and chronic disease-related mortality (all p < .05).

CONCLUSIONS

Sleep plays a critical role in longevity in persons who inject drugs. Research is needed to determine whether interventions targeting sleep improve health and longevity in persons who inject drugs.

Oral microbiome diversity shapes the association between sleep duration and depression

Background

Emerging research suggests the relationship between the oral microbiome and sleep duration with depression, however, the precise mechanisms by which oral microbial diversity influences the sleep-depression nexus remain to be elucidated.

Methods

We analyzed data from 4,692 participants in the National Health and Nutrition Examination Survey (NHANES), incorporating key demographic variables, oral microbiome diversity metrics, sleep duration, and depression assessment variables. Classical multidimensional scaling facilitated dimensionality reduction, while unsupervised clustering divided participants into groups based on β-diversity dissimilarity matrices. We examined the moderating effects of oral microbiome diversity on the sleep-depression relationship by incorporating interaction terms sleep-oral microbiome diversity into multiple linear regression models.

Results

Our analysis revealed a U-shaped relationship between sleep duration and depression. Specifically, α-diversity was a significant moderator, with reduced diversity linked to an increased depression risk in participants with insufficient sleep. Regarding β-diversity, using both Bray-Curtis and UniFrac distance measures, Cluster 2 exhibited the strongest associations in sleep-deprived individuals (Bray-Curtis: β = 1.02, p < 0.001; Weighted UniFrac: β = 0.91, p < 0.001). In contrast, Cluster 1 displayed notable effects in individuals with excessive sleep (Bray-Curtis: β = 0.63, p = 0.008). Additionally, Cluster 3 was prominently associated with depression in sleep-deprived participants using unweighted UniFrac distance (β = 0.93, p < 0.001), and Cluster 2 was significant among those with excessive sleep across both unweighted (β = 0.80, p = 0.0004) and weighted UniFrac distances (β = 0.60, p = 0.001).

Conclusion

This study highlights the crucial role of oral microbiome diversity in moderating the U-shaped relationship between sleep duration and depression risk.

From guidelines to bedside - insomnia treatment practices in South Korea: a nationwide cohort study

Background

Insomnia is a prevalent disorder that impacts quality of life and leads to significant economic costs. Treatment includes both non-medication and pharmacological interventions, with international guidelines recommending cognitive behavioral therapy for insomnia (CBT-I) as the first-line treatment.

Objective

To describe current insomnia treatment practices in South Korea, focusing on pharmacological and non-medication treatments, and to identify gaps in guideline implementation.

Methods

This cohort study used data from the Korea National Health Insurance Service-National Sample Cohort (NHIS-NSC) from 2002 to 2019 and identified 18,003 patients newly diagnosed with insomnia between 2015 and 2019. This study analyzed treatment patterns and utilization rates.

Results

Of the 18,003 patients, 16,181 (89.9%) received pharmacological treatment, resulting in 35,638 prescriptions. Zolpidem (60%) and benzodiazepines (30-40%) were the most prescribed medications. Most patients were treated in clinics, with consistent dosages and increasing treatment lengths. Psychotherapy claims rose from 3.20% in 2015 to 9.14% in 2019, particularly in general hospitals (22.06% to 48.37%), but remained low in clinics (1.26% to 2.08%).

Conclusion

Pharmacological treatments dominate insomnia management in South Korea, with CBT-I being underutilized. Future efforts should focus on integrating non-pharmacological treatment into routine practice and exploring treatment risks and effectiveness based on patient demographics.

Daily Associations Between Sleep Parameters and Depressive Symptoms in Individuals with Insomnia: Investigating Emotional Reactivity and Regulation as Mediators

OBJECTIVES

Previous research suggests that insomnia and depressive symptoms might be causally related. Emotional reactivity and regulation have been proposed to explain the potential causal relationship between insomnia and depression. However, longitudinal evaluations of their mediating effects are limited. Hence, the current study aimed to examine the mediating effects of emotional reactivity and regulation on the longitudinal associations between daily sleep parameters and depressive symptoms over 14 days in individuals with insomnia.

METHODS

Participants were sixty adults aged 18-65 who had clinically significant insomnia. They filled out a survey each morning and evening and wore actigraphy watches for 14 consecutive days. The five sleep parameters were measured by sleep diary in the morning survey (subjective total sleep time, subjective sleep efficiency, and sleep quality) and actigraphy watches (objective total sleep time and objective sleep efficiency). Emotional reactivity and emotion regulation strategy use during the day were assessed in the evening survey using the International Positive and Negative Affect Schedule Short Form, Emotion Regulation Questionnaire, and Cognitive Emotion Regulation Questionnaire. Depressive symptoms of the day were evaluated in the evening survey with the Center for Epidemiologic Studies Depression Scale.

RESULTS

Results showed that sleep quality and depressive symptoms, as well as actigraphy-measured sleep efficiency and depressive symptoms, predicted each other in individuals with insomnia, mediated by negative reactivity but not emotion regulation.

CONCLUSIONS

The present findings support the mediating role of negative emotional reactivity in the bidirectional, daily relationship between sleep parameters and depression in individuals with insomnia.

"So Many Other Things Improve" with Transdiagnostic Treatment for Sleep and Circadian Problems: Interviews with Community Providers on Treating Clients with Serious Mental Illness

Community mental health centers (CMHCs) offer invaluable, publicly-funded treatment for serious mental illness (SMI). Unfortunately, evidence-based psychological treatments are often not delivered at CMHCs, in part due to implementation barriers, such as limited time, high caseloads, and complex clinical presentations. Transdiagnostic treatments may help address these barriers, because they allow providers to treat symptoms across multiple disorders concurrently. However, little research has investigated CMHC providers' experiences of delivering transdiagnostic treatments "on the ground," particularly for adults with SMI. Thus, the aim of the present study was to assess CMHC providers' perspectives on delivering a transdiagnostic treatment - the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) - to adults diagnosed with SMI. In the context of a larger parent trial, providers were randomized to deliver a standard version of TranS-C (Standard TranS-C) or a version adapted to the CMHC context (Adapted TranS-C). Twenty-five providers from the parent trial participated in a semi-structured interview (n = 10 Standard TranS-C; n = 15 from Adapted TranS-C). Responses were deductively and inductively coded to identify themes related to Proctor's taxonomy of implementation outcomes. Four novel "transdiagnostic take homes" were identified: (1) transdiagnostic targets, such as sleep, can be perceived as motivating and appropriate when treating SMI, (2) strategies to bolster client motivation/adherence and address a wider range of symptom severity may improve transdiagnostic treatments, (3) balancing feasibility with offering in-depth resources is an important challenge for transdiagnostic treatment development, and (4) adapting transdiagnostic treatments to the CMHC context may improve provider perceptions of implementation outcomes.

Insomnia and unhealthy alcohol use in a National Sample of Women Veterans 50 years and older enrolled in the Veterans Health Administration

In this study, we examined rates of insomnia and co-occurring unhealthy alcohol use in a national sample of women Veterans age 50 years and older. We further explored associations between sociodemographic measures, insomnia-related clinical characteristics, and unhealthy alcohol use, and analyzed whether women with insomnia were more likely to report unhealthy alcohol use. Study aims were evaluated using national Veterans Health Administration (VA) electronic health records data from VA's Corporate Data Warehouse. Data were extracted for women Veterans ≥50 years old with ≥1 VA primary care visit in each study year (2018: 3/11/18-3/10/19; 2020: 3/11/20-3/10/21; 2022: 3/11/22-3/10/23). Cases of insomnia were identified via diagnostic codes and prescription medications for insomnia. Unhealthy alcohol use was identified via Alcohol Use Disorders Identification Test-Consumption screening scores indicating unhealthy alcohol use. Annual sample sizes ranged from 240,420-302,047. Over the study timeframe, insomnia rates (diagnosis or medication) among women ≥50 years old ranged from 18.11-19.29%; co-occurring insomnia and unhealthy alcohol use rates ranged from 2.02-2.52%. Insomnia and unhealthy alcohol use rates were highest among women aged 50-59 years old. Depression and physical health comorbidities were consistently associated with insomnia; associations by race and ethnicity were less consistent. Compared to women without insomnia, women Veterans with either concurrent or unremitting insomnia were more likely to endorse unhealthy alcohol use. Findings signal a potential need for assessment and preventative efforts aimed at addressing insomnia and unhealthy alcohol use among women Veterans.

Investigating the shared genetic architecture between depression and subcortical volumes

Depression, a widespread and highly heritable mental health condition, profoundly affects millions of individuals worldwide. Neuroimaging studies have consistently revealed volumetric abnormalities in subcortical structures associated with depression. However, the genetic underpinnings shared between depression and subcortical volumes remain inadequately understood. Here, we investigate the extent of polygenic overlap using the bivariate causal mixture model (MiXeR), leveraging summary statistics from the largest genome-wide association studies for depression (N = 674,452) and 14 subcortical volumetric phenotypes (N = 33,224). Additionally, we identify shared genomic loci through conditional/conjunctional FDR analyses. MiXeR shows that subcortical volumetric traits share a substantial proportion of genetic variants with depression, with 44 distinct shared loci identified by subsequent conjunctional FDR analysis. These shared loci are predominantly located in intronic regions (58.7%) and non-coding RNA intronic regions (25.4%). The 269 protein-coding genes mapped by these shared loci exhibit specific developmental trajectories, with the expression level of 55 genes linked to both depression and subcortical volumes, and 30 genes linked to cognitive abilities and behavioral symptoms. These findings highlight a shared genetic architecture between depression and subcortical volumetric phenotypes, enriching our understanding of the neurobiological underpinnings of depression.

Sleep, hopelessness, and suicidal ideation: An ecological momentary assessment and actigraphy study

Recent research shows that sleep disturbances are linked to increased suicidal ideation. In the present longitudinal cohort study, we used subjective (ecological momentary assessment, EMA) and objective (actigraphy) measures to examine the effects of sleep parameters on next-day suicidal ideation. Further, we examined hopelessness as a mediator between insufficient sleep and increased suicidal ideation. Individuals with current suicidal ideation (N = 82) completed 21 days of EMA and actigraphy to estimate suicidal ideation, hopelessness and sleep parameters. Multilevel linear-mixed models were used to examine the effects of sleep parameters on next-day suicidal ideation, as well as for the mediating effect of hopelessness (in the morning) on the association between previous night's sleep and suicidal ideation levels the next day. Significant concordance existed between subjective and objective sleep measures, with moderate-to-large correlations (r = 0.44-0.58). Lower subjective sleep quality and efficiency, shorter total sleep time and increased time awake after sleep onset were significantly associated with increased next-day suicidal ideation (controlling for previous-day suicidal ideation). Actigraphy-measured sleep fragmentation was also a significant predictor of next-day ideation. Hopelessness mediated the effects of the subjective sleep parameters on suicidal ideation, but did not account for the association with sleep fragmentation. Therefore, individuals' psychological complaints (hopelessness, suicidal ideation) were better predicted by subjective sleep complaints than by objective sleep indices. Increased hopelessness following from perceived insufficient sleep appears an important explanatory factor when considering the link between sleep disturbances and suicidal ideation.

A Cross Sectional Survey of Factors Related to Cannabis Use as a Sleep Aid Among Canadian Cancer Survivors

OBJECTIVES

Poor sleep is a common side effect of cancer. Cannabis is increasingly used to manage cancer treatment-related symptoms, including sleep. This study investigated factors related to cannabis use for sleep among Canadian cancer survivors.

METHOD

Adult Canadian cancer survivors (N = 940) were recruited via the Angus Reid Institute and completed an online, cross-sectional survey. Univariate and multiple binomial logistic regression models identified factors associated with cannabis use for sleep.

RESULTS

Of the participants (Mage = 64.5 yrs; Women = 51.1%; White = 92.9%), 25.1% (n = 236) currently use cannabis for sleep. Participants were at greater odds of using cannabis for sleep if they identified as a gender other than man or woman (AOR = 11.132), were diagnosed with multiple medical conditions (2:AOR = 1.988; 3+:AOR = 1.902), two psychological conditions (AOR = 2.171), multiple sleep disorders (AOR = 2.338), insomnia (AOR = 1.942), bone (AOR = 6.535), gastrointestinal (AOR = 4.307), genitourinary (AOR = 2.586), hematological (AOR = 4.739), or an unlisted cancer (AOR = 3.470), received hormone therapy only (AOR = 3.054), drink heavily (AOR = 2.748), or had mild insomnia (AOR = 1.828). Older participants (AOR=.972) and those with sleep apnea were less likely to use cannabis for sleep (AOR=.560).

CONCLUSION

Given its prevalence, research is needed to understand how factors associated with cannabis use as a sleep aid among Canadian cancer survivors may influence its use and effectiveness and whether these factors are barriers to accessing evidence-based treatments.

Effectiveness of a guided digital self-help intervention to improve sleep and the biological clock in university students - Study protocol for a randomized controlled trial

Background

Sleep problems occur in many university students which affects their mental health and daily functioning. Cognitive behavioural therapy for insomnia (CBT-I) has been proven effective in adults but research in university students, who struggle to maintain a 24-hour rhythm, is still limited. We hypothesize that a guided digital CBT-I intervention, enriched with components on the biological clock ('i-Sleep & BioClock') will be effective in reducing insomnia severity and improving mental health outcomes for students with sleep problems.

Objectives

We aim to evaluate the effectiveness of a guided online sleep and biological clock self-help intervention in improving sleep, depression symptoms, anxiety symptoms, functioning, academic performance, and quality of life in university students at 6 weeks and 18 weeks.

Methods

This is a two-arm parallel-group superiority randomized controlled trial, comparing a 5-week guided online 'i-Sleep & BioClock' intervention to online psychoeducation (PE). We aim to include 192 university students (Bachelor, Master, and PhD) with at least subthreshold insomnia (Insomnia Severity Index ≥10), aged ≥16, who can speak Dutch or English. We are excluding students with current risk for suicide or night shifts. The primary outcome is insomnia severity. Secondary outcomes include sleep estimates (sleep and light exposure diary), depression, anxiety, functioning, quality of life, and academic performance. The effectiveness of the intervention compared to online PE will be evaluated using linear mixed models.

Discussion

The current study tests the effectiveness of an online self-help intervention for university students who suffer from sleep problems. This trial builds upon an open feasibility study and will provide evidence of an online guided self-help program for students. The findings of this study will determine the potential wider dissemination of the intervention to address the high need for available and accessible help for students experiencing insomnia.

Trial registration

ClinicalTrials.Gov (NCT06023693), registered on August 3rd, 2023.

High levels of anxiety and depression in women farmers from Ecuador: A cross-section study in Coastal and Highlands regions

BACKGROUND

Previous studies have shown that women farmers are particularly vulnerable to mental health disorders such as depression and anxiety.

AIMS

This study aimed to investigate the prevalence of anxiety and depression in women farmers from Ecuador Coastal and Highlands regions.

METHOD

General Anxiety Disorder‑7 (GAD‑7) and Patient Health Questionnaire‑9 (PHQ‑9) were applied. In addition, self-reported number of children, days off, hours of work, pesticide use, sleep habits and years of work in agriculture, were also collected. This cross-sectional study occurred during 2023 with 443 women, for Coastal (197) and Highlands (246), respectively. Multivariable binary logistic regression models were performed to obtained adjusted odds ratios (aOR) and their 95% confidence intervals (95% CI).

RESULTS

34.5% of Coastal women had depression, while 27.2% of Highlands women had depression. 20.3% of coastal women farmers had anxiety, while in the Highlands 24.8% had anxiety. Coastal mestizo and montubio women exhibited lower probability of depression, but this was not significant in the Highlands. Coastal women farmers that did not have children showed lower odds of depression (aOR 0.05, 95% CI [0.01, 0.34]). A lower likelihood of depression was observed in coastal women that worked more than 8 hours (aOR 0.22, 95% CI [0.07, 0.72]). Women from the Highlands that had shortened sleep duration exhibited lower odds of depression and anxiety.

CONCLUSIONS

A higher proportion of depressed women farmers was observed in the Coast region and slightly higher numbers of anxiety cases in the Highlands. The number of children may cause workload and is correlated with depression in Coastal women.

Advancing Patient-Centered Care: An International Survey of Adolescent Perspectives on Insomnia

OBJECTIVE

The study objective was to inform patient-centered care for adolescent insomnia by describing adolescents' perspectives on insomnia. Specific constructs of interest included: 1) factors that contributed to insomnia development or maintenance, 2) impact of insomnia on day-to-day life, 3) recommended research priorities, and 4) overall experience living with insomnia.

METHOD

A convenience sample of adolescents (ages 13-18 years) self-identifying with insomnia symptoms was recruited through social media. Respondents (n = 3,014) completed an online survey. Responses to an open-ended item assessing patient experience were coded using thematic analysis.

RESULTS

Participants identified as 70.8% White non-Hispanic, 77.0% female, and lived in one of five English-speaking countries (United States, United Kingdom, Canada, Australia, or New Zealand). Most (87.5%) met DSM-V diagnostic criteria for insomnia. The most common contributory factors to insomnia endorsed were stress (72.1%) and depressed mood (63.6%), while common impact areas were mood (72.2%), focus (61.0%), and pain (49.7%). Patient-centered research priorities were identifying insomnia causes (66.4%) and early detection (66.1%). Common adolescent experiences included high distress levels, feelings of invalidation, and helplessness about their insomnia.

CONCLUSIONS

Adolescents with insomnia offer a unique perspective that should inform patient-centered research and care. There is a need for heightened screening and awareness about insomnia as a condition that causes significant distress and impairment for adolescents. To provide validating care, providers should recognize the multifaceted causes of insomnia.

Recent Progress in Biosensors for Depression Monitoring-Advancing Personalized Treatment

Depression is currently a major contributor to unnatural deaths and the healthcare burden globally, and a patient's battle with depression is often a long one. Because the causes, symptoms, and effects of medications are complex and highly individualized, early identification and personalized treatment of depression are key to improving treatment outcomes. The development of wearable electronics, machine learning, and other technologies in recent years has provided more possibilities for the realization of this goal. Conducting regular monitoring through biosensing technology allows for a more comprehensive and objective analysis than previous self-evaluations. This includes identifying depressive episodes, distinguishing somatization symptoms, analyzing etiology, and evaluating the effectiveness of treatment programs. This review summarizes recent research on biosensing technologies for depression. Special attention is given to technologies that can be portable or wearable, with the potential to enable patient use outside of the hospital, for long periods.

Insomnia-related brain functional correlates in first-episode drug-naïve major depressive disorder revealed by resting-state fMRI

Introduction

Insomnia is a common comorbidity symptom in major depressive disorder (MDD) patients. Abnormal brain activities have been observed in both MDD and insomnia patients, however, the central pathological mechanisms underlying the co-occurrence of insomnia in MDD patients are still unclear. This study aimed to explore the differences of spontaneous brain activity between MDD patients with and without insomnia, as well as patients with different level of insomnia.

Methods

A total of 88 first-episode drug-naïve MDD patients including 44 with insomnia (22 with high insomnia and 22 with low insomnia) and 44 without insomnia, as well as 44 healthy controls (HC), were enrolled in this study. The level of depression and insomnia were evaluated by HAMD-17, adjusted HAMD-17 and its sleep disturbance subscale in all subjects. Resting-state functional and structural magnetic resonance imaging data were acquired from all participants and then were preprocessed by the software of DPASF. Regional homogeneity (ReHo) values of brain regions were calculated by the software of REST and were compared. Finally, receiver operating characteristic (ROC) curves were conducted to determine the values of abnormal brain regions for identifying MDD patients with insomnia and evaluating the severity of insomnia.

Results

Analysis of variance showed that there were significant differences in ReHo values in the left middle frontal gyrus, left pallidum, right superior frontal gyrus, right medial superior frontal gyrus and right rectus gyrus among three groups. Compared with HC, MDD patients with insomnia showed increased ReHo values in the medial superior frontal gyrus, middle frontal gyrus, triangular inferior frontal gyrus, calcarine fissure and right medial superior frontal gyrus, medial orbital superior frontal gyrus, as well as decreased ReHo values in the left middle occipital gyrus, pallidum and right superior temporal gyrus, inferior temporal gyrus, middle cingulate gyrus, hippocampus, putamen. MDD patients without insomnia demonstrated increased ReHo values in the left middle frontal gyrus, orbital middle frontal gyrus, anterior cingulate gyrus and right triangular inferior frontal gyrus, as well as decreased ReHo values in the left rectus gyrus, postcentral gyrus and right rectus gyrus, fusiform gyrus, pallidum. In addition, MDD patients with insomnia had decreased ReHo values in the left insula when compared to those without insomnia. Moreover, MDD patients with high insomnia exhibited increased ReHo values in the right middle temporal gyrus, and decreased ReHo values in the left orbital superior frontal gyrus, lingual gyrus, right inferior parietal gyrus and postcentral gyrus compared to those with low insomnia. ROC analysis demonstrated that impaired brain region might be helpful for identifying MDD patients with insomnia and evaluating the severity of insomnia.

Conclusion

These findings suggested that MDD patients with insomnia had wider abnormalities of brain activities in the prefrontal-limbic circuits including increased activities in the prefrontal cortex, which might be the compensatory mechanism underlying insomnia in MDD. In addition, decreased activity of left insula might be associated with the occurrence of insomnia in MDD patients and decreased activities of the frontal-parietal network might cause more serious insomnia related to MDD.

The association between maternal sleep and circadian rhythms during pregnancy and infant sleep and socioemotional outcomes

Studies have established that maternal sleep and circadian rhythm disturbances during pregnancy are associated with poor prenatal and perinatal outcomes for mothers and offspring. However, little work has explored its effects on infant sleep or socioemotional outcomes. The current study examined the relationship between maternal sleep and circadian rhythm disturbances during pregnancy and infant sleep and socioemotional outcomes in a diverse sample of N = 193 mothers and their infants (51% White; 52% Female; Mage = 11.95 months). Maternal sleep and circadian rhythms during pregnancy were assessed using self-reports and actigraphy. Mothers reported on infants' sleep and socioemotional outcomes when infants were one year old. When controlling for infant sex, age, gestational age at birth, family income-to-needs ratios, and maternal depression, mothers who reported more sleep problems during pregnancy had infants with more sleep disturbances when they were one year old. Moreover, mothers who had later sleep timing (i.e., went to bed and woke up later, measured via actigraphy) during pregnancy had infants with more dysregulation (e.g., increased feeding difficulties, sensory sensitivities) and externalizing problems, and mothers with increased intra-daily variability in rest-activity rhythms (as measured via actigraphy) had infants with more externalizing problems. Findings suggest that maternal sleep and circadian rhythm disturbances during pregnancy may be a risk factor for infant sleep problems and socioemotional difficulties.

Uncovering the symptom relationship among sleep quality, anxiety, and depression in Chinese patients with breast cancer: multidimensional data validation using PSQI versus actigraphy

PURPOSE

The interplay between sleep quality, anxiety, and depression among breast cancer patients remains poorly understood. This study aimed to investigate and compare the symptoms relationships among these three factors in Chinese breast cancer patients, utilizing two sleep assessments.

METHODS

Our study encompassed 288 participants diagnosed with breast cancer, from whom we collected demographic information through questionnaires. Sleep quality symptoms were assessed using the Pittsburgh Sleep Quality Index (PSQI) and wrist actigraphy, while anxiety and depression symptoms were measured using the Hospital Anxiety and Depression Scale (HADS). Network analyses were conducted using R to calculate the centrality (strength) and further identify central symptoms and bridge symptoms in two networks that differed by sleep assessments. Central symptoms are closely related to other symptoms, whereas bridge symptoms indicate that symptoms may increase spread risk between different conditions.

RESULTS

In the network using PSQI data, "I have lost interest in my appearance" had the highest strength centrality (rs = 2.417), followed by "sleep duration" (rs = 1.068) and "sleep efficiency" (rs = 0.955). In the network using wrist actigraphy data, "wake after sleep onset" had the highest strength value (rs = 2.437), followed by "sleep efficiency" (rs = 2.397) and "sleep latency" (rs = 1.506). Two bridge symptoms were identified: "I feel cheerful" and "I look forward with enjoyment to things" in both networks.

CONCLUSIONS

Depressive symptoms played a leading role in the sleep-anxiety-depression network, underscoring the need for targeted intervention tailored to survivors' specific needs.

IMPLICATIONS FOR CANCER SURVIVORS

Health workers can give priority to symptom-specific screening and therapies, incorporating psychological support into standard cancer care.

Physical activity and social anxiety symptoms among Chinese college students: a serial mediation model of psychological resilience and sleep problems

BACKGROUND

Social anxiety symptoms are common and harmful psychological illness in college students. Although some studies have illustrated that physical activity could reduce social anxiety symptoms, the specific mechanism is still unclear. Based on theoretical studies on resilience and sleep, this study constructed a serial mediation model to explore whether they mediate between physical activity and social anxiety symptoms among college students.

METHODS

This study surveyed 9,530 college students from three colleges in China to explore the mediating effect of physical activity and sleep problems between physical activity and social anxiety symptoms. Participants were investigated with the International Physical Activity Questionnaire, Connor-Davidson Resilience Scale, Sleep-related problems, and the Social Interaction Anxiety Scale and the Social Phobia Scale. Correlations between variables were analysed using Pearson correlation analysis and mediation analyses were performed using SPSS PROCESS macro 3.3 software.

RESULT

The study found that physical activity was negatively associated with social anxiety symptoms and sleep problems, but positively with psychological resilience. After controlling for sociodemographic variables, physical activity can not only indirectly alleviate social anxiety symptoms through the separate mediation of psychological resilience and sleep problems, but also through the serial mediation of psychological resilience and sleep problems.

CONCLUSION

These results suggest that improving physical activity levels could reduce social anxiety scores by increasing psychological resilience and sleep quality. This is of great reference significance for the prevention and intervention of college students' mental health.

Sedum kamtschaticum Exerts Hypnotic Effects via the Adenosine A2A Receptor in Mice

Insomnia is a common sleep disorder with significant societal and economic impacts. Current pharmacotherapies for insomnia are often accompanied by side effects, necessitating the development of new therapeutic drugs. In this study, the hypnotic effects and mechanisms of Sedum kamtschaticum 30% ethanol extract (ESK) and one of its active compounds, myricitrin, were investigated using pentobarbital-induced sleep experiments, immunohistochemistry (IHC), receptor binding assays, and enzyme-linked immunosorbent assay (ELISA). The pentobarbital-induced sleep experiments revealed that ESK and myricitrin reduced sleep latency and prolonged total sleep time in a dose-dependent manner. Based on c-Fos immunostaining, ESK, and myricitrin enhanced the GABAergic neural activity in sleep-promoting ventrolateral preoptic nucleus (VLPO) GABAergic. By measuring the level of GABA released from VLPO GABAergic neurons, ESK and myricitrin were found to increase GABA release in the hypothalamus. These effects were significantly inhibited by SCH. Moreover, ESK exhibited a concentration-dependent binding affinity for the adenosine A2A receptors (A2AR). In conclusion, ESK and myricitrin have hypnotic effects, and their underlying mechanisms may be related to the activation of A2AR.

A randomized controlled trial of acupuncture and receptive music therapy for sleep disorders in the elderly-ELAMUS: study protocol

BACKGROUND

Globally, the demographic shift towards an aging population leads to significant challenges in healthcare systems, specifically due to an increasing incidence of multimorbidity resulting in polypharmacy among the elderly. Simultaneously, sleep disorders are a common complaint for elderly people. A treatment with pharmacological therapies often leads to side effects causing a high potential for dependency. Within this context, there is a high need to explore non-pharmacological therapeutic approaches. The purpose of this study is to evaluate the effectiveness of acupuncture and music therapy, both individually and combined as a multimodal therapy, in the treatment of sleep disorders in individuals aged 70 years and older.

METHODS

We conduct a confirmatory randomized controlled trial using a two-factorial study design. A total of n = 100 elderly people receive evidence-based standard care information for age-related sleep disorders. Beyond that, patients are randomly assigned into four groups of n = 25 each to receive acupuncture, receptive music therapy with a monochord, multimodal therapy with both acupuncture and music therapy, or no further therapy. The study's primary outcome measurement is the improvement in sleep quality as assessed by the Pittsburgh Sleep Quality Index (PSQI) (global score), at the end of intervention. Additionally, depression scores (Geriatric Depression Scale), health-related quality of life (Short-Form-Health Survey-12), neurovegetative activity measured via heart rate variability, and safety data are collected as secondary outcomes. Using a mixed-methods approach, a qualitative process evaluation will be conducted to complement the quantitative data.

DISCUSSION

The study is ongoing and the last patient in is expected to be enrolled in April 2024. The results can provide valuable insights into the effectiveness of non-pharmacological interventions for sleep disorders among the elderly, contributing to a more personalized and holistic approach in geriatric healthcare.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS00031886).

The effect of physical exercise interventions on insomnia: A systematic review and meta-analysis

6-10 % of Europeans suffer from chronic insomnia. They have a higher risk to develop mental and cardiovascular diseases. Treatment of insomnia primarily recommended by the European guideline is cognitive behavioral therapy for insomnia (CBT-I). A quarter of patients treated with CBT-I do not respond sufficiently. The objective of this paper is to examine the influence of exercise interventions on insomnia by conducting a systematic review and meta-analysis. A database search was conducted, including randomized controlled trials (RCT) in which participants had received a diagnosis of insomnia or experienced symptoms thereof. Exercise interventions had to meet the definition of the World Health Organization (WHO), and their implementation was reported according to the FITT (Frequency, Intensity, Time and Type) principle. There was an inactive control and subjective or objective sleep parameters as outcomes. Nineteen studies were included. Results showed a significant improvement for objective (standardized mean difference, SMD = 0.37; confidence interval, CI = [0.17; 0.57]) as well as subjective (SMD = 0.90; CI = [0.61; 1.19]) sleep parameters. Meta-regression showed that the effect increased with intensity of intervention, mean age of participants and percentage of females, but showed high heterogeneity across studies. These results suggest great potential for treating insomnia. Conducting larger trials is advisable to provide precise recommendations.

Associations between self-reported sleep, overnight memory consolidation, and emotion perception: A large-scale online study in the general population

Experimental studies suggest that short or disrupted sleep impairs memory consolidation, mood, and perception of emotional stimuli. However, studies have chiefly relied on laboratory-based study designs and small sample sizes. The aim of this fully online and pre-registered study was to investigate the association between sleep and overnight memory consolidation, emotion perception, and affect in a large, self-selected UK sample. A total of 1646 participants (473 completed) took part in an online study, where they completed a declarative (word-pairs) memory task, emotion perception task (valence ratings of images), and rated their affect within 2 h of bed-time. The following morning, participants reported on their state affect, sleep for the previous night, completed a cued recall task for the previously presented word-pairs, rated the valence of previously viewed images, and completed a surprise recognition task. Demographic data and habitual sleep quality and duration (sleep traits) were also recorded. Habitual sleep traits were associated with immediate recall for the word-pairs task, while self-reported sleep parameters for the specific night were not associated with overnight memory consolidation. Neither habitual sleep traits, nor nightly sleep parameters were associated with unpleasantness ratings to negative stimuli or overnight habituation. Habitual poor sleep was associated with less positive and more negative affect, and morning affect was predicted by the specific night's sleep. This study suggests that overnight emotional processing and declarative memory may not be associated with self-reported sleep across individuals. More work is needed to understand how findings from laboratory-based studies extrapolate to real-world samples and contexts.

Nutritional interventions in treating menopause-related sleep disturbances: a systematic review

CONTEXT

Sleep disturbances are a core symptom of menopause, which refers to the permanent cessation of menstrual periods. Nutritional interventions may alleviate menopause-related sleep disturbances, as studies have shown that certain interventions (eg, tart cherry juice, or tryptophan-rich foods) can improve relevant aspects of sleep.

OBJECTIVE

The aim of this systematic review was to examine the effect of nutritional interventions for menopause-related sleep disturbances, in order to inform the subsequent development of specific interventional trials and assess their potential as a treatment for menopause-related sleep disturbances.

DATA SOURCES

Published studies in English were located by searching PubMed and PsycArticles databases (until September 15, 2022).

DATA EXTRACTION

Following full-text review, a final total of 59 articles were included. The search protocol was performed in accordance with PRISMA guidelines.

DATA ANALYSIS

A total of 37 studies reported that a nutritional intervention improved some aspect of sleep, and 22 studies observed no benefit. Most (n = 24) studies recruited postmenopausal women, 18 recruited menopausal women, 3 recruited perimenopausal women, and 14 recruited women from multiple groups. The majority of the studies were of low methodological quality. Due to the heterogeneity of the studies, a narrative synthesis without meta-analysis is reported.

CONCLUSION

Despite the large heterogeneity in the studies and choice of intervention, the majority of the identified studies reported that a nutritional intervention did benefit sleep, and that it is mainly subjective sleep that is improved. More high-quality, adequately powered, randomized controlled trials of the identified nutritional interventions are necessary.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42021262367.

Sleep disturbances and incident risk of major depressive disorder in a population-based cohort

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.