Depression in sleep disturbance: A review on a bidirectional relationship, mechanisms and treatment

Registry and survey of circadian rhythm sleep-wake disorder patients

Objective

Circadian Sleep Disorders Network has created a registry of circadian rhythm sleep-wake disorder (CRSWD) patients, and a survey of their experiences. The purpose of the registry is to provide volunteers willing to participate in research; the purpose of the survey is to fill some of the knowledge gaps on these disorders, including information on subjective patient experience and the efficacy and durability of treatments.Researchers are invited to contact Circadian Sleep Disorders Network for permission to use the registry to find potential research participants, and to further analyze the survey data.

Patients

Over 1627 patients have participated; 1298 have completed the entire survey. Here we present results based on the 479 clinically diagnosed CRSWD patients.

Methods

The survey covers a variety of topics relating to CRSWDs, including diagnosis, comorbidities, treatments, and work/educational accommodations.

Conclusions

Results of this survey diverged from much of the literature. More than half the participants reported tiredness even when sleeping on their preferred schedule. While depression may cause sleep problems, our data suggests that sleep/circadian problems often precede depression.There were more people suffering from sighted non-24-hour sleep-wake rhythm disorder than some of the literature would lead us to expect.Current treatments did not appear to be helpful to a large percentage of our participants. Most of them did not find light therapy helpful and nearly all participants who tried phase-delay chronotherapy reported at best only short-term improvement. A sizable proportion of people who tried phase-delay chronotherapy subsequently developed non-24-hour sleep-wake rhythm disorder.

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.

The association of mixed multi-metal exposure with sleep duration and self-reported sleep disorder: A subgroup analysis from the National Health and Nutrition Examination Survey (NHANES)

Sleep disorders significantly affect sleep duration and constitute a major public health issue. However, the relationship between metal exposure and sleep is not fully elucidated. This study utilized publicly available data from the National Health and Nutrition Examination Survey (NHANES) to measure blood concentrations of seven metals-copper (Cu), zinc (Zn), selenium (Se), manganese (Mn), mercury (Hg), cadmium (Cd), and lead (Pb)-in a cohort of 4263 American adults. The relationship between metal exposure and self-reported sleep duration and sleep disorder risk was analyzed using single exposure models like logistic and linear regression and mixedexposure models such as weighted quantile sum (WQS) regression and Bayesian kernel machine regression (BKMR). The results indicated an absence of statistically significant findings in the single exposure model. In contrast, the mixed exposure model revealed a positive correlation between selenium levels and the risk of sleep disorders across the entire population. A "U-shaped" association was identified between copper levels and the risk of sleep disorders in males, females, and individuals aged 60 and above. Moreover, a positive trend was observed between manganese levels and the risk of sleep disorders in individuals aged 60 and above. Additionally, elevated concentrations of metal mixtures were significantly associated with reduced sleep duration among females. Sensitivity analyses corroborated these findings. In conclusion, within the context of metal mixtures, selenium may be a risk factor for sleep disorders in the general population. Manganese may be a unique risk factor in older adults. Copper levels have a "U" shaped link to sleep disorder risk in specific population subgroups. Finally, the accumulation of blood metal mixtures in females, mainly due to lead and mercury, may reduce sleep duration. Further research is necessary to validate these findings.

Identifying trajectories of change in sleep disturbance during psychological treatment for depression

BACKGROUND

Sleep disturbance may impact response to psychological treatment for depression. Understanding how sleep disturbance changes during the course of psychological treatment, and identifying the risk factors for sleep disturbance response may inform clinical decision-making.

METHOD

This analysis included 18,915 patients receiving high-intensity psychological therapy for depression from one of eight London-based Improving Access to Psychological Therapies (IAPT) services between 2011 and 2020. Distinct trajectories of change in sleep disturbance were identified using growth mixture modelling. The study also investigated associations between identified trajectory classes, pre-treatment patient characteristics, and eventual treatment outcomes from combined PHQ-9 and GAD-7 metrics used by the services.

RESULTS

Six distinct trajectories of sleep disturbance were identified: two demonstrated improvement, while one showed initial deterioration and the other three groups displayed only limited change in sleep disturbance, each with varying baseline sleep disturbance. Associations with trajectory class membership were found based on: gender, ethnicity, employment status, psychotropic medication use, long-term health condition status, severity of depressive symptoms, and functional impairment. Groups that showed improvement in sleep had the best eventual outcomes from depression treatment, followed by groups that consistently slept well.

LIMITATION

Single item on sleep disturbance used, no data on treatment adherence.

CONCLUSIONS

These findings reveal heterogeneity in the course of sleep disturbance during psychological treatment for depression. Closer monitoring of changes in sleep disturbance during treatment might inform treatment planning. This includes decisions about when to incorporate sleep management interventions, and whether to change or augment therapy with interventions to reduce sleep disturbance.

The role of biomarkers in clinical development of drugs for neuropsychiatric disorders - A pragmatic guide

The failure rate of drugs being developed for neuropsychiatric indications remains high. Optimizing drug discovery and development requires not only a better neurobiological understanding of disease aetiology and development, but also the means by which we can measure relevant biological and clinical processes related to disease progression, drug target engagement, and sensitivity to treatment. Here we address the role and key considerations for the selection of biomarkers in clinical drug development for neuropsychiatric disorders. We do not provide an exhaustive list of biomarkers; rather we lay out a pragmatic, well-defined biomarker selection strategy that addresses the main goals for each of the phases in the drug development cycle. We discuss the key questions and issues that concern biomarker selection and implementation in each phase of development. For the better development of biomarkers, we emphasize the need to focus on discrete biological dysfunction and/or symptom domains rather than diagnoses. We also advocate the use of biomarker-based patient stratification in phase 2 and 3 to increase sensitivity and power and reduce costs. Our aim is to enhance precision and chances of success for these complex and heterogeneous brain disorders with a high unmet medical need.

Association between allostatic load and depression in patients with sleep disorders: Evidence from the National Health and Nutrition Examination Survey (NHANES)

OBJECTIVE

Allostatic load (AL) is an indicator of the cumulative wear and tear on the body's physiological systems that can predict onset of a range of health problems. However, the relationship between AL and depression in patients with sleep disorders is unclear. This study explored the association between AL and depression in patients with sleep disorders.

METHODS

Using data from the 2015-2016 National Health and Nutrition Examination Survey, a total of 4618 adults aged 18 years and older in the United States were included in this cross-sectional analysis. AL was calculated using nine biological markers, with a score of ≥3 indicating a high level. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), with a score of ≥10 indicating risk for depression. Logistic regression models were employed to analyze the relationship between AL and depression.

RESULTS

Among the 1309 participants diagnosed with sleep disorders, 212 (16.2%) were identified as being at risk for depression on the PHQ-9. A total of 55.2% (n = 117) of depressed persons had high AL levels. In the unadjusted model, AL levels were associated with depression in those with sleep disorders (OR=1.53, 95% CI = 1.14-2.05, p < 0.01). This relationship remained significant in the adjusted model (OR=1.52, 95% CI=1.11-2.10, p < 0.05), after controlling for potential confounders.

CONCLUSION

High AL levels in patients with sleep disorders were positively associated with depression, indicating that elevated AL may increase the risk of depression in this population, or alternatively, depression may increase the risk of AL.

Worse Depression Profiles Are Associated With Higher Symptom Burden and Poorer Quality of Life in Patients With Gynecologic Cancer

BACKGROUND

Depression is a pervasive symptom in patients with gynecological cancer undergoing chemotherapy.

OBJECTIVES

Purposes were to identify subgroups of patients with distinct depression profiles and evaluate for differences in demographic and clinical characteristics, severity of common symptoms, and quality of life (QOL) outcomes among these subgroups.

METHODS

Patients with gynecological cancer (n = 231) completed the Center for Epidemiologic Studies-Depression Scale 6 times over 2 cycles of chemotherapy. All of the other measures were completed prior to the second or third cycle of chemotherapy. Latent profile analysis was done to identify the distinct depression profiles. Differences were evaluated using parametric and nonparametric tests.

RESULTS

Three distinct profiles were identified: low (60.1%), high (35.1%), and very high (4.8%). Compared with low class, the other 2 classes had lower functional status and were more likely to self-report a diagnosis of depression. Patients in the 2 worse profiles reported a higher comorbidity burden, higher levels of trait and state anxiety, sleep disturbance, and fatigue, as well as lower levels of cognitive function and poorer QOL. State and trait anxiety, evening fatigue, and sleep disturbance scores exhibit a "dose-response effect" (ie, as the depression profile worsened, the severity of these symptoms increased).

CONCLUSIONS

Almost 40% of our sample experienced high or very high levels of depression across 2 cycles of chemotherapy.

IMPLICATIONS FOR PRACTICE

Clinicians can use the identified risk factors to identify high patients risk and provide tailored psychological interventions aimed to decrease symptom burden and prevent decrements in QOL.

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.

What internet- and mobile-based interventions are currently available for adults with overweight or obesity experiencing symptoms of depression? A systematic review

Given the high prevalence of overweight and obesity and high comorbidity of depressive symptoms, there is a need for low-threshold, accessible care approaches for people with overweight/obesity aimed at improving mental health. Internet and mobile-based interventions (IMI) represent an innovative complementary treatment option. This review systematically searches for IMI aimed at improving mental health in people with overweight/obesity. We conducted a systematic literature search according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria in the databases MEDLINE, Cochrane Library, PsycINFO, Web of Science and Google Scholar. Randomized controlled trials (RCTs) of IMI for adults with overweight/obesity and comorbid depressive symptoms aiming at improving mental health were screened and extracted. Study quality was assessed with RoB 2 (revised Cochrane Risk of Bias tool in RCTs). After excluding duplicates, n = 790 results were included in title and abstract screening. After full-text-screening of n = 26 studies, n = 3 RCT studies were included. All interventions aimed to reduce both weight and depressive symptoms. In two RCTs, a significant reduction in both depressive symptoms and weight was achieved. One RCT indicated a significant reduction in depressive symptoms, but not in weight. Two intervention had a duration of 6 months and were guided by health carers, the third takes 3 months and can be used without professional guidance. There is evidence that IMI are effective in improving mental health for people with overweight/obesity and comorbid depressive symptoms. However, currently there are few interventions aiming at reducing depressive symptoms, all targeting English-speaking people. As IMI for depressive symptoms can be easily integrated in the somatic therapy of obesity as additional option and has high public health potential, target group-adapted and low-threshold accessible interventions in different languages should be developed and implemented for improving mental health in people with overweight/obesity. Prospero registration number: CRD42023361771.

Reciprocal effects of sleep duration and depressive symptoms among Chinese couples: A longitudinal dyadic analysis

BACKGROUND

The reciprocal effects between sleep and depression have been widely demonstrated. However, current understanding has focused on the association at the individual level. The present study aims to explore the longitudinal, dyadic, and reciprocal associations between sleep duration and depressive symptoms on a couple level and test whether these effects vary by gender.

METHODS

Using data from the China Health and Retirement Longitudinal Study (CHARLS; 2011 and 2018), we analyzed 5683 couples (11,366 individuals) aged 45 and older (Meanage = 58.69, SD = 8.55). Sleep duration was measured by self-report of sleep hours, and depressive symptoms were measured by the CES-D scale. We used actor-partner interdependence models for the analysis.

RESULTS

We found a significant longitudinal and reciprocal association between sleep duration and depressive symptoms for both wives and husbands. Moreover, cross-partner effects differed by gender: Husbands' sleep and depressive symptoms predicted their wives' sleep and depressive symptoms respectively, but the reverse effects from wife to husband were not statistically significant.

LIMITATIONS

The measure of sleep duration relied on self-report and we lacked information about whether couples slept in the same room.

DISCUSSIONS

The results highlight a gendered interdependent influence of sleep duration and depressive symptoms over the 7-year follow-up, particularly from husbands to wives. Further investigation is necessary to understand the underlying mechanisms driving these observed patterns.

Time-Restricted Eating Versus Daily Calorie Restriction: Effect on Sleep in Adults with Obesity over 12 Months

Objective: The aim of this secondary analysis was to compare the effects of time-restricted eating (TRE) versus daily calorie restriction (CR) on sleep quality, duration, insomnia severity, and risk of obstructive sleep apnea in adults with obesity over one year. Methods: A total of 90 participants were randomized to one of three groups for 12 months: 8 h TRE (eating only between 12 p.m. and 8 p.m.); CR (25% daily calorie restriction) or a no-intervention control group. Results: By the end of the study, weight loss was 4.61 kg (95% CI; 7.37 to 1.85 kg; p ≤ 0.01) for the TRE group and 5.42 kg (CI; 9.13 to 1.71 kg; p ≤ 0.01) for the CR group, with no statistically significant difference between TRE and CR (0.81 kg [CI; 3.07 to 4.69]; p = 0.68]). Self-reported sleep quality, sleep duration, insomnia severity, and risk of obstructive sleep apnea did not change in the TRE or CR groups versus controls by month 12. Conclusions: These findings suggest that the weight loss produced by TRE and CR does not have any impact on various sleep parameters in adults with obesity over one year.

The relationship between wearable-derived sleep features and relapse in Major Depressive Disorder

BACKGROUND

Changes in sleep and circadian function are leading candidate markers for the detection of relapse in Major Depressive Disorder (MDD). Consumer-grade wearable devices may enable remote and real-time examination of dynamic changes in sleep. Fitbit data from individuals with recurrent MDD were used to describe the longitudinal effects of sleep duration, quality, and regularity on subsequent depression relapse and severity.

METHODS

Data were collected as part of a longitudinal observational mobile Health (mHealth) cohort study in people with recurrent MDD. Participants wore a Fitbit device and completed regular outcome assessments via email for a median follow-up of 541 days. We used multivariable regression models to test the effects of sleep features on depression outcomes. We considered respondents with at least one assessment of relapse (n = 218) or at least one assessment of depression severity (n = 393).

RESULTS

Increased intra-individual variability in total sleep time, greater sleep fragmentation, lower sleep efficiency, and more variable sleep midpoints were associated with worse depression outcomes. Adjusted Population Attributable Fractions suggested that an intervention to increase sleep consistency in adults with MDD could reduce the population risk for depression relapse by up to 22 %.

LIMITATIONS

Limitations include a potentially underpowered primary outcome due to the smaller number of relapses identified than expected.

CONCLUSION

Our study demonstrates a role for consumer-grade activity trackers in estimating relapse risk and depression severity in people with recurrent MDD. Variability in sleep duration and midpoint may be useful targets for stratified interventions.

Prevalence and clinical correlates of benzodiazepine use in the patients with major depressive disorder

BACKGROUND

Major depressive disorder (MDD) is a serious and disabling condition characterized by abnormal mood changes. Clinical guidelines for depression treatment recommend antidepressant medications, with benzodiazepines acting as short-term synergists. However, little is currently known about the prevalence and associated clinical risk factors of benzodiazepine use among Chinese patients with MDD. This study aimed to explore the prevalence and clinical risk factors associated with benzodiazepine use in this population.

METHODS

A total of 2742 patients with MDD (males/females = 816/1926, aged 14-60 years) participated in this cross-sectional observational study. General information and psychosis assessments were collected online. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), anxiety symptoms using the Generalized Anxiety Disorder-7 (GAD-7), and sleep problems and suicidal tendencies using the third and ninth items of the PHQ-9. Multivariable logistic regression analysis models were employed to identify factors associated with benzodiazepine use.

RESULTS

The prevalence of benzodiazepine use among patients with MDD was 42.9 %. Among these patients, 99.6 % used a single benzodiazepine, with oxazepam being the most frequently prescribed. Age, severity of sleep problems, depressive symptoms, and anxiety symptoms were significantly correlated with benzodiazepine use (all P < 0.001).

LIMITATIONS

The cross-sectional design of this study precludes establishing causal relationships.

CONCLUSION

Our findings indicate a high prevalence of benzodiazepine use among Chinese patients with MDD. Factors such as severe depressive symptoms, anxiety symptoms, age, and sleep problems appear to be associated with benzodiazepine use. These results underscore the importance of vigilance regarding benzodiazepine use in patients with MDD.

Research of related factors of depression in COPD patients

We aimed to investigate the related risk factors of depression in patients with chronic obstructive pulmonary disease (COPD) to detect depressed patients early and perform timely intervention to improve the disease prognosis of chronic obstructive pulmonary disease. This cross-sectional study included COPD patients who were discharged from the First People's Hospital of Hefei, China from October 2018 to October 2019, and all participants were diagnosed with COPD according to the Global Initiative for Chronic Obstructive Pulmonary Disease. There was no COPD exacerbation during follow-up 1 month after discharge. Psycho-cognitive disorders, psychiatric disorders or other conditions causing psychiatric symptoms were excluded. We divided stable patients with chronic obstructive pulmonary disease into depression group (HAM-D 24 ≥ 8) and non-depression group (<8), and compared the sociodemographic data, clinical characteristics and serum inflammatory parameters between the 2 groups. In this cross-sectional study, 100 eligible COPD patients were initially recruited, 64 of whom completed all the programs. Univariate logistic regression analysis, female, chronic obstructive pulmonary disease assessment test (CAT) score, serum interferon alpha-a (IFN-α) level, and low smoking index were associated with depression in patients with chronic obstructive pulmonary disease. Multivariate logistic regression analysis showed that high serum IFN-α level (OR = 1.099, 95% CI: 1.010-1.196; P = .028), high CAT score (OR = 1.250, 95% CI: 1.052-1.484; P = .011) and low smoking index (OR = 10.154, 95% CI: 1.886-54.664; P = .007) were significant risk factors for depression in patients with chronic obstructive pulmonary disease. Our findings suggest that high serum IFN-α levels, and high CAT scores are risk factors for comorbid depression in COPD patients. Continuous high-dose smoking may aggravate the primary disease and ultimately aggravate depression.

Association between sleep duration from midlife to late life and the risk of depressive symptoms: the Singapore Chinese Health Study

BACKGROUND

The prospective association between sleep duration and the development of late-life depressive symptomology is unclear.

AIMS

To investigate sleep duration from midlife to late life in relation to risk of depressive symptoms in late life.

METHOD

A total of 14 361 participants from the Singapore Chinese Health Study were included in the present study. Daily sleep duration was self-reported at baseline (mean age of 52.4 years; 1993-98), follow-up 2 (mean age of 65.2 years; 2006-10) and follow-up 3 (mean age of 72.5 years; 2014-16) interviews. Depressive symptoms were evaluated using the Geriatric Depression Scale at follow-up 3 interviews. Modified Poisson regression models were performed to estimate relative risks and 95% confidence intervals of late-life depressive symptoms in relation to sleep duration at baseline and the two follow-up interviews.

RESULTS

Compared with sleeping 7 h per day, a short sleep duration of ≤5 h per day at baseline (i.e. midlife) was related to a higher risk of depressive symptoms (relative risk 1.10, 95% CI 1.06-1.15), and this risk was not affected by subsequent prolongation of sleep. Conversely, a long sleep duration of ≥9 h per day at baseline was not related to risk of depressive symptoms. At follow-up 3 (i.e. late life), both short sleep (relative risk 1.20, 95% CI 1.16-1.25) and long sleep (relative risk 1.12, 95% CI 1.07-1.18) duration were cross-sectionally associated with depressive symptoms.

CONCLUSION

Short sleep duration in midlife, regardless of subsequent prolongation, is associated with an increased risk of depression in late life. Contrariwise, both short and long sleep duration in late life co-occur with depressive symptoms.

Effects of Trazodone on Sleep: A Systematic Review and Meta-analysis

BACKGROUND AND OBJECTIVES

Sleep problems and insomnia are common, challenging to treat, and transcend specific diagnoses. Although trazodone is a popular choice, robust meta-analytic evidence is lacking. This systematic review and meta-analysis investigates the efficacy and safety of trazodone for sleep disturbances, reflecting recent updates in insomnia diagnosis and treatment.

METHODS

We searched Medline, Embase, APA PsycINFO, the Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) up to 1 May 2024, for Randomized Controlled Trials (RCTs) comparing trazodone with placebo and reporting sleep-related outcomes. The minimum pharmacotherapy duration was 5 days. Included were all RCTs regardless of blinding (open-label or single- or double-blind), while quasi-randomized studies were excluded. The Cochrane Risk of Bias Tool for Randomized Trials assessed bias. Analyses used a random-effects model on an intention-to-treat (ITT) basis. Risk ratio (RR) was used for dichotomous outcomes and weighted mean difference (WMD) for continuous outcomes. When different units or scales were used, Hedge's adjusted g standardized mean difference (SMD) was calculated. Subgroup and preplanned sensitivity analyses explored heterogeneity and evaluated findings' strength and consistency.

RESULTS

In total, 44 RCTs with 3935 participants were included. Trazodone did not significantly impact subjective total sleep time (TST) [WMD = 0.73 min, 95% confidence interval (CI) - 24.62; 26.07, p = 0.96] but improved sleep quality (SQ) (SMD = - 0.58, 95% CI - 0.87; - 0.28, p < 0.01) and secondary outcomes. These included the number of nocturnal awakenings (SMD = - 0.57, 95% CI - 0.85; - 0.30], p < 0.01), nocturnal time awake after sleep onset (WMD = - 13.47 min, 95% CI - 23.09; - 3.86], p < 0.01), objective TST by polysomnography (WMD = 27.98 min, 95% CI 4.02; 51.95, p = 0.02), and sleep efficiency (WMD = 3.32, 95% CI 0.53; 1.57, p = 0.02). Tolerability issues included more dropouts owing to adverse effects (RR = 2.30, 95% CI 1.45; 3.64, p < 0.01), any sleep-related adverse effects (RR = 3.67, 95% CI 1.07; 12.47, p = 0.04), more adverse effects in general (RR = 1.18, 95% CI 1.03; 1.33, p = 0.02), and more sleep-related adverse effects (RR = 4.31, 95% CI 2.29; 8.13, p < 0.01).

CONCLUSION

Trazodone extends total sleep time but does not affect perceived sleep duration. It may improve sleep quality and continuity but has minor effects on sleep latency, efficiency, and daytime impairment. Trazodone is associated with adverse effects, necessitating a careful risk-benefit assessment. Limited data restrict generalizability, underscoring the need for more research.

REGISTRATION

PROSPERO registration number,CRD42022383121.

Associations of classical HLA alleles with sleep behaviours

Immune dysregulation has been observed in individuals with sleep disturbance, with HLA molecules play a crucial role in the immune response. This study aimed to investigate the associations between HLA alleles and sleep behaviours, considering several environmental factors. Data were sourced from the UK Biobank. Logistic regression analyses were performed to explore the associations between 359 HLA alleles and 4 sleep behaviours, including chronotype (n = 204,636), insomnia (n = 227,553), snoring (n = 214,350) and daytime dozing (n = 227,197). Furthermore, gene-environmental interaction studies (GEIS) were conducted to evaluate the interactions of HLA alleles with environmental factors on sleep behaviours. This study analysed a total sample and subgroups stratified by sex to elucidate the impact of HLA alleles on sleep behaviours. Our findings revealed several associations between specific HLA alleles and sleep behaviours. Notably, HLA-A*23:01 was associated with evening chronotype in the total sample (OR = 0.918, 95%CI: 0.872-0.965), while HLA-A*32:01 was associated with evening chronotype in males (OR = 1.089, 95%CI: 1.037-1.144). Furthermore, GEIS identified multiple sets of interactions associated with sleep behaviours. For example, the interaction of HLA-DPA1*01:04 with alcohol consumption was associated with daytime dozing in the total sample (OR = 1.993, 95%CI: 1.351-2.941), while the interaction of HLA-DQB1*05:04 with ever suffered mental distress preventing usual activities was associated with insomnia in males (OR = 0.409, 95%CI: 0.254-0.658). Our findings highlight the involvement of HLA in sleep regulation and underscore the potential interactions between HLA alleles and environmental factors in modulating susceptibility to sleep behaviours.

Correlation between psychological stress and depressive symptoms among Japanese university students: a cross-sectional analysis

[Purpose] Higher education students face significant environmental changes, placing them at heightened risk of developing depressive symptoms that have been exacerbated by the coronavirus infectious disease pandemic. This study examined the association between psychological stress and depressive symptoms among Japanese university students. [Participants and Methods] We conducted an online and face-to-face questionnaire survey with 145 Japanese university students studying rehabilitation sciences. Depressive symptoms and psychological stress were evaluated using the Self-rating Depression Scale and Stress Response Scale-18, respectively. [Results] Among the participants, 88 had depressive symptoms. Compared to the non-depressive symptom group, the depressive symptom group experienced higher psychological stress and comprised significantly more women and individuals with insomnia. Logistic regression analysis revealed that psychological stress and insomnia were independent predictors of depressive symptoms. [Conclusion] Psychological stress is independently associated with depressive symptoms. The correlation between insomnia, stress, and depressive symptoms requires further investigation. Future research should explore the causal relationship between psychological stress and depressive symptoms and consider the factors that may influence this relationship.

The Combined Influence of Sleep Disturbance and Depression on 12-month Outcomes After Lumbar Spine Surgery

STUDY DESIGN

Retrospective analysis of prospectively collected data.

OBJECTIVE

To examine the combined influence of preoperative sleep disturbance and depression on 12-month patient-reported outcomes after lumbar spine surgery (LSS).

SUMMARY OF BACKGROUND DATA

Psychological and behavioral factors are considered major risk factors for poor outcomes after LSS. However, there is a need to explore the combined effects of preoperative factors such as sleep disturbance and depression. Understanding the influence of sleep disturbance and depression can inform evidence-based preoperative assessment and shared-decision making of preoperative and postoperative treatment.

METHODS

Data from 700 patients undergoing LSS were analyzed. Preoperative sleep disturbance and depression were assessed with PROMIS subscales. Established thresholds defined patients with moderate/severe symptoms. Outcomes for disability (Oswestry Disability Index) and back and leg pain (Numeric Rating Scales) were assessed preoperatively and at 12 months. Separate multivariable linear regressions examined the influence of each factor on 12-month outcomes with and without accounting for the other and in combination as a 4-level variable: (1) moderate/severe sleep disturbance alone, (2) moderate/severe depression alone, (3) both moderate/severe sleep disturbance and depression, (4) no moderate/severe sleep disturbance or depression.

RESULTS

Preoperative sleep disturbance and depression were associated with 12-month disability and pain ( P <0.05). After accounting for depression, preoperative sleep disturbance remained associated with disability, while preoperative depression adjusting for sleep disturbance remained associated with all outcomes ( P <0.05). Patients reporting both moderate/severe sleep disturbance and moderate/severe depression had 12.6 points higher disability and 1.5 points higher back and leg pain compared with patients without moderate/severe sleep disturbance or depression.

CONCLUSIONS

The combination of sleep disturbance and depression impacts postoperative outcomes considerably. The high-risk group of patients with moderate/severe sleep disturbance and depression could benefit from targeted treatment strategies.

LEVEL OF EVIDENCE

Level II.

The affective factors of depression symptoms in hypertensive patients and the protective effect of physical activity

OBJECTIVE

To investigate the potential affective factors of depressive symptoms in patients with hypertension and explore the protective effects of physical activity.

METHODS

211 hypertensive patients aged over 18 years were consecutively recruited. All patients completed a self-designed questionnaire and the Hospital Anxiety and Depression Scale (HADS) to assess the coexistence of depressive symptoms, and psychiatrists were invited to diagnose depression when necessary. Full-night polysomnography was performed to detect the sleep pattern. The association between sleep structure and depressive symptoms was tested by using logistic regression analysis, and contributing factors as well as the effect of physical activity were assessed among patients with and without depressive symptoms.

RESULTS

Of the 211 subjects, 33.6% of cases were coexistent with depressive symptoms. Female gender [OR (95%CI): 2.83 (1.44-5.57), P = 0.003) and the greater percentage of REM stage [OR (95%CI): 1.09 (1.01-1.18), P = 0.024] were the risk factors of depressive symptoms, while doing physical activity showed as the protective factor. Patients with REM stage ≥ 20% showed a higher score on HADS-D than those with REM stage < 20% [(4.9 ± 3.8) vs. (3.7 ± 3.1), P = 0.018]. Compared to individuals who never did physical activity, those who did physical activity 1-2 times per week and ≥ 3 times per week had a 52% and 62% risk reduction in depressive symptoms respectively. Patients who did physical activity had lower levels of high-sensitivity C-reactive protein (hs-CRP) compared to those who never did physical activity.

CONCLUSION

Female gender and a higher percentage of REM stage are risk factors for depressive symptoms in hypertension, while physical activity may benefit depressive symptoms by reducing serum levels of hs-CRP.

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.

Improvements in Sleep Quality in Patients With Major Depressive and Generalized Anxiety Disorders Treated With Individualized, Parcel-Guided Transcranial Magnetic Stimulation

INTRODUCTION

Poor quality sleep has often been cited as a cause of lowered quality of life in patients with affective disorders such as major depressive disorder (MDD) and generalized anxiety disorder (GAD). As sleep and affective disorders are affected by multi-network interactions, we hypothesize that the modulation of the central executive network (CEN), salience, and default mode networks (DMNs) through individualized repetitive transcranial magnetic stimulation (rTMS) may improve sleep and quality of life.

METHODS

A retrospective analysis from 2020 to 2023 was conducted in patients with affective disorders at Cingulum Health. Multiple targets were selected based on anomalies detected from individual, functional connectivity networks from a machine-learning connectivity software. rTMS was conducted with accelerated continuous or intermittent theta burst stimulation (TBS) based on the anomaly detected. Pittsburgh Sleep Quality Index (PSQI), EuroQol (EQ5D), Beck's Depression Inventory (BDI), and the General Anxiety Disorder-7 (GAD-7) questionnaires were administered prior to, after, and at follow-up of rTMS.

RESULTS

Twenty-seven patients were identified, and the most common diagnoses were MDD (41%) or MDD with GAD (41%). All patients had at least one rTMS target in the CEN. The most common target (19 patients) was L8Av in the dorsolateral prefrontal cortex (dlPFC). Patients experienced significant improvements in sleep, quality of life, depressive, and anxiety symptoms after rTMS and during follow-up. Improvements in sleep correlated with quality of life at follow-up.

CONCLUSION

This study suggests that personalized, parcel-guided rTMS is safe and may provide sustained improvements in sleep, quality of life, and affective symptoms for patients with affective disorders.

Association between sleep disorder and depression in stroke in the National Health and Nutrition Examination Surveys (NHANES) 2005 to 2014

BACKGROUND

To investigate the association between sleep disorder and depression in stroke population using data from the National Health and Nutrition Examination Surveys (NHANES) conducted between 2005 and 2014.

METHODS

Participants included stroke population who reported on sleep disorder and completed the Patient Health Questionnaire-9 (PHQ-9) to assess depressive symptom. Sleep disorder was self-reported and categorized dichotomously. Multivariate logistic regression, subgroup analysis, receiver operating characteristic curve (ROC) and restricted cubic spline (RCS) were used to explore the association between sleep disorder and depression.

RESULTS

The final sample included 566 stroke survivors (weighted n = 3,326,625). Multivariate logistic regression analysis confirmed that sleep disorder was independently associated with an increased risk of depression even after adjusting for potential confounders (OR = 2.616, 95 % CI: 2.561 to 2.599, P < 0.0001). Subgroup analysis indicated that this association was particularly strong among female stroke population (OR = 5.515). Sleep disorder as a significant predictor of depression, while the relationship between sleep time and depression is characterized by non-linearity.

CONCLUSIONS

Sleep disorder is significantly associated with an increased risk of depression in stroke. This relationship remains robust across various sociodemographic and lifestyle factors, highlighting the need for integrated interventions targeting both sleep and mood disturbances in stroke care.

Burdened breaths: The influence of depression on obstructive sleep apnea

Depression and metabolic syndrome could exacerbate the risks of the other, leading to a series of severe coexisting conditions. One notable comorbidity that must be mentioned is obstructive sleep apnea (OSA). Current studies suggested that depression increases susceptibility to OSA. As the prevalence of depression rises, it becomes critical to prevent and manage its complications or comorbidities, including OSA. Predictive models, non-invasive electroencephalogram monitoring, genetic research, and other promising technologies are being applied to the prevention, diagnosis, and personalized treatment of depression and OSA.

Association between dietary total antioxidant capacity and sleep problems and depressive symptoms among U.S. adults

Background

In this study, we aim to examine the impact of dietary total antioxidant capacity (TAC) on sleep problems and depressive symptoms (DS); besides, we seek to elucidate the potential mediating effect of dietary TAC on the relationships between sleep problems and DS.

Methods

Weighted Kruskal-Wallis tests for continuous variables and Chi-square tests for categorical variables were employed to discriminate between DS and non-DS participants. Multivariable logistic regression and restricted cubic spline analysis were applied to evaluate the associations of TAC with DS and sleep problems.

Results

Among the 21,805 participants, 1,947 participants suffered from DS. Weighted multivariable logistical regression indicated that shorter sleep hours were linked to an increased likelihood of risk of DS even after complete adjustments. Restricted cubic spline cure displayed that TAC was almost non-linearly correlated with DS and sleep problems. Mediation analysis indicated that sleep duration slightly mediated the association between TAC and DS (proportion of mediation: 3.12%, p < 0.001).

Conclusion

This study illustrated the inverse association between TAC value and sleep problems and DS. Furthermore, TAC slightly mediated the effect of sleep duration on the DS, and there was a nearly non-linear relationship between TAC and DS, and TAC and sleep problems.

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.

Depressive symptoms mediate the longitudinal relationships between sleep quality and cognitive functions among older adults with mild cognitive impairment: A cross-lagged modeling analysis

Although it is generally recognized that sleep quality, depressive symptoms, and cognitive functions are related respectively, the main ambiguity comes from difficulties in determining their cause-effect relationships. The present study aimed to explore the longitudinal causation relationships among sleep quality, depressive symptoms, and cognitive functions in older people with mild cognitive impairment (MCI). A total of 134 patients from 24 communities in Ningbo City, Zhejiang Province, China with MCI were interviewed at baseline, while 124 of them were re-interviewed 2 months later, and 122 were re-interviewed 4 months later. The Patient Health Questionnaire-9, the Pittsburgh Sleep Quality Index and the Montreal Cognitive Assessment Scale were assessed in the interview. Cross-lagged models were tested to disentangle the relationships among sleep quality, depressive symptoms, and cognitive functions using structural equation modeling with latent variables on the four-mouth longitudinal data. The correlation coefficients between sleep quality and depressive symptoms were significant showing the stability across time points of assessment, while the correlation coefficient of cognitive function was not significant (r = 0.159, p > 0.05). The results of index of model fit indicated that the cross-lagged model was acceptable (CFI = 0.934, TLI = 0.899, RMSEA = 0.075, χ2/df = 1.684). The results of cross-lagged model analysis supported the complete mediating role of depressive symptoms in the association between sleep quality and cognitive functions, where worse sleep quality may lead to more severe depressive symptoms, which in turn leads to more severe cognitive decline. In Conclusion, sleep quality is significantly correlated with cognitive functions in patients with mild cognitive impairment, which association is fully mediated by depressive symptoms. Approaches addressing sleep quality and depressive symptoms are recommended and hold promise for the management of mild cognitive impairment.

Mental health, substance use, and a composite of sleep health in adults, 2018 Ohio behavioral risk factor surveillance system

OBJECTIVES

Various factors impact sleep health including mental health and substance use. Mental health issues and substance use continue to rise in the United States. Yet, the association between mental health, substance use and sleep health in adults remains unclear.

METHODS

We used multivariable linear regression models to examine the associations between mental health (poor mental health days in the past 30 days) and substance use (marijuana, tobacco, alcohol) with sleep health (individual dimensions of sleep: alertness, sleep efficiency, duration, and sleep health composite score) in 4333 participants from the 2018 Ohio Behavioral Risk Factor Surveillance System Survey.

RESULTS

Better mental health was associated with higher alertness, higher sleep efficiency, longer sleep duration and a higher sleep health composite score even after controlling for covariates (individual: sex at birth, age, body mass index, race, education, sleep disordered breathing, and area-level: socioeconomic deprivation) (all p < .001). Higher marijuana and tobacco use were associated with lower individual sleep health dimensions (marijuana with sleep efficiency and duration and tobacco use with lower efficiency) and a lower sleep health composite score even after controlling for covariates for tobacco use (p < .001). Contrary to the hypothesis, higher alcohol use was associated with higher alertness and a higher sleep health composite score (p < .001), however after adjusting for covariates these associations were no longer significant.

CONCLUSIONS

The implications of these trends on sleep health are important to address as mental health and substance use are modifiable targets to consider when addressing sleep health.

Effects of perceived stress on college students' sleep quality: a moderated chain mediation model

BACKGROUND

Perceived Stress has been shown as a key contributor to sleep quality, but the underlying mechanism between perceived stress and sleep quality remains unknown. This study aimed to investigate the impact of perceived stress on sleep quality of college students and the chain mediating roles of presence of meaning in life (PML) and depression, as well as the moderating role of search for meaning in life (SML).

METHODS

Participants were 8178 college students (4599 boys and 3579 girls; Mage = 19.10 years, SD = 1.08) who completed self-report questionnaire, including the Perceived Stress Scale (PSS), the Pittsburgh Sleep Quality Index (PSQI), the Meaning in Life Questionnaire (MLQ), and the Patient Health Questionnaire-9 (PHQ-9).

RESULTS

The results showed that higher perceived stress was directly related to poorer sleep quality. This negative impact on sleep quality was mediated through the chained roles of PML and depression. Additionally, the study found that SML moderates the influence of perceived stress, PML and depression on sleep quality. Specifically, for individuals actively search for meaning, the adverse effects of perceived stress and depression on sleep quality are diminished. Concurrently, the positive influence of PML on sleep quality is enhanced.

CONCLUSION

This study revealed that the PML and depression mediate the effect of perceived stress on sleep quality, with SML playing a significant protective role. These results emphasize the necessity of integrating strategies to enhance PML and SML into interventions designed to improve emotion management and sleep quality among college students.

Experiences of adult patients living with depression-related insomnia: a qualitative systematic review

OBJECTIVE

The objective of this review was to identify and synthesize the best available evidence on how adult patients experience living with depression-related insomnia, and their experiences related to pharmacological and non-pharmacological interventions aimed at improving sleep.

INTRODUCTION

Insomnia affects 80% to 90% of patients with depression. The costs of insomnia are considerable for the individual and society alike. To understand the role and consequences of insomnia for an individual with depression and to optimize sleep interventions, an in-depth understanding of patients' experiences is needed. Therefore, this review addresses how adult patients experience living with depression-related insomnia, along with the experiences of pharmacological and non-pharmacological sleep interventions among patients with depression-related insomnia.

INCLUSION CRITERIA

Studies focusing on adult patients aged 18 years and older with a diagnosis of depression who had experiences with insomnia and pharmacological and/or non-pharmacological sleep interventions were included. All studies with qualitative research findings from inpatient and outpatient populations were considered.

METHODS

The following databases were searched: MEDLINE (PubMed), Embase (Elsevier), CINAHL (EBSCOhost), PsycINFO (ProQuest), Cochrane CENTRAL, SveMed+, Scopus, and Web of Science Core Collection. Google Scholar and ProQuest Dissertations and Theses were searched for eligible dissertations and theses. The searches were conducted on May 3-5, 2022, and updated on June 13-19, 2023. Studies published in English, Danish, German, Norwegian, and Swedish were considered. Databases were searched from their inception to the search date. All studies were screened against the inclusion criteria and critically and independently appraised by 2 reviewers for methodological quality. Findings were pooled using meta-aggregation, and a ConQual Summary of Findings was created.

RESULTS

Ten qualitative studies were included. The studies were conducted in 6 countries and counted a total of 176 participants. In all, 127 findings were extracted and aggregated into 11 categories. From the 11 categories, 3 synthesized findings were developed: 1) Disruption of sleep challenges coping with everyday life by depleting both physical and mental resources; 2) Sleep is an escape and a protective factor against suicide; and 3) Choices, support, and personalized interventions from non-pharmacological approaches addressing depression-related insomnia are valued.

CONCLUSIONS

This review underlined the relationship between depression-related insomnia, its profound impact on individuals' lives, and the value of non-pharmacological sleep interventions to address these issues. Specifically, the study revealed the physical and emotional consequences of insomnia while emphasizing how wakefulness during night hours may exacerbate feelings of loneliness and vulnerability to negative thoughts and suicide. Moreover, it provides an overview of patients' experiences of non-pharmacological approaches to address depression-related insomnia and highlights their diverse treatment experiences and preferences.

SUPPLEMENTAL DIGITAL CONTENT

A Danish-language version of the abstract of this review is available as Supplemental Digital Content [http://links.lww.com/SRX/A64].

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42021276048.

The impact of sleep problems during late childhood on internalizing problems in early-mid adolescence

OBJECTIVES

Sleep and internalizing problems escalate during adolescence and can negatively impact long-term health. However, the directionality of this risk-relationship remains poorly understood within a developmental context. The current study aimed to determine the directionality of this relationship in adolescents with no history of psychiatric disorder and whether sex at birth played a role in this relationship.

METHODS

We used data from the Adolescent Brain Cognitive Development, an ongoing multisite longitudinal US study, that covered four waves (W1:9-11 years; W2:10-12 years; W3:11-13 years; W4:12-14 years). Analyses included 3,128 youth (50.99%girls) with no past or current psychiatric disorders at W1. The Sleep Disturbance Scale for Children and the Child Behavior Checklist were used to measure sleep and internalizing problems. Cross-lagged panel models were used to evaluate the cross-lagged relationships across waves.

RESULTS

The sleep-internalizing cross-lagged relationship was unidirectional, with medium-large effect sizes: greater total sleep problems were associated with more severe internalizing problems at later waves (W2➔W3, coefficient = 0.052, p = .021; W3➔W4, coefficient = 0.091, p < .001), with problems in initiating and maintaining sleep predicting internalizing problems early on. Girls showed greater sleep-internalizing risk than boys.

CONCLUSIONS

Sleep-internalizing relationships change across adolescence, becoming significant and more specific from early to mid-adolescence. Sleep interventions delivered in early adolescence, to girls in particular, may have a positive short and long-term impact on internalizing outcomes.

Association between depression severity and trouble sleeping: A population-based study

This study investigates the association between insomnia and depression severity, exploring sleep disturbances in individuals with depression. The aim is to establish a new foundation for managing patients with co-occurring depression and insomnia, using 2015 to 2016 National Health and Nutrition Examination Survey (NHANES) data. We employed a cross-sectional design, using NHANES data from 2015 to 2018. The study included 11,261 participants after excluding incomplete data. Depression severity, assessed using Patient Health Questionnaire-9 (PHQ-9) scores, served as the exposure variable. We considered various demographic and lifestyle factors as covariates in the multivariate adjustment model. Statistical analyses adhered to CDC recommendations, with sample weights incorporated to account for NHANES' complex sample design. Our study, encompassing 19,225 participants, revealed that higher PHQ-9 scores correlated with an increased likelihood of sleep disorders. In the fully adjusted model, a positive association emerged between PHQ-9 scores and trouble sleeping (OR = 3.95, 95% CI: 3.35-4.66, P < .0001). This relationship displayed an inverted U-shaped curve, with an inflection point at 28. Subgroup analysis and interaction tests indicated no reliance on factors such as gender, age, marital status, or BMI for the connection between depression severity and trouble sleeping (all P for interaction > .05). We identified a significant inverted U-shaped correlation between sleep disturbances and depression severity. This underscores the crucial importance of assessing sleep disorder risks in individuals with varying degrees of depression severity, facilitating personalized therapeutic interventions.

Prevalence of sleep disorders in geriatrics: an exploratory study using sleep questionnaires

OBJECTIVES

This study aimed to investigate the prevalence of sleep problems in older subjects, considering sex and age differences.

METHODS

Subjects admitted to a geriatrics clinic underwent a medical visit and completed a battery of questionnaires assessing sleep quality, insomnia, sleep apnea risk, excessive daytime sleepiness (EDS), restless legs syndrome (RLS), chronotype, depression and global cognition.

RESULTS

Fifty-eight subjects (58.6 % women, mean age 77.36±6.07) were included. The most predominant sleep-related complaint was poor sleep quality (36.2 %), followed by sleep apnea risk (34.5 %), insomnia symptoms (25.9 %), EDS (15.5 %) and RLS (12.1 %). Older women reported more insomnia, poorer sleep quality and depressive symptoms than males. Patients aged ≥ 75 years old had more comorbidities and higher sleep apnea risk compared to those under 75 years old.

CONCLUSIONS

Sleep problems are frequent in older adults, requiring their screening and treatment for possibly improving well-being and reduce the burden of neuropsychiatric and medical comorbidities.

Navigating the skies: a cross-sectional study of depression among Saudi Arabian airline pilots

BACKGROUND

Depression poses a significant challenge globally, including in safety-critical industries such as aviation. In Saudi Arabia, where the aviation sector is rapidly expanding, pilots encounter unique stressors inherent to their profession. However, research on pilot mental health, particularly within the Saudi context, remains limited despite its critical role in flight safety.

METHODS

This cross-sectional survey was designed to estimate the self-reported prevalence of depression in a convenience sample of airline pilots in Saudi Arabia. Participants were recruited from various commercial airlines in Saudi Arabia. Recruitment efforts utilized targeted outreach on social media platforms, focusing on pilot forums and groups. The survey was administered online for accessibility and convenience. The structured questionnaire, developed through a literature review and expert consultation, comprises sections on demographic and professional characteristics, occupational information, health habits, and depression assessment via the Patient Health Questionnaire-9 (PHQ-9).

RESULTS

This study enrolled 310 participants, with the largest cohort (34.8%, n = 108) falling within the 30-39 years age group, closely followed by individuals under 30 years (30.0%, n = 93). Males dominated the sex distribution (99.0%, n = 307). The mean PHQ-9 score was 8.2 ± 5.4. Notably, 40.6% (n = 126) of the participants had a score of 10 or higher, indicating the potential for moderate, moderate-severe, or severe depression. Multivariable binary logistic regression analysis revealed that pilots with 11-15 years of experience had greater odds of experiencing depression than did those with 0-10 years of experience did (odds ratio [OR]: 3.0, 95% confidence interval [CI]: [1.1-8.4], p = 0.04). Pilots with rest times exceeding 24 h had lower odds of depression than did those with rest times less than 1 h (OR: 0.3, 95% CI: [0.1-0.8], p = 0.02). Engaging in regular exercise was associated with reduced odds of depression (OR: 0.3, 95% CI: [0.2-0.5], p < 0.01), as was longer sleep duration (> 8 h) (OR: 0.2, 95% CI: [0.1-1.0], p = 0.04).

CONCLUSION

Our study estimates the prevalence and severity of self-reported depressive symptoms among airline pilots in Saudi Arabia, surpassing global estimates. The identified factors, including lack of regular exercise, short sleep duration, and insufficient rest between flights, underscore the complex mental health challenges faced by pilots in this region. Addressing these issues is crucial not only for pilot well-being but also for flight safety.

Biological and behavioral pathways from prenatal depression to offspring cardiometabolic risk: Testing the developmental origins of health and disease hypothesis

Given prior literature focused on the Developmental Origins of Health and Disease framework, there is strong rationale to hypothesize that reducing depression in the prenatal period will cause improvements in offspring cardiometabolic health. The current review outlines evidence that prenatal depression is associated with offspring cardiometabolic risk and health behaviors. We review evidence of these associations in humans and in nonhuman animals at multiple developmental periods, from the prenatal period (maternal preeclampsia, gestational diabetes), neonatal period (preterm birth, small size at birth), infancy (rapid weight gain), childhood and adolescence (high blood pressure, impaired glucose-insulin homeostasis, unfavorable lipid profiles, abdominal obesity), and into adulthood (diabetes, cardiovascular disease). In addition to these cardiometabolic outcomes, we focus on health behaviors associated with cardiometabolic risk, such as child eating behaviors, diet, physical activity, and sleep health. Our review focuses on child behaviors (e.g., emotional eating, preference for highly palatable foods, short sleep duration) and parenting behaviors (e.g., pressuring child to eat, modeling of health behaviors). These changes in health behaviors may be detected before changes to cardiometabolic outcomes, which may allow for early identification of and prevention for children at risk for poor adult cardiometabolic outcomes. We also discuss the methods of the ongoing Care Project, which is a randomized clinical trial to test whether reducing prenatal maternal depression improves offspring's cardiometabolic health and health behaviors in preschool. The goal of this review and the Care Project are to inform future research, interventions, and policies that support prenatal mental health and offspring cardiometabolic health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Sleep Quality is Poor in Rheumatoid Arthritis Patients and Correlates with Anxiety, Depression, and Poor Quality of Life

Objective

Sleep quality is poor in most rheumatoid arthritis (RA) patients. We planned this study to see the association of sleep quality with anxiety, depression, and quality of life (QOL) in Indian RA patients.

Methods

One hundred twelve RA patients and 93 controls were included in this cross-sectional study. Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI). Quality of life was assessed using the World Health Organisation Quality of Life (WHOQOL-BREF). Anxiety and depression were assessed using the hospital anxiety and depression scale (HADS). The disease activity was measured by Disease Activity Score for 28 joints with 3 variables. Functional disability was measured by using the Indian version of the Health Assessment Questionnaire (HAQ).

Results

Poor sleep quality was seen in 103(92%) of the patients and 26(28%) controls (p<0.0001). RA patients had significantly higher PSQI scores as compared to the control group (10.8±3.7 vs.3.9±1.2, P<0.0001). Poor sleepers were more likely to be females (90% vs.0%, p = 0.02), and had longer disease duration (5.2±4.8 years vs. 2.8±2 years, p=0.01). Poor sleepers had more pain (VAS 42.2±23.6 mm vs.16.2±11.6 mm, p<0.001) and poor functional status (HAQ 1.2±0.5 vs. 0.6±0.4, p<0.01). There was a significant effect of the physical domain of WHOQOL-BREF, anxiety, and age on poor sleep quality.

Conclusion

Poor sleep quality is seen in a majority of RA patients and correlates with anxiety, depression, and poor QOL. RA patients need to be routinely assessed for sleep quality and factors affecting poor sleep quality need to be addressed.

A closer look at depression and sleep quality relation: A cross-sectional study of taxi drivers in Tabriz metropolis

Background and Aim

Taxi drivers play a significant role in urban mobility and safety as professional drivers. They typically have poor incomes, long work hours, lack of sleep, and high levels of stress, which increase the risk of physical and mental illnesses. The goal of this study was to explore the relationship between sleep disorders and depression among Tabriz metropolis taxi drivers.

Methods

Using the street intercept technique, a cross-sectional study was conducted with the participation of 402 taxi drivers in Tabriz during January and March 2020. Data collection tools included the Pittsburgh Sleep Quality Index (PSQI) and Patient Health Questionnaire as well as demographic information. Twenty taxi stops were used as sampling sites, and the method used was random sampling based on the number of drivers at each stop. Statistical analysis was performed using Stata 13.

Results

The majority of drivers worked an average of 6 days each week, with a mean tenure of 13.3 years. The sleep quality mean score for drivers was 5 (SD = 2.3). Approximately, 21% of them had sleep disorder (PSQI >6). Moderate depression was recognized in 13% of drivers and moderately severe depression has been found in 5% of them. Drivers were more likely to experience sleep disorders if they had mild (odds ratio [OR] = 3.9), moderate (OR = 16.4), or fairly severe depression symptoms (OR = 35.3). A seven times higher risk of depression was identified among drivers with sleep disorders.

Conclusion

It might be contended that a mutual relationship has been found between sleep disorders and depression, and disregarding this will deteriorate sleep turbulences. Considering the pivotal role of taxi drivers in urban mobility, accommodating initiatives that give a break time for drivers and improve their mental health is recommended.

Association and mediators between the impact of oral health-related quality of life and depression

OBJECTIVES

Our research intended to explore the association and mediators (perceived social support and sleep quality) between the impact of oral health-related quality of life (OHRQoL) and depression among Chinese older adults.

METHODS

A stratified, multi-stage random sampling approach was used in our study. A total of 3896 older individuals aged 60 years and older were included. Process macro 3.5 for SPSS was utilized for testing mediation hypotheses.

RESULTS

The mean score of the OHRQoL of the elderly was 3.26 ± 7.15. The correlation coefficient between OHRQoL and depression was 0.25 (p < 0.001). Perceived social support (β = 0.009, 95% CI = 0.006, 0.012) and sleep quality (β = 0.073, 95% CI = 0.074, 0.093) mediated the relationship between OHRQoL and depression, respectively. The association between OHRQoL and depression was mediated sequentially by perceived social support and sleep quality (β = 0.004, 95% CI = 0.002, 0.006).

CONCLUSIONS

The participants reported relatively good OHRQoL. OHRQoL and depression showed a significant positive correlation. The relationship between OHRQoL and depression among Chinese seniors was mediated by perceived social support and sleep quality. Both directly and indirectly, OHRQoL can affect depression.

Paternal Postpartum Depression and Associated Factors Among Partners of Women Who Gave Birth in Seka Town, Southwest Ethiopia

Despite epidemiologic studies demonstrating the increased incidence of paternal postpartum depression, their emotional health is overlooked throughout their partner's pregnancy and postpartum period as postpartum depression has been traditionally construed as a disease of women. Traditional masculinity norms also result in a lack of recognition and barriers to the treatment of depression in men. This study is aimed to determine the prevalence and factors of paternal postpartum depression among fathers whose wives gave birth. A community-based cross-sectional study was conducted from July 7 to 17, 2023. The 288 sample size was estimated using a single population proportion formula and selected by random sampling technique. The data were exported from Kobo Toolbox and analyzed using SPSS version 26. Candidate variables were identified in bivariate at p < .25 for the multivariate analysis. A p < .05 and adjusted odds ratio (AOR) were used to determine the significance. A total of 280 partners participated making a 97.22% response rate. Paternal postpartum depression was 19.6%(95% confidence interval [CI] = [15.4%, 24.3%]). It was significantly associated with history of depression (AOR = 4.4, 95% CI = [1.7, 10.9]), unplanned pregnancy (AOR = 4.7, 95% CI = [1.9, 11.3]), alcohol consumption (AOR: 3.0, 95% CI = [1.3, 7.4]), infant sleeping problem (AOR: 3.0, 95% CI = [1.1, 8.9]), and mode of delivery (AOR: 3.0, 95% CI = [1.3, 7.6]). This study concluded that paternal postpartum depression was high. The researchers recommended the inclusion of men's mental health services like screening into women's postnatal health care.

Comparison of number of people with freezing of gait in Parkinson's disease with and without sleep disturbances: A systematic review

Parkinson's disease (PD) is a progressive neurodegenerative disorder, involving motor and non-motor symptoms (NMS). Sleep disturbances (SD) are the second most common NMS in PD and include rapid eye movement (REM) sleep behavior disorder (RBD), excessive daytime sleepiness and insomnia. Freezing of gait (FOG) is a gait impairment frequently reported in people with PD greatly hampering functional independence and quality of life. Presence of FOG has been associated with increased frequency and severity of NMS, including SD. Thus, the aim of this study was to systematically review the literature comparing the number of people with FOG in PD with (PD + SD) and without SD (PD-SD). By systematically searching PubMed and Web of Science databases to identify original peer-reviewed articles, 8 studies including 5251 people with PD (2025 PD + SD and 3226 PD-SD) met eligibility criteria and were included in the review. In 6 studies (4 studies investigating RBD, 2 studies investigating overall sleep quality), the group of PD + SD had higher prevalence of FOG compared with PD-SD. Although a limited number of studies, our findings suggest that PD + SD present more frequently FOG than PD-SD. More studies are required to investigate the possible mechanism underlying this association between FOG and sleep.

Association between vitamin D, depression, and sleep health in the National Health and Nutrition Examination Surveys: a mediation analysis

OBJECTIVE

This study aimed to assess the association between vitamin D and sleep health and to investigate whether depression could mediate this relationship.

METHODS

A cross-sectional analysis was performed using the 2005-2014 US National Health and Nutrition Examination Survey (NHANES) data. The logistic regression models were conducted to evaluate association of serum vitamin D concentrations with sleep health and depression. Mediation analyses were conducted to investigate the mediated effects of depression on the association of vitamin D with sleep health.

RESULTS

In multivariate logistic models, vitamin D was found to be negatively associated with an increased risk of poor sleep health, with an odds ratio (OR) of vitamin D deficiency versus sufficiency was 1.256 (95% CI = 1.084-1.455). Additionally, univariate logistic models showed that vitamin D was also negatively associated with depression risk (vitamin D deficiency vs. sufficiency: OR = 1.699, 95% CI = (1.373-2.103). Further mediation analyses showed that the association of vitamin D with sleep health was mediated by depression, with the mediating effects of depression accounted for 44.56% of the total effects.

CONCLUSION

Vitamin D affects sleep health directly and indirectly through depression. The results suggest that interventions increasing intake of vitamin D should be prioritized to promote sleep health of persons with or at risk of depression.

Obstructive Sleep Apnea and Serotoninergic Signalling Pathway: Pathomechanism and Therapeutic Potential

Obstructive Sleep Apnea (OSA) is a disorder characterized by repeated upper airway collapse during sleep, leading to apneas and/or hypopneas, with associated symptoms like intermittent hypoxia and sleep fragmentation. One of the agents contributing to OSA occurrence and development seems to be serotonin (5-HT). Currently, the research focuses on establishing and interlinking OSA pathogenesis and the severity of the disease on the molecular neurotransmitter omnipresent in the human body-serotonin, its pathway, products, receptors, drugs affecting the levels of serotonin, or genetic predisposition. The 5-HT system is associated with numerous physiological processes such as digestion, circulation, sleep, respiration, and muscle tone-all of which are considered factors promoting and influencing the course of OSA because of correlations with comorbid conditions. Comorbidities include obesity, physiological and behavioral disorders as well as cardiovascular diseases. Additionally, both serotonin imbalance and OSA are connected with psychiatric comorbidities, such as depression, anxiety, or cognitive dysfunction. Pharmacological agents that target 5-HT receptors have shown varying degrees of efficacy in reducing the Apnea-Hypopnea Index and improving OSA symptoms. The potential role of the 5-HT signaling pathway in modulating OSA provides a promising avenue for new therapeutic interventions that could accompany the primary treatment of OSA-continuous positive airway pressure. Thus, this review aims to elucidate the complex role of 5-HT and its regulatory mechanisms in OSA pathophysiology, evaluating its potential as a therapeutic target. We also summarize the relationship between 5-HT signaling and various physiological functions, as well as its correlations with comorbid conditions.

The association between diet and sleep with internalising symptoms in young athletes: a serial multiple mediation models

Introduction

Athletes frequently experience anxiety and depression at rates similar to or higher than non-athletes. A balanced diet can alleviate athletes internalizing symptoms. Moreover, diet and sleep are all associated with internalising symptoms. Our study investigates how sleep quality mediates the impact of dietary habits on internalizing symptoms in athletes.

Methods

The current cross-sectional study involved 758 Chinese young athletes. The adapted Australian Athletes Diet Index was used to assess dietary patterns, and sleep was measured using the Athletes Sleep Screening Questionnaire. The Generalised Anxiety Disorder 7 scale and the Patient Health Questionnaire 9-item scale were used to assess symptoms of anxiety and depression. Structural Equation Modelling (SEM) analysis was used to examine the mediating role of sleep quality in young athletes. Raw scores of chronotypes, sleep quality, anxiety and depression were calculated for the statistical analysis.

Results

No significant indirect effects were found in adolescents. In adult athletes, diet mediated the relationship between chronotype and sleep quality (β = -0.028, p  <  0.001). Sleep quality mediated the association between diet and anxiety (β = -0.060, p = 0.001), and depression (β = -0.076, p = 0.001). Additionally, diet and sleep quality mediated the association between chronotypes and anxiety (β = -0.028, p = 0.001), and depression (β = -0.028, p = 0.001).

Conclusion

Sleep quality mediated the relationship between dietary patterns and internalising symptoms in young adult athletes. Additionally, diet and sleep quality mediated the association between chronotypes and internalising symptoms in young adult athletes.

Analyzing the Prevalence of Depression and Its Influencing Factors in Elderly Patients With Obstructive Sleep Apnea: A Machine Learning Approach

Objective: Depressive symptoms are prevalent and detrimental in elderly patients with obstructive sleep apnea (OSA). Understanding the factors influencing these symptoms is crucial. This study aims to use machine learning algorithms to identify the contributing factors in this population. Method: The National Health and Nutrition Examination Survey database provided the data for this study. The study includes elderly patients who are eligible for diagnostic evaluation for OSA. Logistic regression was used to screen their influencing factors, and random forest (RF), extreme gradient boosting (XGB), artificial neural network (ANN), and support vector machine (SVM) were utilized to 4 algorithms were used to construct depressive symptoms classification models, and the best model performance was selected for feature importance ranking. Influential factors included demographics (age, gender, education, etc.), chronic disease status (diabetes, hypertension, etc.), and laboratory findings (white blood cells, C-reactive protein, cholesterol, etc.). Result: Ultimately, we chose 1538 elderly OSA patients for the study, out of which 528 (34.4%) suffered from depressive symptoms. Logistic regression initially identified 17 influencing factors and then constructed classification models based on those 17 using RF, XGB, ANN, and SVM. We selected the best-performing SVM model [area under the curve (AUC) = 0.746] based on the AUC values of 0.73, 0.735, 0.742, and 0.746 for the 4 models. We ranked the variables in order of importance: General health status, sleep disorders, gender, frequency of urinary incontinence, liver disease, physical activity limitations, education, moisture, eosinophils, erythrocyte distribution width, and hearing loss. Conclusion: Elderly OSA patients experience a high incidence of depressive symptoms, influenced by various objective and subjective factors. The situation is troubling, and healthcare institutions and policymakers must prioritize their mental health. We should implement targeted initiatives to improve the mental health of high-risk groups in multiple dimensions.

Low-Grade Inflammation Associated with Major Depression Subtypes: A Cross-Sectional Study

Major depressive disorder (MDD) is associated with inflammation and a high level of comorbidities. Atypical depression (AD) is a MDD subtype based on DSM criteria, that could have specific underlying biological mechanisms. AD is associated with elevated cardiovascular (CVD) comorbidities, higher risk of suicide attempts, hypersomnia, and anxiety disorder. In this study, we aim to investigate if AD and polysomnographic parameters could be associated with low-grade inflammation (LGI). LGI is defined by a range from 3 to 10 mg/L of C-reactive protein levels. We carried out a retrospective cohort study in which 765 individuals with MDD were split into two groups: with and without LGI. Our results exhibit differences between the groups for the polysomnographic parameters, with the LGI group showing parameters already associated with inflammation such as reduced rapid eye movement sleep and elevated hypoxemia markers (identified as CVD risk factor). We found that AD is associated with LGI (OR 1.48; p = 0.047) after adjustment. Likewise, we found an LGI prevalence in AD higher (34.8%) than in MDD without atypical features (26.8%). Overall, these results confirm the low-grade inflammation feature of AD and highlight polysomnographic parameters associated with LGI that could also act as risk factors in this context.

Elucidating genetic and molecular basis of altered higher-order brain structure-function coupling in major depressive disorder

Previous studies have shown that major depressive disorder (MDD) patients exhibit structural and functional impairments, but few studies have investigated changes in higher-order coupling between structure and function. Here, we systematically investigated the effect of MDD on higher-order coupling between structural connectivity (SC) and functional connectivity (FC). Each brain region was mapped into embedding vector by the node2vec algorithm. We used support vector machine (SVM) with the brain region embedding vector to distinguish MDD patients from health controls (HCs) and identify the most discriminative brain regions. Our study revealed that MDD patients had decreased higher-order coupling in connections between the most discriminative brain regions and local connections in rich-club organization and increased higher-order coupling in connections between the ventral attentional network and limbic network compared with HCs. Interestingly, transcriptome-neuroimaging association analysis demonstrated the correlations between regional rSC-FC coupling variations between MDD patients and HCs and α/β-hydrolase domain-containing 6 (ABHD6), β 1,3-N-acetylglucosaminyltransferase-9(β3GNT9), transmembrane protein 45B (TMEM45B), the correlation between regional dSC-FC coupling variations and retinoic acid early transcript 1E antisense RNA 1(RAET1E-AS1), and the correlations between regional iSC-FC coupling variations and ABHD6, β3GNT9, katanin-like 2 protein (KATNAL2). In addition, correlation analysis with neurotransmitter receptor/transporter maps found that the rSC-FC and iSC-FC coupling variations were both correlated with neuroendocrine transporter (NET) expression, and the dSC-FC coupling variations were correlated with metabotropic glutamate receptor 5 (mGluR5). Further mediation analysis explored the relationship between genes, neurotransmitter receptor/transporter and MDD related higher-order coupling variations. These findings indicate that specific genetic and molecular factors underpin the observed disparities in higher-order SC-FC coupling between MDD patients and HCs. Our study confirmed that higher-order coupling between SC and FC plays an important role in diagnosing MDD. The identification of new biological evidence for MDD etiology holds promise for the development of innovative antidepressant therapies.

Chronic sleep restriction during juvenility alters hedonic and anxiety-like behaviours in a sex-dependent fashion in adolescent Wistar rats

Chronic reduction of sleep time in children and adolescents has been related to increased incidence of anxiety and depression. In rats, protocols of protracted sleep deprivation or chronic sleep restriction (CSR) are considered a stressor. In previous studies we showed that post-weaning CSR in male rats induces anxiety-like behaviour and changes in neurotransmission in emotion-related brain areas. In the present study we examined whether the effects of this adversity are sex-dependent. Twenty-two litters, containing four males and four females were distributed into control (CTL) and CSR groups. CSR began on postnatal day (PND) 21 and lasted for 21 days; each day the animals were placed onto small platforms immersed in water for 18 h and were allowed to sleep freely in their home-cages for the remaining 6 h. Throughout the CSR, all animals underwent the sucrose splash test once/week to assess their self-care and hedonic behaviours. Body weight was measured on PNDs 21 and 42. At the end of CSR period, the adolescents were allowed to sleep freely for 2 days, after which, behavioural tests began. Within each litter, one male and one female (pair) were not tested and provided blood and brain for determination of basal corticosterone (CORT) levels and hippocampal BDNF. One pair was tested in the sucrose preference test (SPT), one pair on the elevated plus maze (EPM) and one pair in the forced swim test (FST). CORT was measured after all conditions. CSR impaired self-care behaviour and body weight gain in males and females and increased relative adrenal weight only in males. There were no changes in sucrose intake in the SPT; CSR females displayed less immobility in the FST and CSR males displayed more anxiety-like behaviour in the EPM. CORT levels were similar between CTL and CSR males, whilst lower in CSR females than CTL ones in all experimental conditions. No changes in BDNF levels were detected in the dorsal hippocampus of CSR rats. The results indicate that CSR impaired self-care behaviour in both sexes, but only males displayed anxiety-like behaviour, whilst sleep recovery in females appeared to normalise their behaviour.

The differing relationships between academic discipline, sleep hygiene, and dysfunctional sleep attitudes on sleep quality and duration in Canadian university students

Objectives

This study sought to understand how university student's academic discipline relates to sleep factors including attitudes, hygiene, quality, and duration.

Methods

Using a cross-sectional approach, a 30-min survey was advertised to students at two Canadian universities in March of 2022. Sleep measures included the Dysfunctional Beliefs and Attitudes Scale, the Sleep Hygiene Index, the Pittsburgh Sleep Quality Index, and the Insomnia Severity Index. Academic discipline was categorized into four groups: Health, Arts, Sciences, and Engineering. Multiple linear regressions were used to investigate (1) the effect of academic discipline on sleep measures, and (2) the effect of academic discipline, dysfunctional sleep attitudes, and sleep hygiene practices on insomnia, sleep quality and duration.

Results

1,566 students completed the survey (69.4% women; 80.3% undergraduates). Compared to Health students, Art students had worse dysfunctional sleep attitudes, hygiene, quality, and insomnia severity (p < 0.001). This relationship disappeared after controlling for differences in mental health (p ≥ 0.05). Art students had longer sleep durations (p < 0.01), whereas Engineering students had shorter sleep durations (p < 0.05). When dysfunctional sleep attitudes and hygiene were included in the model, both academic discipline (p < 0.05) and sleep hygiene (p < 0.001) were associated with sleep duration. Sleep hygiene and attitudes were also associated with sleep quality and insomnia severity (p < 0.001), while academic discipline was not (p ≥ 0.05).

Discussion

These results suggest differences in sleep quality across academic discipline are impacted by dysfunctional sleep attitudes, sleep hygiene, and mental health, whereas differences in sleep duration appear to be independent of these factors. Overall, students in different academic disciplines have unique relationships with sleep and thus may require targeted approaches to improve their sleep. Future interventions should focus on supporting sleep hygiene and attitudes to improve students' sleep and well-being.

[Quality of life and sleep quality in patients with chronic pruritus]

Pruritus is defined as a symptom that leads to scratching. Clinically, a heterogeneous group of clinical pictures of different etiology must be considered. Pruritus is characterized by varying intensity and duration. Many patients and/or their social environment, which is influenced by this, cite the impact on sleep quality as an accompanying main symptom. The patient's quality of life is affected depending on the severity of the pruritus and often leads to comorbidity such as depressive disorders or sleep disorders as well as to an impact on psychosocial well-being if it becomes chronic. To date, in addition to the medical history, the established examination methods have been the determination of the disease burden by assessing disease activity, e.g., with validated disease-specific scores, plus the assessment of quality of life using a dermatological quality of life index (DLQI). The latest studies show that this is by no means sufficient to determine the severity of disease and, as a result, to identify adequate treatment options.

The training times of athletes could play a role in clinical sleep problems due to their associations with sleep difficulty scores

OBJECTIVES

Sleep is a key component of athletic recovery, yet training times could influence the sleep of athletes. The aim of the current study was to compare sleep difficulties in athletes across different training time groups (early morning, daytime, late evening, early morning plus late evening) and to investigate whether training time can predict sleep difficulties.

METHODS

Athletes from various sports who performed at a national-level (n = 273) answered the Athlete Sleep Screening Questionnaire (ASSQ) along with several other questionnaires related to demographics, exercise training, and mental health. From the ASSQ, a Sleep Difficulty Score (SDS) was calculated. Transformed SDS (tSDS) was compared across different training time categories using multiple one-way ANOVAs. A stepwise regression was then used to predict tSDS from various sleep-related factors.

RESULTS

SDSs ranged from none (31%), mild (38%), moderate (22%), and severe (9%). However, the one-way ANOVAs revealed training earlier or later vs. training daytime shifted the tSDS in a negative direction, a trend toward increased sleep difficulty. In particular, athletes training in the late evening (>20:00 or >21:00) had a significantly higher tSDS when compared to daytime training (p = .03 and p < .01, respectively). The regression model (p < .001) explained 27% of variance in the tSDS using depression score, age, training time, and chronotype score.

CONCLUSION

Among a heterogeneous sample of national-level athletes, 31% displayed moderate to severe SDSs regardless of their training time. However, when athletes trained outside daytime hours there was a tendency for the prevalence of sleep difficulties to increase.