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Furukawa Y, Nagaoka D, Sato S, Toyomoto R, Takashina HN, Kobayashi K, Sakata M, Nakajima S, Ito M, Yamamoto R, Hara S, Sakakibara E, Perlis M, Kasai K. Cognitive behavioral therapy for insomnia to treat major depressive disorder with comorbid insomnia: A systematic review and meta-analysis. J Affect Disord 2024; 367:359-366. [PMID: 39242039 DOI: 10.1016/j.jad.2024.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 08/31/2024] [Accepted: 09/03/2024] [Indexed: 09/09/2024]
Abstract
OBJECTIVE Cognitive behavioral therapy for insomnia (CBT-I) has demonstrated efficacy for both insomnia and depression. With a tenfold increase in expected participant numbers, we aimed to update the systematic review and meta-analysis of CBT-I for major depressive disorders (MDD). METHODS Multiple databases were searched up to March 27th 2024 to include all randomized controlled trials examining CBT-I among adults with MDD. The certainty of evidence was evaluated using GRADE. The primary outcome was depression response at post-treatment. Secondary outcomes included insomnia remission and all-cause dropout at post-treatment. Frequentist random-effects pairwise meta-analyses were performed using odds ratio (OR) for dichotomous outcomes. This study was prospectively registered (https://osf.io/kcndz/). RESULTS Nineteen trials with 4808 randomized participants were identified (mean age, 33.2 [standardized deviation 15.0] years, 73.2 % women. Mean Insomnia Severity Index 19.2 [5.4], median Patient Health Questionnaire-9 16 [range, 8-21]). CBT-I was more beneficial than control conditions for depression response (OR 2.28 [95 % Confidence Interval (CI), 1.67-3.12; GRADE certainty of evidence: moderate), insomnia remission (OR 3.57 [95%CI, 2.48-5.14]: moderate) but could lead to more dropout (OR 1.69 [95%CI, 0.98-2.89]: low). Depression improvement was seen beyond the sleep domain. With a control condition depression response rate of 17 % at post-treatment (median 8 weeks), CBT-I yielded a 32 % response rate (95 % CI, 26 %-39 %). CONCLUSIONS This meta-analysis indicates that CBT-I has significant effects on depressive symptoms beyond the sleep domain among people with MDD. Despite higher dropout rates, these findings suggest CBT-I is an effective treatment for depression comorbid with insomnia.
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Affiliation(s)
- Yuki Furukawa
- Department of Neuropsychiatry, The University of Tokyo, Tokyo, Japan.
| | - Daiki Nagaoka
- Department of Neuropsychiatry, The University of Tokyo, Tokyo, Japan
| | - Shunichi Sato
- Department of Child Psychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Rie Toyomoto
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Hikari N Takashina
- Research Center for Child Mental Development, Chiba University, Chiba, Japan; Awarefy Inc., Tokyo, Japan
| | - Kei Kobayashi
- Department of Neuropsychiatry, The University of Tokyo, Tokyo, Japan
| | - Masatsugu Sakata
- Department of Neurodevelopmental Disorders, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Shun Nakajima
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Ibaraki, Japan
| | - Masami Ito
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan; Nursing Department, Sodegaura Satsuki-dai Hospital, Social Medical Corporation, Satsuki-kai, Chiba, Japan
| | - Ryuichiro Yamamoto
- College of Sociology, Department of Psychology and Humanities, Sleep Research Institute, Edogawa University, Chiba, Japan
| | - Shintaro Hara
- Division of Developmental Support and Clinical Psychology in Education, Graduate School of Education, Joetsu University of Education, Niigata, Japan
| | - Eisuke Sakakibara
- Department of Neuropsychiatry, The University of Tokyo, Tokyo, Japan
| | - Michael Perlis
- Behavioral Sleep Medicine Program, Department of Psychiatry, The School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, International Research Center for NeuroIntelligence, The University of Tokyo, Tokyo, Japan
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Wang T, Yin J, Hu C, Tang W, Che X, Liu Y. Sleep disturbance and medical requests among university and college students in Chongqing, China: A cross-sectional study. Saudi Med J 2023; 44:1153-1159. [PMID: 37926449 PMCID: PMC10712779 DOI: 10.15537/smj.2023.44.11.20230420] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/12/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVES To investigate the prevalence of sleep disturbance, sleep patterns, sleep-related factors, and medical demands among university and college students in Chongqing, China. METHODS Demographic data and responses to the sleep problem questionnaire (SPQ) were collected from 1973 students from 11 universities and 10 colleges between November 2022 and January 2023. RESULTS The prevalence of sleep disturbance in university and college students was different in different periods (58.17% during campus lockdown and 40.30% after the lifting of lockdown). The combined prevalence was 49.72%. The prevalence of the 6 types of sleep disturbance showed the same trend. The average sleep latency was 32.79 minutes and the average sleep duration was 7.53 hours. Male, university students, upper-class students, history of depression, academic stress, major life events, bad bedroom environment, and campus lockdown were factors related to sleep disturbance among respondents. Most of the respondents (52.09%) had no medical care requests, and the major reasons were a lack of access to medical care (75.15%), economic pressure (68.49%), concerns regarding curative effects (58.51%), and academic pressure (56.56%). CONCLUSION The prevalence of sleep disturbance for university and college students was obviously improved after the lifting of campus lockdown, and the major factors related to sleep disturbance were study, life, mental health, and sleep environment. The students examined herein reported relatively low medical care requests when they experience sleep disturbance.
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Affiliation(s)
- Ting Wang
- From the Department of Nursing (Wang, Tang, Che, Liu), Faculty of Nursing, Chongqing Medical and Pharmaceutical College, from the Department of General Surgery (Yin), The Second Affiliated Hospital, Army Medical University, and from the Department of Encephalopathy (Hu), Chongqing Traditional Chinese Medicine Hospital, Chongqing, China.
| | - Jiuheng Yin
- From the Department of Nursing (Wang, Tang, Che, Liu), Faculty of Nursing, Chongqing Medical and Pharmaceutical College, from the Department of General Surgery (Yin), The Second Affiliated Hospital, Army Medical University, and from the Department of Encephalopathy (Hu), Chongqing Traditional Chinese Medicine Hospital, Chongqing, China.
| | - Chen Hu
- From the Department of Nursing (Wang, Tang, Che, Liu), Faculty of Nursing, Chongqing Medical and Pharmaceutical College, from the Department of General Surgery (Yin), The Second Affiliated Hospital, Army Medical University, and from the Department of Encephalopathy (Hu), Chongqing Traditional Chinese Medicine Hospital, Chongqing, China.
| | - Wanzhen Tang
- From the Department of Nursing (Wang, Tang, Che, Liu), Faculty of Nursing, Chongqing Medical and Pharmaceutical College, from the Department of General Surgery (Yin), The Second Affiliated Hospital, Army Medical University, and from the Department of Encephalopathy (Hu), Chongqing Traditional Chinese Medicine Hospital, Chongqing, China.
| | - Xiaowen Che
- From the Department of Nursing (Wang, Tang, Che, Liu), Faculty of Nursing, Chongqing Medical and Pharmaceutical College, from the Department of General Surgery (Yin), The Second Affiliated Hospital, Army Medical University, and from the Department of Encephalopathy (Hu), Chongqing Traditional Chinese Medicine Hospital, Chongqing, China.
| | - Ying Liu
- From the Department of Nursing (Wang, Tang, Che, Liu), Faculty of Nursing, Chongqing Medical and Pharmaceutical College, from the Department of General Surgery (Yin), The Second Affiliated Hospital, Army Medical University, and from the Department of Encephalopathy (Hu), Chongqing Traditional Chinese Medicine Hospital, Chongqing, China.
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Sun A, Wu X. Efficacy of non-pharmacological interventions on improving sleep quality in depressed patients: A systematic review and network meta-analysis. J Psychosom Res 2023; 172:111435. [PMID: 37451171 DOI: 10.1016/j.jpsychores.2023.111435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Depression and sleep are closely related and tend to affect each other. To improve the sleep quality in depressed patients and the depression severity, there is an urgent need to find safer and more effective treatments - non-pharmacological interventions. This network meta-analysis aimed to investigate the effects of non-pharmacological interventions on improving sleep quality of patients with depression. METHODS All published literature were searched from four databases (Pubmed, Embase, Cochrane, Web of Science) as of November 2022. The risk of bias of the included studies was assessed using the Cochrane Systematic Review Manual 2.0 bias risk assessment tool. The primary outcome was sleep quality and, the secondary outcome was depression severity. RESULTS This study included 26 randomized controlled trials, involving 11 interventions and 3748 depressed patients. Cognitive-behavioral therapy (CBT) (SMD: 2.80; 95% CI: 1.63,3.96), aromatherapy (SMD: 3.95; 95% CI: 0.71,7.19), and acupuncture (SMD:3.49; 95% CI: 0.88,6.10) statistically and significantly improved sleep quality, compared to education only. CBT and acupuncture both were significantly more effective than education in depression severity. The cluster analysis showed that acupuncture, exercise, and cognitive-behavioral therapy were considered to be more effective non-pharmacological interventions. CONCLUSION Non-pharmacological interventions are promising in the daily care of depressed patients. In future research, we should value the need for psychological and social aspects of psychiatric care and make better use of nonpharmacological interventions through the biopsychosocial model. (PROSPERO registration number: CRD42023402316).
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Affiliation(s)
- Aiwen Sun
- Centre for Mental Health Education, Zhujiang College, South China Agricultural University, No. 2004, Guangcong North Road, Jiangpu Street, Conghua District, Guangzhou, China.
| | - Xia Wu
- The Fourth Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, No.1 Fuhua Road, Futian District, Shenzhen, China
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DelRosso LM, Bruni O, Mogavero MP, Fickensher A, Schenck CH, Ferri R. Frequency of antidepressant use and clinical characteristics of children and adolescents undergoing polysomnography: an observational study. Child Adolesc Psychiatry Ment Health 2023; 17:55. [PMID: 37120595 PMCID: PMC10149005 DOI: 10.1186/s13034-023-00599-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/03/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND Antidepressants are increasingly used in children for various psychiatric disorders but also for sleep disorders such as insomnia; however, it is currently unknown how many children undergoing polysomnography (PSG) are taking anti-depressants. The aims were: to determine the frequency of use of antidepressants in paediatric patients referred for PSG, to identify the most common antidepressants used, to investigate the reasons for their use, and to analyse the PSG parameters found in children taking antidepressants. METHOD An observational cross-sectional retrospective chart review of all children undergoing PSG at Seattle Children's Hospital from 6/14/2020 to 12/8/2022 was carried out. Clinical features (such as diagnosis, especially psychiatric), sleep disorders (such as insomnia and restless sleep), and class of antidepressant used [selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCA), or atypical antidepressants], and PSG parameters were collected for further analysis. RESULTS Among 3,371 patients who underwent PSG during the study, 367 children were selected who were taking one antidepressant only (154 boys and 213 girls, mean age was 13.7 ± years 3.69). A significantly decreased sleep stage N3 was found in girls, who were older than boys. Children with insomnia had longer sleep latency than children without, but more N3. There was a prolonged rapid eye movement (REM) sleep latency in children with attention-deficit/hyperactivity disorder and children with autism. REM latency was longer and REM percentage smaller in children taking SNRIs. Periodic leg movement index ≥ 5/hour was found in a higher number of children taking SSRIs or SNRIs (24.9%) than in subjects taking TCA or atypical antidepressants (13.3%) (chi-square 5.29, p = 0.013). CONCLUSIONS Child and adolescent psychiatrists should question about the effects on sleep (both positive and negative) after initiating therapy with antidepressant medications.
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Affiliation(s)
- Lourdes M DelRosso
- Pulmonary and Sleep Medicine, University of California San Francisco-Fresno, Fresno, CA, USA
| | - Oliviero Bruni
- Department of Social and Developmental Psychology, Sapienza University, Rome, Italy
| | - Maria P Mogavero
- Vita-Salute San Raffaele University, Milan, Italy
- Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | | | - Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, Department of Psychiatry, Hennepin County Medical Center, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Raffaele Ferri
- Oasi Research Institute - IRCCS, via C. Ruggero 73, Troina, 94018, Italy.
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