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Furihata R, Endo D, Nagaoka K, Hori A, Ito T, Iwami T, Akahoshi T. Association between a composite measure of sleep health and depressive symptoms in patients with obstructive sleep apnea treated with CPAP therapy: Real-world data. Sleep Med 2024; 120:22-28. [PMID: 38852260 DOI: 10.1016/j.sleep.2024.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/19/2024] [Accepted: 05/24/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVE Sleep health is known to be multidimensional, and there is increasing clinical interest in composite sleep health scores that capture the number of adverse sleep characteristics. We investigated whether a composite sleep health score was associated with depressive symptoms in patients with obstructive sleep apnea (OSA) treated with continuous positive airway pressure (CPAP). METHODS Participants were OSA patients using CPAP (n = 1768, (92.1 % men, age 52.7 ± 10.7 years) attending sleep clinics in Japan. A cross-sectional survey conducted in 2020 assessed self-reported sleep and depressive symptoms. Sleep health was categorized as "good' or "poor' on five dimensions: satisfaction, daytime sleepiness, mid-sleep time, efficiency, and duration. A composite sleep health score was calculated by summing the "poor' dimensions. Depressive symptoms were assessed using two items from the Patient Health Questionnaire (PHQ-2). Associations between sleep health and depressive symptoms were assessed using multivariable logistic regression analysis. RESULTS Individual sleep health symptoms of poor satisfaction and efficiency were significantly associated with depressed mood; poor satisfaction, daytime sleepiness, and duration were significantly associated with loss of interest; and poor satisfaction, efficiency, and duration were significantly associated with depressive symptoms. Composite sleep health scores were associated with greater odds of depressive symptoms in a graded manner. CONCLUSIONS Individual and composite sleep health scores were associated with depressive symptoms. Measures of multidimensional sleep health may provide a better understanding of the association between poor sleep and depressive symptoms among patients with OSA using CPAP, accounting for CPAP adherence, leading to improved intervention strategies.
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Affiliation(s)
- Ryuji Furihata
- Agency for Student Support and Disability Resources, Kyoto University, Kyoto, Japan
| | - Daisuke Endo
- Shinjuku Sleep and Respiratory Clinic, KEISHINKINENKAI Medical Corporation, Tokyo, Japan
| | - Kenichi Nagaoka
- Yurakucho Sleep and Respiratory Clinic, KEISHINKINENKAI Medical Corporation, Tokyo, Japan; Division of Respiratory Medicine, Department of Internal Medicine, Nihon University, School of Medicine, Tokyo, Japan
| | - Ayako Hori
- Shinjuku Sleep and Respiratory Clinic, KEISHINKINENKAI Medical Corporation, Tokyo, Japan
| | - Tatsuya Ito
- Shinjuku Sleep and Respiratory Clinic, KEISHINKINENKAI Medical Corporation, Tokyo, Japan
| | - Taku Iwami
- Department of Preventive Services, Kyoto University School of Public Health, Graduate School of Medicine, Kyoto, Japan
| | - Toshiki Akahoshi
- Shinjuku Sleep and Respiratory Clinic, KEISHINKINENKAI Medical Corporation, Tokyo, Japan; Yurakucho Sleep and Respiratory Clinic, KEISHINKINENKAI Medical Corporation, Tokyo, Japan; Division of Respiratory Medicine, Department of Internal Medicine, Nihon University, School of Medicine, Tokyo, Japan.
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Thomas MC, Buysse DJ, Soreca I. Same sleep disorder but different sleep patterns: individual differences in sleep health and depressive symptomatology in veterans with obstructive sleep apnea. Sleep Breath 2024:10.1007/s11325-024-03007-2. [PMID: 38457023 DOI: 10.1007/s11325-024-03007-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/29/2024] [Accepted: 02/12/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE Poor sleep health, a composite measure of key sleep characteristics, may relate to increased depressive symptoms among individuals treated for obstructive sleep apnea. The current investigation examined the association between sleep health and depressive symptomatology. METHODS In a pilot sample of 13 symptomatic OSA military Veterans with adequate CPAP adherence (mean age = 54.8, 76.9% male, 100% White), empirically validated cutoffs were applied to actigraphy-derived sleep variables: duration, efficiency, timing, and regularity. RESULTS Participants with zero optimal sleep scores had significantly higher depressive scores (M = 19.0, SD = 3.0) than participants with 1 or 2 (M = 9.8. SD = 4.3, p = .016) and 3 or more optimal sleep scores (M = 11.3, SD = 4.9, p = .038). CONCLUSIONS These preliminary findings suggest that better sleep health was associated with lower depressive symptomatology. Future work should replicate these preliminary findings in a larger sample.
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Affiliation(s)
- Mark C Thomas
- Veterans Integrated Service Network (VISN) 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, University Dr C-151R, Pittsburgh, PA, 15240, USA.
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Isabella Soreca
- Veterans Integrated Service Network (VISN) 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, University Dr C-151R, Pittsburgh, PA, 15240, USA
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Tapia AL, Yu L, Lim A, Barnes LL, Hall MH, Butters MA, Buysse DJ, Wallace ML. Race and sex differences in the longitudinal changes in multidimensional self-reported sleep health characteristics in aging older adults. Sleep Health 2023; 9:947-958. [PMID: 37802678 PMCID: PMC10841494 DOI: 10.1016/j.sleh.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 06/28/2023] [Accepted: 08/15/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVES We examined within-individual changes in self-reported sleep health as community-dwelling older adults age as well as potential differences in these changes by self-reported sex and racial identity. METHODS Participants were from the United States and enrolled in the Rush Memory and Aging Project, Minority Aging Research Study, or Religious Orders Study (N = 3539, 20% Black, 75% female, mean 78years [range 65-103]), and they received annual, in-person clinical evaluations (median 5 visits [range 1-27]). A sleep health composite score measured the number of poor sleep characteristics among satisfaction, daytime sleepiness, efficiency, and duration. Mixed effects models estimated associations of age, race, sex, and their interactions on the composite and individual sleep measures, accounting for key confounders. RESULTS As they aged, Black participants shifted from reporting two poor sleep characteristics to one poor sleep characteristic, while White participants shifted from one poor characteristic to two. Regardless of age, sex, and race, participants reported that they "often" felt satisfied with their sleep and "sometimes" had trouble staying asleep. Females over age 85 and males of all ages reported the most daytime sleepiness, and older White participants (>age 90) reported the most difficulty falling asleep. CONCLUSIONS Although self-reported sleep characteristics were typically stable across age, identifying race and sex differences in self-reported sleep health can help guide future research to understand the mechanisms that underlie these differences.
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Affiliation(s)
- Amanda L Tapia
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lan Yu
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrew Lim
- Department of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Lisa L Barnes
- Department of Neurological Sciences, Rush University, Chicago, Illinois, USA
| | - Martica H Hall
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Meredith L Wallace
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Bjorvatn B, Waage S, Pallesen S, Buysse DJ, Saxvig IW. The association between different sleep health dimensions and sex, age, education, circadian preference, and chronic insomnia: a representative population-based study. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2023; 4:zpad041. [PMID: 37954092 PMCID: PMC10635412 DOI: 10.1093/sleepadvances/zpad041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/12/2023] [Indexed: 11/14/2023]
Abstract
Objectives The aims were to explore multidimensional sleep health and the different dimensions of sleep health in the adult Norwegian population in relation to sex, age, education, circadian preference, and chronic insomnia. Methods A representative sample of 1028 Norwegians, aged 18 + years completed a cross-sectional web-based survey. Sleep health was measured with the multidimensional RU_SATED scale, which assesses the dimensions of regularity, satisfaction, alertness, timing, efficiency, and duration. Insomnia was assessed with the Bergen Insomnia Scale. Data were analyzed with chi-square tests, t-tests, one-way ANOVAs, and regression analyses, as appropriate. Response rate was 33.5%. Results Sleep health was better in males, with increasing age, and with higher educational level, and was poorer in participants with evening preference and chronic insomnia, compared to their respective counterparts. When investigating the different sleep health dimensions, males scored better than females on satisfaction (adjusted odds ratio [aOR] = 0.69, 95% CI = 0.51 to 0.93), timing (aOR = 0.66, 95% CI = 0.49 to 0.88), and efficiency (aOR = 0.68, 95% CI = 0.52 to 0.89). Older age was associated with better scores on regularity and satisfaction, whereas young age was associated with better scores on alertness and duration. High educational level was associated with better scores on alertness, timing, and duration. Evening types scored worse than morning types on regularity (aOR = 0.27, 95% CI = 0.18 to 0.41), satisfaction (aOR = 0.37, 95% CI = 0.26 to 0.53), and timing (aOR = 0.36, 95% CI = 0.26 to 0.51). Participants with chronic insomnia scored worse than participants without insomnia on all six sleep health dimensions. Conclusions Sleep health differed significantly in relation to sex, age, education, circadian preference, and chronic insomnia. However, specific group differences were not equally evident in all sleep health dimensions.
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Affiliation(s)
- Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Siri Waage
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Ståle Pallesen
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Ingvild W Saxvig
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
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Yoo A, Vgontzas A, Chung J, Mostofsky E, Li W, Rueschman M, Buysse D, Mittleman M, Bertisch S. The association between multidimensional sleep health and migraine burden among patients with episodic migraine. J Clin Sleep Med 2023; 19:309-317. [PMID: 36263856 PMCID: PMC9892733 DOI: 10.5664/jcsm.10320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 02/04/2023]
Abstract
STUDY OBJECTIVES Using the Sleep Regularity, Satisfaction, Alertness, Timing, Satisfaction, and Duration (Ru-SATED) sleep health framework, we examined the association between multidimensional sleep health and headache burden in a cohort of 98 adults with episodic migraine. METHODS Participants wore wrist actigraphs and completed twice-daily electronic diaries regarding sleep, headaches, and other health habits for 6 weeks. We calculated separate composite sleep health scores from diary and actigraphy assessed measures using the Ru-SATED framework. We used adjusted multivariable linear regression models to examine the association between composite sleep health scores and headache frequency, duration, and pain intensity. RESULTS Among 98 participants (mean age: 35 ± 12 years; 87.8% female), 83 had healthy ranges in ≥ 3 sleep dimensions. In models adjusted for age, sex, menopausal status, physical activity and alcohol intake, good sleep health was associated with fewer headache days/month (actigraphy: 3.1 fewer days; 95% confidence interval: 0.9, 5.7; diary: 4.0 fewer days; 95% confidence interval: 1.1, 6.9). Results did not change substantively with further adjustment for stress and depressive symptoms. We did not observe an association between sleep health and headache duration or intensity, respectively. CONCLUSIONS Among patients with episodic migraine, good multidimensional sleep health, but not the majority of singular dimensions of sleep, is associated with approximately 3-4 fewer headache days/month. In addition, there was no association with headache duration or intensity. These findings highlight the importance of assessing multiple dimensions of sleep and suggest that improving sleep health may be a potential clinical strategy to reduce headache frequency. CITATION Yoo A, Vgontzas A, Chung J, et al. The association between multidimensional sleep health and migraine burden among patients with episodic migraine. J Clin Sleep Med. 2023;19(2):309-317.
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Affiliation(s)
- Alexander Yoo
- Department of Neurology, University of Rochester, Rochester, New York
| | - Angeliki Vgontzas
- Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Joon Chung
- Harvard Medical School, Boston, Massachusetts
- Program in Sleep Medicine Epidemiology, Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Elizabeth Mostofsky
- Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Wenyuan Li
- Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Michael Rueschman
- Program in Sleep Medicine Epidemiology, Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Daniel Buysse
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Murray Mittleman
- Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Suzanne Bertisch
- Harvard Medical School, Boston, Massachusetts
- Program in Sleep Medicine Epidemiology, Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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Cavaillès C, Yaffe K, Blackwell T, Buysse D, Stone K, Leng Y. Multidimensional Sleep Health and Long-Term Cognitive Decline in Community-Dwelling Older Men. J Alzheimers Dis 2023; 96:65-71. [PMID: 37742655 PMCID: PMC11021854 DOI: 10.3233/jad-230737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Specific sleep characteristics have been associated with cognitive decline, Alzheimer's disease, and related dementias; however, studies examining the association between multidimensional sleep (a more comprehensive integration of sleep parameters) and cognitive decline are lacking. Among 2,811 older men without dementia, those with none, 1-2, and 3-5 "poor" self-reported sleep health dimensions had an adjusted 10-year change score of global cognition (3MS) of 2.9, 4.0 and 3.5 points (p-trend = 0.05), and in executive function (Trails B) completion time of 36.7, 42.7, and 46.7 seconds (p-trend < 0.01), respectively. In conclusion, a multidimensional measure of sleep health was associated with greater cognitive decline.
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Affiliation(s)
- Clémence Cavaillès
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Kristine Yaffe
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
- Department of Neurology and Epidemiology, University of California, San Francisco, CA, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Terri Blackwell
- Department of Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - Daniel Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine, PA, USA
| | - Katie Stone
- Department of Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - Yue Leng
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
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