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van Rheede JJ, Alagapan S, Denison TJ, Riva-Posse P, Rozell CJ, Mayberg HS, Waters AC, Sharott A. Cortical signatures of sleep are altered following effective deep brain stimulation for depression. Transl Psychiatry 2024; 14:103. [PMID: 38378677 PMCID: PMC10879134 DOI: 10.1038/s41398-024-02816-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/17/2024] [Accepted: 02/01/2024] [Indexed: 02/22/2024] Open
Abstract
Deep brain stimulation (DBS) of the subcallosal cingulate cortex (SCC) is an experimental therapy for treatment-resistant depression (TRD). Chronic SCC DBS leads to long-term changes in the electrophysiological dynamics measured from local field potential (LFP) during wakefulness, but it is unclear how it impacts sleep-related brain activity. This is a crucial gap in knowledge, given the link between depression and sleep disturbances, and an emerging interest in the interaction between DBS, sleep, and circadian rhythms. We therefore sought to characterize changes in electrophysiological markers of sleep associated with DBS treatment for depression. We analyzed key electrophysiological signatures of sleep-slow-wave activity (SWA, 0.5-4.5 Hz) and sleep spindles-in LFPs recorded from the SCC of 9 patients who responded to DBS for TRD. This allowed us to compare the electrophysiological changes before and after 24 weeks of therapeutically effective SCC DBS. SWA power was highly correlated between hemispheres, consistent with a global sleep state. Furthermore, SWA occurred earlier in the night after chronic DBS and had a more prominent peak. While we found no evidence for changes to slow-wave power or stability, we found an increase in the density of sleep spindles. Our results represent a first-of-its-kind report on long-term electrophysiological markers of sleep recorded from the SCC in patients with TRD, and provides evidence of earlier NREM sleep and increased sleep spindle activity following clinically effective DBS treatment. Future work is needed to establish the causal relationship between long-term DBS and the neural mechanisms underlying sleep.
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Affiliation(s)
- Joram J van Rheede
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
| | - Sankaraleengam Alagapan
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Timothy J Denison
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Institute for Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Patricio Riva-Posse
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Christopher J Rozell
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Helen S Mayberg
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Allison C Waters
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew Sharott
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
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Lin WC, Winkelman JW. Insomnia and treatment-resistant depression. PROGRESS IN BRAIN RESEARCH 2023; 281:115-129. [PMID: 37806712 DOI: 10.1016/bs.pbr.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Depression and sleep disturbance are related closely with bidirectional relationship. The heterogenic diagnostic criteria of major depressive disorder composed by the myriad combination of symptoms including sleep disturbance. Insomnia is an identifiable risk factor for depression and the treatment of insomnia might be able to prevent subsequent major depressive episodes which draws psychiatrists' attention to the interface of psychiatry and sleep medicine field. It is important to identify occult sleep disturbance in patients with treatment-resistant depression to improve treatment outcome. New tools to objectively measure sleep at home environment represent a great march in clinical care and research modalities but need further validation before they can be applying widespread at sleep and depression intersection. Careful evaluation and measurement of the phenotype and nature of sleep disturbance will continue to advance understanding of the biological bases of psychiatric disorders and the connections with sleep.
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Affiliation(s)
- Wei-Chen Lin
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan; Institute of Brain Science, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.
| | - John Weyl Winkelman
- Sleep Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Sleep Disorders Clinical Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Departments of Psychiatry and Neurology, Massachusetts General Hospital, Boston, MA, United States
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Yeon PS, Kim IO, Kang SN, Lee NE, Kim GY, Min GM, Chung CY, Lee JS, Kim JG, Shin WS. Effects of Urban Forest Therapy Program on Depression Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:507. [PMID: 36612825 PMCID: PMC9819035 DOI: 10.3390/ijerph20010507] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
Depression is a common serious mental health condition that can have negative personal and social consequences, and managing it is critical for treating depression patients. Forest therapy is emerging as a promising non-pharmacological intervention to improve mental health. However, although the effectiveness of forest therapy programs using forests far from the city has been proven, it is not well known that urban forests can be easily accessed in daily life. Therefore, this study aimed to examine the effects of an urban forest therapy program on depression symptoms, sleep quality, and somatization symptoms of depression patients. To evaluate this, a randomized controlled trial (RCT) design was employed. A total of 47 depression patients participated in this study (22 in the urban forest therapy program group and 25 in the control group). The Beck Depression Inventory (BDI), the Hamilton Rating Scale for Depression (HRSD), the Pittsburgh Sleep Quality Index (PSQI), and the Patient Health Questionnaire-15 (PHQ-15) were administered to each participant to assess the effects of the urban forest therapy program. The results of this study revealed that depression patients in the urban forest therapy program had significantly alleviated depression symptoms and improved sleep quality and somatization symptoms compared to the control group. In conclusion, this study demonstrates the possibility that the urban forest therapy program could be used as an effective non-pharmacological treatment to alleviate depression disorder.
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Affiliation(s)
- Poung-Sik Yeon
- Department of Forest Sciences, Chungbuk National University, Cheongju 28644, Republic of Korea
| | - In-Ok Kim
- Graduated Department of Forest Therapy, Chungbuk National University, Cheongju 28644, Republic of Korea
| | - Si-Nae Kang
- Graduated Department of Forest Therapy, Chungbuk National University, Cheongju 28644, Republic of Korea
| | - Nee-Eun Lee
- Graduated Department of Forest Therapy, Chungbuk National University, Cheongju 28644, Republic of Korea
| | - Ga-Yeon Kim
- Graduated Department of Forest Therapy, Chungbuk National University, Cheongju 28644, Republic of Korea
| | - Gyeong-Min Min
- Graduated Department of Forest Therapy, Chungbuk National University, Cheongju 28644, Republic of Korea
| | - Chung-Yeub Chung
- Gwanghwamun Forest Psychiatric Clinic, Seoul 03156, Republic of Korea
| | - Jung-Sok Lee
- Gwanghwamun Forest Psychiatric Clinic, Seoul 03156, Republic of Korea
| | - Jin-Gun Kim
- Korea Forest Therapy Forum Incorporated Association, Cheongju 28644, Republic of Korea
| | - Won-Sop Shin
- Department of Forest Sciences, Chungbuk National University, Cheongju 28644, Republic of Korea
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Hsiao SH, Cheng CC, Lin IJ, Yu CP, Huang YC, Huang SH, Sun CA, Fann LY, Sheu MY, Chien WC. Persistent Depressive Disorder-Related Effect of Sleep Disorder on the Highest Risk of Suicide in Taiwan, 2000-2015. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13169. [PMID: 36293761 PMCID: PMC9603005 DOI: 10.3390/ijerph192013169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE to investigate whether persistent depressive disorder (PDD) affects sleep disorders (SDs) and increased suicide risk. METHODS in this study, we used the National Health Insurance Research Database (NHIRD) to select 117,033 SD patients, of whom 137 died by suicide, and 468,132 non-SD patients, of whom 118 died by suicide, and analyzed gender, age, and co-existing diseases. Hazard ratios (HRs) and 95% confidence intervals (CI) were calculated using a multivariate Cox proportional hazards model. RESULTS the hazard ratio of suicide in SD patients was 1.429 times that of non-SD patients. The hazard ratio of suicide in female patients was 1.297 times higher than in males. Compared with people without PDD, people with PDD had a 7.195 times higher hazard ratio for suicide than those without PDD. PDD patients with SDs had a 2.05 times higher hazard ratio for suicide than those with no SDs. CONCLUSIONS suicide risk was increased in SD patients, and the maximum suicide risk was greater in SD patients with PDD than in non-PDD patients. PDD affected SDs and increased suicide risk. Clinicians should be aware of the possibility that PDD affects patients with SDs and contributes to suicide risk.
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Affiliation(s)
- Sheng-Huang Hsiao
- Department of Neurosurgery, Taipei City Hospital, Ren-Ai Branch, Taipei 10629, Taiwan
- Department of Psychology, National Chengchi University, Taipei 11605, Taiwan
| | - Chih-Chien Cheng
- Department of Mechanical Engineering, National Central University, Jhongli 32001, Taiwan
- Department of Obstetrics/Gynecology, Taipei City Hospital, Taipei 10341, Taiwan
- School of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei City 242062, Taiwan
| | - Iau-Jin Lin
- Department of Medical Research, Tri-Service General Hospital, Taipei 11490, Taiwan
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan
| | - Chia-Peng Yu
- Department of Medical Research, Tri-Service General Hospital, Taipei 11490, Taiwan
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan
| | - Yao-Ching Huang
- Department of Medical Research, Tri-Service General Hospital, Taipei 11490, Taiwan
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei 10608, Taiwan
| | - Shi-Hao Huang
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei 10608, Taiwan
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City 242062, Taiwan
- Big Data Center, College of Medicine, Fu-Jen Catholic University, New Taipei City 242062, Taiwan
| | - Li-Yun Fann
- Department of Medical Research, Tri-Service General Hospital, Taipei 11490, Taiwan
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan
- Department of Nursing, Taipei City Hospital, Taipei 10684, Taiwan
- Department of Nurse-Midwifery and Women Health, National Taipei University of Nursing and Health Sciences, Taipei 11220, Taiwan
| | - Miin-Yea Sheu
- Department of Nursing, Taipei City Hospital, Taipei 10684, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, Taipei 11490, Taiwan
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 11490, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei 11490, Taiwan
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The interaction between suicidal ideation, insomnia symptoms, and student status. EXPERIMENTAL RESULTS 2021. [DOI: 10.1017/exp.2021.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Abstract
Evidence demonstrates increased vulnerability to thoughts and behaviors related to suicide (i.e., suicidal ideation) in students. This study examined the interaction between insomnia-symptoms and student-status (students vs. non-students) on reports of suicidal thoughts of behaviors. A total of 363 (N = 363) university students and 300 (N = 300) members of the general population provided complete data on measures of insomnia-symptoms and suicidal ideation. Students indicated greater reports of both total and lifetime ideation while also considering suicidal behavior within the past year. However, no differences were observed in reports of possible future attempt(s) and the disclosure of suicidal thoughts and behaviors to another person. Moreover, students presenting concurrent symptoms of insomnia reported significantly elevated levels of suicidal ideation relative to nonstudents. These outcomes highlight the possible role of insomnia symptoms in accentuating suicidal thoughts and behaviors in the student population.
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Das SC, Mallicka, Sahoo P, Priyadarshini P, Manasa RV. Prevalence of Severe Depression among Adolescents in Rural Area of Odisha, India. Indian J Community Med 2021; 46:438-441. [PMID: 34759483 PMCID: PMC8575193 DOI: 10.4103/ijcm.ijcm_570_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 04/14/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In adolescents, major depression is projected to rank the second most cause of human illness by the year 2022. Unfortunately, half of the depressed adolescents go undiagnosed in primary care settings. OBJECTIVES The objective is to estimate the prevalence of severe depression among rural adolescents and also to identify few epidemiological determinants causing severe depression. SETTINGS AND DESIGN This cross-sectional study included 341 adolescents from a selected village of Balasore, Odisha. MATERIALS AND METHODS A semi-structured questionnaire, and "Beck's Depression Inventory II" questionnaire for screening depression. RESULTS Only 24 (7%) of adolescents were found to be having severe depression. The subcategories of depression showed mild mood disturbance in 8.8%, borderline depression in 15.2%, and moderate depression in 12% individuals. Almost 267 (78.2%) were between 15 and 19 years of age. The mean age (standard deviation) of the participants was 16 ± 1.9 years. Majority of the participants belonged to joint family and lower middle-class status as per the Modified Kuppuswamy Scale. CONCLUSION Female gender was found to be significantly associated with depression (P = 0.006). Other contributory factors for depression were sleep duration (<6 h), parental fighting, and socioeconomic status.
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Affiliation(s)
- Sai Chandan Das
- Department of Community Medicine, Fakir Mohan Medical College and Hospital, Balasore, India
| | - Mallicka
- Department of Community Medicine and Public Health, Kings George's Medical University, Lucknow, Uttar Pradesh, India
| | - Prabhudarsan Sahoo
- Department of Psychology, Nayagarh Autonomous College, Nayagarh, Odisha, India
| | | | - R. V. Manasa
- Department of Community Medicine and Biostatistics, GIMSR, Vishakapatnam, Andhra Pradesh, India
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Wu H, Zheng Y, Zhan Q, Dong J, Peng H, Zhai J, Zhao J, She S, Wu C. Covariation between spontaneous neural activity in the insula and affective temperaments is related to sleep disturbance in individuals with major depressive disorder. Psychol Med 2021; 51:731-740. [PMID: 31839025 DOI: 10.1017/s0033291719003647] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Affective temperaments have been considered antecedents of major depressive disorder (MDD). However, little is known about how the covariation between alterations in brain activity and distinct affective temperaments work collaboratively to contribute to MDD. Here, we focus on the insular cortex, a critical hub for the integration of subjective feelings, emotions, and motivations, to examine the neural correlates of affective temperaments and their relationship to depressive symptom dimensions. METHODS Twenty-nine medication-free patients with MDD and 58 healthy controls underwent magnetic resonance imaging scanning and completed the Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS). Patients also received assessments of the Hamilton Depression Rating Scale (HDRS). We used multivariate analyses of partial least squares regression and partial correlation analyses to explore the associations among the insular activity, affective temperaments, and depressive symptom dimensions. RESULTS A profile (linear combination) of increased fractional amplitude of low-frequency fluctuations (fALFF) of the anterior insular subregions (left dorsal agranular-dysgranular insula and right ventral agranuar insula) was positively associated with an affective-temperament (depressive, irritable, anxious, and less hyperthymic) profile. The covariation between the insula-fALFF profile and the affective-temperament profile was significantly correlated with the sleep disturbance dimension (especially the middle and late insomnia scores) in the medication-free MDD patients. CONCLUSIONS The resting-state spontaneous activity of the anterior insula and affective temperaments collaboratively contribute to sleep disturbances in medication-free MDD patients. The approach used in this study provides a practical way to explore the relationship of multivariate measures in investigating the etiology of mental disorders.
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Affiliation(s)
- Huawang Wu
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou510370, China
| | - Yingjun Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou510370, China
| | - Qianqian Zhan
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou510370, China
| | - Jie Dong
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou510370, China
| | - Hongjun Peng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou510370, China
| | - Jinguo Zhai
- School of Mental Health, Jining Medical University, Jining272067, China
| | - Jingping Zhao
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou510370, China
| | - Shenglin She
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou510370, China
| | - Chao Wu
- School of Nursing, Peking University Health Science Center, Beijing100191, China
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Inada K, Enomoto M, Yamato K, Marumoto T, Takeshima M, Mishima K. Effect of residual insomnia and use of hypnotics on relapse of depression: a retrospective cohort study using a health insurance claims database. J Affect Disord 2021; 281:539-546. [PMID: 33401142 DOI: 10.1016/j.jad.2020.12.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/03/2020] [Accepted: 12/11/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Residual insomnia is associated with a risk of depression recurrence. METHODS In this retrospective, longitudinal cohort study, the recurrence pattern of depression in patients with or without residual insomnia was assessed using a health insurance claims database. Patients who were diagnosed with major depressive disorder and prescribed antidepressants, between January 2006 and June 2017 in Japan, were enrolled in the study. Residual insomnia was defined by a prescription of hypnotics, and recurrence of depression by prescription of antidepressants. Main outcomes included time to recurrence and the 1-year recurrence rate. Factors associated with recurrence of depression were assessed by multivariate analyses. The effect of residual insomnia on the frequency of recurrence was assessed by Chi-square test. RESULTS Of the 30,381 patients analyzed, there were 4,166 and 26,215 patients with or without residual insomnia, respectively. Time to recurrence in patients with residual insomnia was significantly shorter compared with those without residual insomnia (p <0.001), with a 1-year recurrence rate (95% CI) of 43.4% (41.9-45.0) and 7.4% (7.1-7.7), respectively. The frequency of recurrence was significantly higher in patients with residual insomnia than in those without (p <0.0001). A higher risk of depression recurrence (odds ratio 9.98, 95% CI 9.22-10.81) was found for residual insomnia compared with other significant factors. LIMITATIONS The diagnosis stated in the receipt data may not accurately reflect the patient's condition, and medication adherence was unknown but assumed. CONCLUSIONS Residual insomnia is a significant risk factor for depression recurrence in Japanese patients.
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Affiliation(s)
- Ken Inada
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Minori Enomoto
- Department of Medical Technology, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Kentaro Yamato
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Tatsuro Marumoto
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan; Department of Psychophysiology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan; International Institute for Integrative Sleep Medicine, Tsukuba, Japan.
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9
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Chen TY, Saito Y. Longitudinal effects of nocturnal insomnia symptom subtypes and nonrestorative sleep on the incidence of depression among community-dwelling older adults: results from the Health and Retirement Study. Sleep Med 2021; 79:155-163. [PMID: 33540204 DOI: 10.1016/j.sleep.2021.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 11/05/2020] [Accepted: 01/03/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The relationships between different insomnia symptom subtypes and the onset of depression among older adults are inconsistent. It may be that each subtype has a distinct temporal effect on depression not easily captured by the different follow-up intervals used in past studies. We systemically investigated the temporal effects by examining the links between subtypes and the onset of depression at different follow-up intervals among community-dwelling older adults. METHODS We used the 2006 wave of the Health and Retirement Study as baseline (n = 9151). The outcome was the onset of depression at 2-year (2008 wave), 4-year (2010 wave), and 6-year (2012 wave) follow-ups. The independent variables were difficulty with falling asleep (initial insomnia), waking up during the night (middle insomnia), waking up too early and being unable to fall asleep again (late insomnia), and nonrestorative sleep at baseline. Factors known to be related to depression among older adults were included as covariates. RESULTS Our findings showed that each insomnia symptom subtype had distinct temporal effects on the onset of depression. It appeared that the effects of initial insomnia may take longer to emerge than indicated in previous studies. Middle insomnia and late insomnia had weak relationships with depression. Nonrestorative sleep predicted the onset of depression at every follow-up period. CONCLUSIONS We found that documenting the temporal effects of insomnia symptom subtypes helps both to classify individuals' insomnia symptoms and predict the onset of depression. We recommend taking temporal effects of insomnia symptom subtypes into account in future investigations and clinical practice.
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Affiliation(s)
- Tuo-Yu Chen
- Master Program in Global Health and Development, College of Public Health, Taipei Medical University, No. 250, Wuxing Street, Xinyi District, Taipei, 110, Taiwan.
| | - Yasuhiko Saito
- College of Economics and Population Research Institute, Nihon University, 2-chōme-1 Misakichō, Chiyoda City, Tokyo, 101-0061, Japan
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Borentain S, Williamson D, Turkoz I, Popova V, McCall WV, Mathews M, Wiegand F. Effect of Sleep Disturbance on Efficacy of Esketamine in Treatment-Resistant Depression: Findings from Randomized Controlled Trials. Neuropsychiatr Dis Treat 2021; 17:3459-3470. [PMID: 34880615 PMCID: PMC8646953 DOI: 10.2147/ndt.s339090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/12/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the relationship of sleep disturbance to the antidepressant effects of esketamine. MATERIALS AND METHODS Two double-blind, 4-week studies randomized adults with treatment-resistant depression (TRD) to placebo or esketamine nasal spray, each with newly initiated antidepressant. Sleep was assessed using Montgomery-Åsberg Depression Rating Scale (MADRS) item 4. Change in response (≥50% decrease in MADRS total score) and remission (total MADRS score ≤12) at day 28 was examined by presence/absence of baseline sleep disturbance using logistic regression models. Impact on reported sleep disturbance (MADRS item 4 score) was examined using ANCOVA models. RESULTS At baseline, most patients reported disturbed sleep - moderate/severe (65.3%, 369/565), mild (25.3%, 143/565), or none/slightly (9.4%, 53/565) - with similar distribution between treatment groups. A higher proportion of esketamine-treated patients achieved response (OR = 2.05; 95% CI: 1.40-3.02; P < 0.001) and remission (OR = 1.81; 95% CI: 1.23-2.66; P = 0.003) at day 28 compared to antidepressant plus placebo, regardless of presence/severity of sleep disturbance. Consistent with this, sleep (MADRS item 4 score) improved in both groups after the first dose, more so with esketamine by day 8 (between-group difference: P ≤ 0.02 at all time points). Across both treatment groups, 1-point improvement in sleep at day 8 increased the probability of antidepressant response on day 28 by 26% (OR = 1.26, 95% CI: 1.12-1.42; P < 0.001), and remission by 28% (OR = 1.28, 95% CI: 1.14-1.43; P < 0.001). CONCLUSION Antidepressant efficacy of esketamine was demonstrated in patients with TRD, regardless of the presence of sleep disturbance. After 8 days of treatment and thereafter, significantly more esketamine-treated patients reported improvement in sleep versus antidepressant plus placebo.
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Affiliation(s)
- Stephane Borentain
- Department of Global Medical Affairs, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - David Williamson
- CNS Scientific Affairs Liaisons, Janssen Scientific Affairs, LLC, Titusville, NJ, USA.,Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Ibrahim Turkoz
- Department of Clinical Statistics, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Vanina Popova
- Department of Neuroscience Clinical Development, Janssen Research & Development, Beerse, Belgium
| | - William V McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Maju Mathews
- Department of Global Medical Affairs, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Frank Wiegand
- Department of Global Medical Affairs, Janssen Research & Development, LLC, Titusville, NJ, USA
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11
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Walters EM, Phillips AJ, Hamill K, Norton PJ, Drummond SP. Anxiety predicts dyadic sleep characteristics in couples experiencing insomnia but not in couples without sleep disorders. J Affect Disord 2020; 273:122-130. [PMID: 32421592 DOI: 10.1016/j.jad.2020.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/08/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Anxiety and depression are commonly comorbid with sleep problems. Despite growing acknowledgement that bedpartners are important determinants of sleep quality, few studies have explored mental health as a risk factor for disrupted sleep of the bedpartner. We examined whether anxiety or depression symptoms predicted an individual's sleep or their bedpartner's sleep, in couples where one partner experienced insomnia and in couples without sleep disorders. METHODS Fifty-two bed-sharing couples where one individual had insomnia ("Patient"), and 55 non-sleep-disordered couples completed the Beck Anxiety Inventory, Patient Health Questionnaire-9, and Insomnia Severity Index (ISI). Sleep was monitored for seven nights. Actor-Partner Interdependence Models assessed whether anxiety or depression symptoms predicted individual or dyadic sleep (wake transmission). RESULTS Greater anxiety symptoms predicted increased vulnerability to being woken by their bedpartner, as well as increased frequency of waking their bedpartner up during the night in Patients with insomnia, but not in non-sleep-disordered couples. Neither anxiety nor depression symptoms predicted an individual's or their bedpartner's sleep efficiency in either subsample. However, ISI was positively predicted by own anxiety and depression symptoms for Patients with insomnia and in non-sleep-disordered couples. LIMITATIONS The non-sleep-disordered subsample experienced only mild symptoms of anxiety and depression, potentially reducing predictive power. CONCLUSIONS Anxiety may help reveal social determinants of sleep in couples experiencing insomnia. These data underscore the importance of considering sleep, the bedpartner, and affective symptoms in mental health and sleep assessments.
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Affiliation(s)
- Elizabeth M Walters
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, Victoria, 3800, Australia
| | - Andrew Jk Phillips
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, Victoria, 3800, Australia
| | - Kellie Hamill
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, Victoria, 3800, Australia
| | - Peter J Norton
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, Victoria, 3800, Australia
| | - Sean Pa Drummond
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, Victoria, 3800, Australia.
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Abstract
AbstractRecent studies by Cloninger suggest that the temperament dimension of harm avoidance might be related to serotonergic activity. Since serotonergic mechanisms equally play a major role in sleep regulation, we decided to use Cloninger’s psychobiological model of temperament and character to assess whether there is a link between psychophysiologic insomnia and specific personality traits. Chronic insomnia is a common complaint in modern society, and it is still controversial whether insomniacs share specific personality traits. Thirty-two chronic insomniacs (<50 years) were studied. They underwent polysomnography for two consecutive nights and filled out the 226-item self-questionnaire of Temperament and Character Inventory as well as the Hospital Anxiety and Depression scale. (1) Harm avoidance for all subscores was significantly higher in insomniac patients when compared with controls; (2) self-directedness scores were lower in insomniacs; (3) sleep latency was positively correlated to harm avoidance; (4) HA1 (anticipatory worry) was negatively correlated to REM latency. Temperament and Character Inventory is a useful tool in the investigation of chronic insomnia. Serotonergic mechanisms might explain the high incidence of harm avoidance as personality trait in psychophysiologic insomniac patients. Further studies are needed to see whether harm avoidance could be a psychological vulnerability marker for primary insomnia and be used as predictor of SSRI treatment responders.
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Affiliation(s)
- Zara de Saint Hilaire
- Sleep Laboratory, University Hospital of Geneva, Belle-idée, 2 chemin Petit Bel-Air, 1225, Chêne-Bourg, Switzerland.
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Tubbs AS, Gallagher R, Perlis ML, Hale L, Branas C, Barrett M, Gehrels JA, Alfonso-Miller P, Grandner MA. Relationship between insomnia and depression in a community sample depends on habitual sleep duration. Sleep Biol Rhythms 2020; 18:143-153. [PMID: 34305449 DOI: 10.1007/s41105-020-00255-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sleep disturbances, such as short sleep duration and insomnia, are core features of depression. However, it is unclear if sleep duration and insomnia have an interactive effect on depression severity or individual symptoms. Data were drawn from a community sample (N = 1007) containing responses on the Insomnia Severity Index, Patient Health Questionnaire-9 (PHQ-9), and average sleep duration. Regression analyses determined the prevalence risks (PR) of symptoms of depression based on insomnia severity and sleep duration. Depression severity was related to insomnia severity (PR 1.09, p < 0.001) and short sleep duration (PR 1.52, p < 0.001), but the interaction between the two was negative (PR 0.97, p < 0.001). Insomnia severity increased the prevalence risk of all individual depression symptoms between 8 and 15%, while sleep duration increased the prevalence risk of appetite dysregulation (PR 1.86, p < 0.001), fatigue (PR 1.51, p < 0.001), difficulty concentrating (PR 1.61, p = 0.003), feelings of failure (PR 1.58, p = 0.002), and suicidal behavior (PR 2.54, p = 0.01). The interaction of sleep duration and insomnia was negative and ranged between 3 and 6%. In clinically significant depression (PHQ >=10), only insomnia severity increased the prevalence risk of depression severity (PR 1.02, p = 0.001). Insomnia and short sleep predict prevalent depression, but their interactive effect was negative. Thus, while insomnia had a greater association with depression severity and symptoms, this association was dependent on habitual sleep duration.
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Affiliation(s)
- Andrew S Tubbs
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, 1501 N Campbell Blvd Suite 7326, Tucson, AZ 85724, USA
| | - Rebecca Gallagher
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael L Perlis
- Behavioral Sleep Medicine Program, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren Hale
- Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Charles Branas
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Marna Barrett
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Jo-Ann Gehrels
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, 1501 N Campbell Blvd Suite 7326, Tucson, AZ 85724, USA
| | - Pamela Alfonso-Miller
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, 1501 N Campbell Blvd Suite 7326, Tucson, AZ 85724, USA
| | - Michael A Grandner
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, 1501 N Campbell Blvd Suite 7326, Tucson, AZ 85724, USA
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Akram U, Akram A, Gardani M, Ypsilanti A, McCarty K, Allen S, Lazuras L. The Relationship between Depression and Insomnia Symptoms Amongst a Sample of UK University Students. SLEEP MEDICINE RESEARCH 2019. [DOI: 10.17241/smr.2019.00332] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Depression and sleep duration: findings from middle-aged and elderly people in China. Public Health 2019; 166:148-154. [DOI: 10.1016/j.puhe.2018.10.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 09/16/2018] [Accepted: 10/08/2018] [Indexed: 11/18/2022]
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Gee B, Orchard F, Clarke E, Joy A, Clarke T, Reynolds S. The effect of non-pharmacological sleep interventions on depression symptoms: A meta-analysis of randomised controlled trials. Sleep Med Rev 2018; 43:118-128. [PMID: 30579141 DOI: 10.1016/j.smrv.2018.09.004] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/07/2018] [Accepted: 09/20/2018] [Indexed: 01/28/2023]
Abstract
Poor sleep is a significant risk factor for depression across the lifespan and sleep problems have been hypothesised to contribute to the onset and maintenance of depression symptoms. However, sleep problems are usually not a direct target of interventions for depression. A range of non-pharmacological treatments can reduce sleep problems but it is unclear whether these interventions also reduce other depression symptoms. The aim of this review was to examine whether non-pharmacological interventions for sleep problems are effective in reducing symptoms of depression. We carried out a systematic search for randomised controlled trials of non-pharmacological sleep interventions that measured depression symptoms as an outcome. Forty-nine trials (n = 5908) were included in a random effects meta-analysis. The pooled standardised mean difference for depression symptoms after treatment for sleep problems was -0.45 (95% CI: -0.55,-0.36). The size of the effect on depression symptoms was moderated by the size of the effect on subjective sleep quality. In studies of participants with mental health problems, sleep interventions had a large effect on depression symptoms (d = -0.81, 95% CI: -1.13,-0.49). The findings indicate that non-pharmacological sleep interventions are effective in reducing the severity of depression, particularly in clinical populations. This suggests that non-pharmacological sleep interventions could be offered as a treatment for depression, potentially improving access to treatment.
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Affiliation(s)
- Brioney Gee
- Norfolk and Suffolk NHS Foundation Trust, UK; Norwich Medical School, University of East Anglia, UK.
| | - Faith Orchard
- School of Psychology and Clinical Language Sciences, University of Reading, UK
| | | | - Ansu Joy
- Norfolk and Suffolk NHS Foundation Trust, UK
| | - Tim Clarke
- Norfolk and Suffolk NHS Foundation Trust, UK; Norwich Medical School, University of East Anglia, UK
| | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, UK
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Research into an Association between Anhedonia and Decreased REM Latency in Moderately to Severely Depressed Patients. SLEEP DISORDERS 2018; 2018:1636574. [PMID: 30057824 PMCID: PMC6051023 DOI: 10.1155/2018/1636574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/16/2018] [Indexed: 11/17/2022]
Abstract
Anhedonia stands as a core symptom and potential trait marker of major depressive disorder (MDD). The importance of rapid eye movement sleep latency (REML) as a biological marker of depression has previously and repeatedly been studied. The aim of this paper is to analyse the relationship between anhedonia and REML in moderately to severely depressed patients. The shortened Beck Depression Inventory (BDI-13) was chosen to assess depressive symptoms and, among them, more particularly, anhedonic symptoms. Two-way ANCOVA was used for statistical analyses. A significant association between anhedonic symptoms and REML was found when the number of sleep cycles (NCy) and the severity of depression were added as covariates. Our findings suggest that REML may be a useful variable to differentiate some diagnostic subtypes of depression related to anhedonia.
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Santangeli O, Porkka-Heiskanen T, Virkkala J, Castaneda AE, Marttunen M, Paunio T, Urrila AS. Sleep and slow-wave activity in depressed adolescent boys: a preliminary study. Sleep Med 2017; 38:24-30. [PMID: 29031752 DOI: 10.1016/j.sleep.2017.06.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 06/22/2017] [Accepted: 06/23/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Adolescence is a vulnerable period of life that is characterized by increasing incidence of depression. Sleep disturbance is one of the diagnostic symptoms of depressive disorder. Adolescence is also characterized by dramatic maturational changes in sleep and its regulation. The goal of this study was to assess sleep macroarchitecture and slow-wave activity (SWA) in depressed adolescent boys. METHODS Eight non-medicated adolescent boys meeting the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for depressive disorder and 10 age-matched healthy controls (average age 16.0 years) underwent polysomnography in their home environment for two consecutive nights. Sleep macroarchitecture, SWA, and SWA dissipation were assessed in all subjects. RESULTS Depressed boys showed a flattened pattern of SWA dissipation through the night. SWA power was lower during the first non-rapid eye movement (NREM) episode in the frontal derivation and higher during the third NREM episode in the central derivation in the group of depressed boys as compared to healthy boys. The SWA dissipation pattern correlated with the severity of depressive symptoms, and the correlation was strongest in the frontal derivation. In addition, total sleep time was shorter in patients as compared to the control group, but no other differences were found in the macroarchitecture of sleep. CONCLUSION Depression in adolescent boys is characterized by more evenly distributed SWA through the night as compared to healthy subjects, and we showed for the first time that this pattern of SWA distribution is associated with severity of depressive symptoms. These findings suggest that homeostatic regulation of sleep may be impaired in adolescent depression.
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Affiliation(s)
- Olena Santangeli
- Department of Physiology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Tarja Porkka-Heiskanen
- Department of Physiology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jussi Virkkala
- Finnish Institute for Occupational Health, Helsinki, Finland
| | - Anu E Castaneda
- Equality and Inclusion Unit, Department of Welfare, National Institute for Health and Welfare, Helsinki, Finland
| | - Mauri Marttunen
- Unit of Mental Health, Department of Health, National Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tiina Paunio
- Genomics and Biomarkers Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna S Urrila
- Unit of Mental Health, Department of Health, National Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Sex Differences in the Relationship Between Depressive Symptoms and Actigraphic Assessments of Sleep and Rest-Activity Rhythms in a Population-Based Sample. Psychosom Med 2017; 79:479-484. [PMID: 27922568 PMCID: PMC5413387 DOI: 10.1097/psy.0000000000000434] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Depression is often associated with disruptions in sleep and circadian rhythms. We aimed to confirm these relationships via actigraphic assessment in a large, population-based sample and test whether sex moderates these relationships. METHODS A total of 418 participants (age = 35-85 years, mean [standard deviation] = 57.04 [11.47]) completed questionnaires and 1 week of actigraphy, used to calculate sleep and rest-activity statistics including mesor (mean activity level), amplitude (height of rhythm), and acrophase (time of day that rhythm peaks). RESULTS Depressive symptoms, assessed via Center for Epidemiologic Studies Depression Scale, were associated with disrupted sleep and rest-activity rhythms. Furthermore, men demonstrated longer sleep onset latency (SOL, B = -13.28, p < .001), longer wake time after sleep onset (B = -6.26, p < .01), lower sleep efficiency (B = 5.91, p < .001), and lower total sleep time (TST, B = 33.16, p < .001) than women. Sex moderated the relationship between depression and SOL, TST, mesor, and amplitude; sex-stratified models revealed that higher depression scores were associated with greater SOL (B = 1.05, p < .001) and less TST (B = -0.87, p < .10) for women with higher depressive symptoms, but lower mesor (B = -1.75, p < .01) and amplitude (B = -1.94, p < .01) for men with higher depressive symptoms. CONCLUSIONS Depressive symptoms were related to disrupted sleep continuity and rest-activity rhythms in this population-based sample; however, these relationships differed by sex. Women with greater depressive symptoms exhibited difficulty with sleep continuity, whereas men with greater depressive symptoms demonstrated disruption throughout the 24-hour rhythm.
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Aoki T, Sakuma H, Ishii K. Effects of the 12 months walking exercise intervention on sleep quality in older adults. ACTA ACUST UNITED AC 2017. [DOI: 10.7600/jspfsm.66.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Takumi Aoki
- Physical Fitness and Sports Medicine Research Center, Doshisha University
| | - Haruo Sakuma
- Faculty of Health and Sports Science, Ritsumeikan University
| | - Kojiro Ishii
- Faculty of Health and Sports Science, Doshisha University
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Bosch P, van den Noort M, Staudte H, Lim S, Yeo S, Coenen A, van Luijtelaar G. Sleep disorders in patients with depression or schizophrenia: A randomized controlled trial using acupuncture treatment. Eur J Integr Med 2016. [DOI: 10.1016/j.eujim.2016.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lotrich FE, Sears B, McNamara RK. Polyunsaturated fatty acids moderate the effect of poor sleep on depression risk. Prostaglandins Leukot Essent Fatty Acids 2016; 106:19-25. [PMID: 26598106 PMCID: PMC4775327 DOI: 10.1016/j.plefa.2015.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 09/09/2015] [Accepted: 10/10/2015] [Indexed: 12/25/2022]
Abstract
Although potentially modifiable risk factors for interferon-alpha (IFN-α)-associated depression (IFN-MDD) have been identified, it is not currently known how they interact to confer risk. In the present study we prospectively investigated interactions among poor sleep quality, high-stress, pre-existing depressive symptoms, and polyunsaturated fatty acid status. Non-depressed hepatitis C patients (n=104) were followed prospectively during IFN-α therapy. IFN-MDD occurs in 20-40% of patients and was diagnosed using the Structured Clinical Interview of DSM-IV (SCID-IV), with incidence examined using Cox regression. Baseline Pittsburgh Sleep Quality Inventory (PSQI), Perceived Stress Scale (PSS), Beck Depression Inventory (BDI), and a range of plasma long-chain fatty acid levels were measured (gas chromatography) - focusing on the ratio of arachidonic acid (AA) to docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) (AA/EPA+DHA). The AA/EPA+DHA ratio (Β=0.40 ± 0.16; p=0.006), PSQI (Β=0.12 ± 0.04; p=0.001), PSS (Β=0.07 ± 0.02; p<0.001), and baseline BDI (Β=0.05 ± 0.02; p<0.001) each individually predicted IFN-MDD incidence. In step-wise Cox regression eliminating non-significant variables, two interactions remained significantly predictive: PSQI*AA/EPA+DHA (p=0.008) and PSS*AA/EPA+DHA (p=0.01). Receiver Operator Curves (ROC) were used to examine the specificity and sensitivity of IFN-MDD prediction. When sleep was normal (PSQI<5), AA/EPA+DHA was strongly predictive of IFN-MDD (AUC=91 ± 6; p=0.002). For example, among those with AA/EPA+DHA less than the median (4.15), none with PSQI<5 developed depression. Conversely, neither PSS nor PSQI was statistically associated with depression risk in those with an elevated AA/EPA+DHA ratio. These data demonstrate that the AA/EPA+DHA ratio moderates the effect of poor sleep on risk for developing IFN-MDD and may have broader implications for predicting and preventing MDD associated with inflammation.
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Affiliation(s)
- Francis E Lotrich
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
| | - Barry Sears
- Inflammation Research Foundation, Marblehead, MA, United States
| | - Robert K McNamara
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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Abstract
The article provides an overview of common and differentiating self-reported and objective sleep disturbances seen in mood-disordered populations. The importance of considering sleep disturbances in the context of mood disorders is emphasized, because a large body of evidence supports the notion that sleep disturbances are a risk factor for onset, exacerbation, and relapse of mood disorders. In addition, potential mechanisms for sleep disturbance in depression, other primary sleep disorders that often occur with mood disorders, effects of antidepressant and mood-stabilizing drugs on sleep, and the adjunctive effect of treating sleep in patients with mood disorders are discussed.
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Affiliation(s)
- Meredith E Rumble
- Department of Psychiatry, University of Wisconsin, 6001 Research Park Boulevard, Madison, WI 53719, USA.
| | - Kaitlin Hanley White
- Department of Psychiatry, University of Wisconsin, 6001 Research Park Boulevard, Madison, WI 53719, USA
| | - Ruth M Benca
- Department of Psychiatry, University of Wisconsin, 6001 Research Park Boulevard, Madison, WI 53719, USA
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Hey Mr. Sandman: dyadic effects of anxiety, depressive symptoms and sleep among married couples. J Behav Med 2015; 39:225-32. [PMID: 26546242 DOI: 10.1007/s10865-015-9693-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 10/24/2015] [Indexed: 12/13/2022]
Abstract
This study examined associations among anxiety, depressive symptoms, and sleep duration in a sample of middle-aged couples using the actor-partner interaction model with dyadic data. Self-report measures were completed independently by both partners as part of the health histories obtained during their annual preventive medical examinations in 2011 and 2012. Results showed that husbands' anxiety and depressive symptoms had a stronger effect on their wives' anxiety and depression than the other way around, but this was not moderated by one's own sleep duration. For both wives and husbands, higher levels of depressive symptoms and anxiety predicted shorter sleep duration for their partner 1 year later, although the effect of husbands' mental health on their wives' was again stronger. The findings suggest that sleep problems might better be treated as a couple-level phenomenon than an individual one, particularly for women.
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Cheng P, Goldschmied J, Deldin P, Hoffmann R, Armitage R. The role of fast and slow EEG activity during sleep in males and females with major depressive disorder. Psychophysiology 2015; 52:1375-81. [PMID: 26175101 PMCID: PMC4507274 DOI: 10.1111/psyp.12472] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 05/29/2015] [Indexed: 11/30/2022]
Abstract
Sleep difficulties are highly prevalent in depression, and appear to be a contributing factor in the development and maintenance of symptoms. However, despite the generally acknowledged relationship between sleep and depression, the neurophysiological substrates underlying this relationship still remain unclear. Two main hypotheses were tested in this study. The first hypothesis states that sleep in depression is characterized by inadequate generation of restorative sleep, as indexed by reduced amounts of slow-wave activity. Conversely, the second hypothesis states that poor sleep in depression is due to intrusions of fast-frequency activity that may be reflective of a hyperaroused central nervous system. This study aimed to test both hypotheses in a large sample of individuals with clinically validated depression, as well as to examine sex as a moderator. Results suggest that depression is better characterized by an overall decrease in slow-wave activity, which is related to elevated anxious and depressed mood the following morning. Results also suggest that females may be more likely to experience fast frequency activity related to depression symptom severity.
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Affiliation(s)
- Philip Cheng
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Patricia Deldin
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert Hoffmann
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Roseanne Armitage
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
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Pigeon WR, Heffner KL, Crean H, Gallegos AM, Walsh P, Seehuus M, Cerulli C. Responding to the need for sleep among survivors of interpersonal violence: A randomized controlled trial of a cognitive-behavioral insomnia intervention followed by PTSD treatment. Contemp Clin Trials 2015; 45:252-260. [PMID: 26343743 DOI: 10.1016/j.cct.2015.08.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/27/2015] [Accepted: 08/30/2015] [Indexed: 02/03/2023]
Abstract
Sleep disturbance is a common feature of posttraumatic stress disorder (PTSD), but is not a focus of standard PTSD treatments. Psychological trauma exposure is associated with considerable physical and mental health morbidity, possibly due to the alterations in neuroendocrine function and inflammation observed in trauma exposed individuals. Although PTSD treatments are efficacious, they are associated with high drop-out rates in clinical trials and clinical practice. Finally, individuals with PTSD stemming from exposure to interpersonal violence represent an especially under-treated population with significant sleep disturbance. Community-based participatory research was utilized to design and prepare a clinical trial that randomizes recent survivors of interpersonal violence who have PTSD, depression, and insomnia to receive either: (1) Cognitive Behavioral Therapy for Insomnia (CBTi) followed by Cognitive Processing Therapy (CPT) for trauma, or (2) attention control followed by CPT. Outcome measures include subjective and objective measures of sleep, clinician-administered PTSD and depression scales, inflammatory cytokines, and salivary cortisol. Assessments are conducted at baseline, following the sleep or control intervention, and again following CPT. The design allows for: (1) the first test of a sleep intervention in this population; (2) the comparison of sequenced CBTi and CPT to attention control followed by CPT, and (3) assessing the roles of neuroendocrine function, inflammatory processes, and objective sleep markers in mediating treatment outcomes. The study's overarching hypothesis is that treating insomnia will produce reduction in insomnia, PTSD, and depression severity, allowing patients to more fully engage in, and derive optimal benefits from, cognitive processing therapy.
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Affiliation(s)
- Wilfred R Pigeon
- Sleep and Neurophysiology Research Laboratory, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY USA; U.S. Department of Veterans Affairs Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY USA.
| | - Kathi L Heffner
- Sleep and Neurophysiology Research Laboratory, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY USA
| | - Hugh Crean
- School of Nursing, University of Rochester Medical Center, Rochester, NY USA
| | - Autumn M Gallegos
- Sleep and Neurophysiology Research Laboratory, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY USA
| | - Patrick Walsh
- Sleep and Neurophysiology Research Laboratory, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY USA
| | - Martin Seehuus
- Sleep and Neurophysiology Research Laboratory, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY USA
| | - Catherine Cerulli
- Susan B. Anthony Center and Laboratory of Interpersonal Violence and Victimization, University of Rochester Medical Center, Rochester, NY USA
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Senba E. A key to dissect the triad of insomnia, chronic pain, and depression. Neurosci Lett 2015; 589:197-9. [DOI: 10.1016/j.neulet.2015.01.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 01/05/2015] [Indexed: 01/01/2023]
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Kung PY, Chou KR, Lin KC, Hsu HW, Chung MH. Sleep disturbances in patients with major depressive disorder: incongruence between sleep log and actigraphy. Arch Psychiatr Nurs 2015; 29:39-42. [PMID: 25634873 DOI: 10.1016/j.apnu.2014.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/12/2014] [Accepted: 09/30/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Depression has become a severe global health problem, and sleeping difficulties are typically associated with depression. The purpose of this study was to investigate the relationships among subjective sleep quality, objective sleep quality, and the sleep hygiene practices of hospitalized patients with major depressive disorder. METHOD Daily sleep logs and actigraphy were used to obtain subjective and objective sleep data. Thirty patients were recruited from a regional teaching hospital in Taipei and completed the Hamilton Rating Scale for Depression and the Sleep Hygiene Practice Scale. RESULTS Significant differences were found between subjective and objective sleep data in patients with major depressive disorder (MDD). For patients with more severe depression, subjective measurements obtained using sleep logs, such as total sleep time and sleep efficiency, were significantly lower than those obtained using actigraphy by controlling for demographics. CONCLUSIONS The results regarding the differences between subjective and objective sleep data can be a reference for care providers when comforting depression patients who complain of sleep disturbance.
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Affiliation(s)
- Pei-Ying Kung
- Tri-Service General Hospital Songshan Branch, Taipei, Taiwan
| | - Kuei-Ru Chou
- Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Chia Lin
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Hsin-Wei Hsu
- Taipei City Hospital, Songde Branch, Taipei, Taiwan
| | - Min-Huey Chung
- Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
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Robillard R, Hermens DF, Naismith SL, White D, Rogers NL, Ip TK, Mullin SJ, Alvares GA, Guastella AJ, Smith KL, Rong Y, Whitwell B, Southan J, Glozier N, Scott EM, Hickie IB. Ambulatory sleep-wake patterns and variability in young people with emerging mental disorders. J Psychiatry Neurosci 2015; 40:28-37. [PMID: 25203899 PMCID: PMC4275328 DOI: 10.1503/jpn.130247] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The nature of sleep-wake abnormalities in individuals with mental disorders remains unclear. The present study aimed to examine the differences in objective ambulatory measures of the sleep-wake and activity cycles across young people with anxiety, mood or psychotic disorders. METHODS Participants underwent several days of actigraphy monitoring. We divided participants into 5 groups (control, anxiety disorder, unipolar depression, bipolar disorder, psychotic disorder) according to primary diagnosis. RESULTS We enrolled 342 participants aged 12-35 years in our study: 41 healthy controls, 56 with anxiety disorder, 135 with unipolar depression, 80 with bipolar disorder and 30 with psychotic disorders. Compared with the control group, sleep onset tended to occur later in the anxiety, depression and bipolar groups; sleep offset occurred later in all primary diagnosis groups; the sleep period was longer in the anxiety, bipolar and psychosis groups; total sleep time was longer in the psychosis group; and sleep efficiency was lower in the depression group, with a similar tendency for the anxiety and bipolar groups. Sleep parameters were significantly more variable in patient subgroups than in controls. Cosinor analysis revealed delayed circadian activity profiles in the anxiety and bipolar groups and abnormal circadian curve in the psychosis group. LIMITATIONS Although statistical analyses controlled for age, the sample included individuals from preadolescence to adulthood. Most participants from the primary diagnosis subgroups were taking psychotropic medications, and a large proportion had other comorbid mental disorders. CONCLUSION Our findings suggest that delayed and disorganized sleep offset times are common in young patients with various mental disorders. However, other sleep-wake cycle disturbances appear to be more prominent in broad diagnostic categories.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ian B. Hickie
- Correspondence to: I.B. Hickie, Brain & Mind Research Institute, University of Sydney, Level 4, 94 Mallett St., Camperdown NSW 2050 Australia;
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Wang D, Li Z, Li L, Hao W. Real-world, open-label study to evaluate the effectiveness of mirtazapine on sleep quality in outpatients with major depressive disorder. Asia Pac Psychiatry 2014; 6:152-60. [PMID: 23857869 DOI: 10.1111/appy.12060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Accepted: 12/20/2012] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The objective of this study was to evaluate the effect of mirtazapine on sleep quality in real-world outpatients with major depressive disorder (MDD). METHODS Demographic characteristics of MDD outpatients were collected and the Pittsburgh Sleep Quality Index (PSQI) was assessed before and after treatment. RESULTS In 3,924 MDD outpatients after treatment, sleep efficiency was significantly higher (P < 0.001), global PSQI score was significantly lower (P < 0.01), the reduction rates of sleep latency (P < 0.01) and global PSQI score (P < 0.001) were notably higher, and the proportion of using sleep medications (P < 0.05) was significantly lower in the mirtazapine group. In 3,455 MDD outpatients with insomnia after treatment, the reduction of sleep latency (P < 0.001), the prolongation of sleep duration (P < 0.001), and the increase in habitual sleep efficiency (P < 0.001) were more obvious, the reduction rates of sleep latency (P < 0.05) and global PSQI score (P < 0.001) were significantly higher, and the proportion of using sleep medications (P < 0.001) was significantly lower in the mirtazapine group. In 469 MDD outpatients without insomnia after treatment, the reduction of sleep latency (P < 0.05), the increase in sleep duration (P < 0.001) and habitual sleep efficiency (P < 0.001), and the reduction rate of global PSQI score (P < 0.05) were significantly greater in the mirtazapine group. DISCUSSION This real-world study suggests that mirtazapine improves sleep quality of MDD outpatients, and decreases the concomitant use of sleep medications.
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Affiliation(s)
- Dan Wang
- Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha, China
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Ellis JG, Perlis ML, Bastien CH, Gardani M, Espie CA. The natural history of insomnia: acute insomnia and first-onset depression. Sleep 2014; 37:97-106. [PMID: 24470699 DOI: 10.5665/sleep.3316] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES While many studies have examined the association between insomnia and depression, no studies have evaluated these associations (1) within a narrow time frame, (2) with specific reference to acute and chronic insomnia, and (3) using polysomnography. In the present study, the association between insomnia and first-onset depression was evaluated taking into account these considerations. DESIGN A mixed-model inception design. SETTING Academic research laboratory. PARTICIPANTS Fifty-four individuals (acute insomnia [n = 33], normal sleepers [n = 21]) with no reported history of a sleep disorder, chronic medical condition, or psychiatric illness. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Participants were assessed at baseline (2 nights of polysomnography and psychometric measures of stress and mood) and insomnia and depression status were reassessed at 3 months. Individuals with acute insomnia exhibited more stress, poorer mood, worse subjective sleep continuity, increased N2 sleep, and decreased N3 sleep. Individuals who transitioned to chronic insomnia exhibited (at baseline) shorter REM latencies and reduced N3 sleep. Individuals who exhibited this pattern in the transition from acute to chronic insomnia were also more likely to develop first-onset depression (9.26%) as compared to those who remitted from insomnia (1.85%) or were normal sleepers (1.85%). CONCLUSION The transition from acute to chronic insomnia is presaged by baseline differences in sleep architecture that have, in the past, been ascribed to Major Depression, either as heritable traits or as acquired traits from prior episodes of depression. The present findings suggest that the "sleep architecture stigmata" of depression may actually develop over the course transitioning from acute to chronic insomnia.
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Affiliation(s)
- Jason G Ellis
- Northumbria Centre for Sleep Research, Northumbria University, Newcastle, UK
| | | | | | - Maria Gardani
- Institute of Mental Health and Wellbeing, University of Glasgow, UK
| | - Colin A Espie
- Nuffield Department of Clinical Neurosciences/Sleep & Circadian Neuroscience Institute, University of Oxford, UK
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Pellicciari MC, Cordone S, Marzano C, Bignotti S, Gazzoli A, Miniussi C, De Gennaro L. Dorsolateral prefrontal transcranial magnetic stimulation in patients with major depression locally affects alpha power of REM sleep. Front Hum Neurosci 2013; 7:433. [PMID: 23935577 PMCID: PMC3731627 DOI: 10.3389/fnhum.2013.00433] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 07/16/2013] [Indexed: 02/05/2023] Open
Abstract
Sleep alterations are among the most important disabling manifestation symptoms of Major Depression Disorder (MDD). A critical role of sleep importance is also underlined by the fact that its adjustment has been proposed as an objective marker of clinical remission in MDD. Repetitive transcranial magnetic stimulation (rTMS) represents a relatively novel therapeutic tool for the treatment of drug-resistant depression. Nevertheless, besides clinical evaluation of the mood improvement after rTMS, we have no clear understanding of what are the neurophysiological correlates of such treatment. One possible marker underlying the clinical outcome of rTMS in MDD could be cortical changes on wakefulness and sleep activity. The aim of this open-label study was to evaluate the efficacy of a sequential bilateral rTMS treatment over the dorsolateral prefrontal cortex (DLPFC) to improve the mood in MDD patients, and to determine if rTMS can induce changes on the sleep structure, and if those changes can be used as a surrogate marker of the clinical state of the patient. Ten drug-resistant depressed patients participated to ten daily sessions of sequential bilateral rTMS with a low-frequency TMS (1 Hz) over right-DLPFC and a subsequent high-frequency (10 Hz) TMS over left-DLPFC. The clinical and neurophysiological effects induced by rTMS were evaluated, respectively by means of the Hamilton Depression Rating Scale (HDRS), and by comparing the sleep pattern modulations and the spatial changes of EEG frequency bands during both NREM and REM sleep, before and after the real rTMS treatment. The sequential bilateral rTMS treatment over the DLPFC induced topographical-specific decrease of the alpha activity during REM sleep over left-DLPFC, which is significantly associated to the clinical outcome. In line with the notion of a left frontal hypoactivation in MDD patients, the observed local decrease of alpha activity after rTMS treatment during the REM sleep suggests that alpha frequency reduction could be considered as a marker of up-regulation of cortical activity induced by rTMS, as well as a surrogate neurophysiological correlate of the clinical outcome.
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Affiliation(s)
| | - Susanna Cordone
- Department of Psychology, University of Rome SapienzaRome, Italy
| | - Cristina Marzano
- Department of Psychology, University of Rome SapienzaRome, Italy
| | - Stefano Bignotti
- Cognitive Neuroscience Section, IRCCS Centro San Giovanni di Dio FatebenefratelliBrescia, Italy
| | - Anna Gazzoli
- Cognitive Neuroscience Section, IRCCS Centro San Giovanni di Dio FatebenefratelliBrescia, Italy
| | - Carlo Miniussi
- Cognitive Neuroscience Section, IRCCS Centro San Giovanni di Dio FatebenefratelliBrescia, Italy
- Department of Clinical and Experimental Sciences, National Institute of Neuroscience, University of BresciaBrescia, Italy
| | - Luigi De Gennaro
- Department of Psychology, University of Rome SapienzaRome, Italy
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Abstract
Sleep has been described as being of the brain, by the brain, and for the brain. This fundamental neurobiological behavior is controlled by homeostatic and circadian (24-hour) processes and is vital for normal brain function. This review will outline the normal sleep-wake cycle, the changes that occur during aging, and the specific patterns of sleep disturbance that occur in association with both mental health disorders and neurodegenerative disorders. The role of primary sleep disorders such as insomnia, obstructive sleep apnea, and REM sleep behavior disorder as potential causes or risk factors for particular mental health or neurodegenerative problems will also be discussed.
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Affiliation(s)
- Kirstie N Anderson
- Department of Neurology, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
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Perlis M, Pigeon W, Gehrman P, Findley J, Drummond S. Neurobiological Mechanisms in Chronic Insomnia. Sleep Med Clin 2012. [DOI: 10.1016/j.jsmc.2012.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Frey S, Birchler-Pedross A, Hofstetter M, Brunner P, Götz T, Münch M, Blatter K, Knoblauch V, Wirz-Justice A, Cajochen C. Challenging the sleep homeostat: Sleep in depression is not premature aging. Sleep Med 2012; 13:933-45. [DOI: 10.1016/j.sleep.2012.03.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 01/30/2012] [Accepted: 03/06/2012] [Indexed: 11/28/2022]
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Jakubcakova V, Flachskamm C, Landgraf R, Kimura M. Sleep phenotyping in a mouse model of extreme trait anxiety. PLoS One 2012; 7:e40625. [PMID: 22808211 PMCID: PMC3394752 DOI: 10.1371/journal.pone.0040625] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 06/11/2012] [Indexed: 01/19/2023] Open
Abstract
Background There is accumulating evidence that anxiety impairs sleep. However, due to high sleep variability in anxiety disorders, it has been difficult to state particular changes in sleep parameters caused by anxiety. Sleep profiling in an animal model with extremely high vs. low levels of trait anxiety might serve to further define sleep patterns associated with this psychopathology. Methodology/Principal Findings Sleep-wake behavior in mouse lines with high (HAB), low (LAB) and normal (NAB) anxiety-related behaviors was monitored for 24 h during baseline and recovery after 6 h sleep deprivation (SD). The amounts of each vigilance state, sleep architecture, and EEG spectral variations were compared between the mouse lines. In comparison to NAB mice, HAB mice slept more and exhibited consistently increased delta power during non-rapid eye movement (NREM) sleep. Their sleep patterns were characterized by heavy fragmentation, reduced maintenance of wakefulness, and frequent intrusions of rapid eye movement (REM) sleep. In contrast, LAB mice showed a robust sleep-wake rhythm with remarkably prolonged sleep latency and a long, persistent period of wakefulness. In addition, the accumulation of delta power after SD was impaired in the LAB line, as compared to HAB mice. Conclusions/Significance Sleep-wake patterns were significantly different between HAB and LAB mice, indicating that the genetic predisposition to extremes in trait anxiety leaves a biological scar on sleep quality. The enhanced sleep demand observed in HAB mice, with a strong drive toward REM sleep, may resemble a unique phenotype reflecting not only elevated anxiety but also a depression-like attribute.
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Affiliation(s)
| | | | | | - Mayumi Kimura
- Max Planck Institute of Psychiatry, Munich, Germany
- * E-mail:
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Fitzpatrick K, Winrow CJ, Gotter AL, Millstein J, Arbuzova J, Brunner J, Kasarskis A, Vitaterna MH, Renger JJ, Turek FW. Altered sleep and affect in the neurotensin receptor 1 knockout mouse. Sleep 2012; 35:949-56. [PMID: 22754041 DOI: 10.5665/sleep.1958] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
STUDY OBJECTIVE Sleep and mood disorders have long been understood to have strong genetic components, and there is considerable comorbidity of sleep abnormalities and mood disorders, suggesting the involvement of common genetic pathways. Here, we examine a candidate gene implicated in the regulation of both sleep and affective behavior using a knockout mouse model. DESIGN Previously, we identified a quantitative trait locus (QTL) for REM sleep amount, REM sleep bout number, and wake amount in a genetically segregating population of mice. Here, we show that traits mapping to this QTL correlated with an expression QTL for neurotensin receptor 1 (Ntsr1), a receptor for neurotensin, a ligand known to be involved in several psychiatric disorders. We examined sleep as well as behaviors indicative of anxiety and depression in the NTSR1 knockout mouse. MEASUREMENTS AND RESULTS NTSR1 knockouts had a lower percentage of sleep time spent in REM sleep in the dark phase and a larger diurnal variation in REM sleep duration than wild types under baseline conditions. Following sleep deprivation, NTSR1 knockouts exhibited more wake and less NREM rebound sleep. NTSR1 knockouts also showed increased anxious and despair behaviors. CONCLUSIONS Here we illustrate a link between expression of the Ntsr1 gene and sleep traits previously associated with a particular QTL. We also demonstrate a relationship between Ntsr1 and anxiety and despair behaviors. Given the considerable evidence that anxiety and depression are closely linked with abnormalities in sleep, the data presented here provide further evidence that neurotensin and Ntsr1 may be a component of a pathway involved in both sleep and mood disorders.
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Affiliation(s)
- Karrie Fitzpatrick
- Center for Sleep and Circadian Biology, Northwestern University, Evanston, IL, USA
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IWAKI S, SATOH K, MATSUMOTO Y, ECHIZENYA M, KATOH T, KUSANAGI H, KITAMURA S, SHIMIZU T, MISHIMA K. Treatment-resistant residual insomnia in patients with recurrent major depressive episodes. Sleep Biol Rhythms 2012. [DOI: 10.1111/j.1479-8425.2012.00564.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Beneficial behavioural and neurogenic effects of agomelatine in a model of depression/anxiety. Int J Neuropsychopharmacol 2012; 15:321-35. [PMID: 21473810 DOI: 10.1017/s1461145711000356] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Agomelatine (S20098) is a novel antidepressant drug with melatonergic agonist and 5-HT2C receptor antagonist properties, displaying antidepressant/anxiolytic-like properties in animal models and in humans. In a depression/anxiety-like mouse model in which the response of the HPA axis is blunted, we investigated whether agomelatine could reverse behavioural deficits related to depression/anxiety compared to the classical selective serotonin reuptake inhibitor, fluoxetine. Adult mice were treated for 8 wk with either vehicle or corticosterone (35 μg/ml.d) via drinking water. During the final 4 wk, animals were treated with vehicle, agomelatine (10 or 40 mg/kg i.p.) or fluoxetine (18 mg/kg i.p.) and tested in several behavioural paradigms and also evaluated for home-cage activity. Our results showed that the depressive/anxiety-like phenotype induced by corticosterone treatment is reversed by either chronic agomelatine or fluoxetine treatment. Moreover, agomelatine increased the dark/light ratio of home-cage activity in vehicle-treated mice and reversed the alterations in this ratio induced by chronic corticosterone, suggesting a normalization of disturbed circadian rhythms. Finally, we investigated the effects of this new antidepressant on neurogenesis. Agomelatine reversed the decreased cell proliferation in the whole hippocampus in corticosterone-treated mice and increased maturation of newborn neurons in both vehicle- and corticosterone-treated mice. Overall, the present study suggests that agomelatine, with its distinct mechanism of action based on the synergy between the melatonergic agonist and 5-HT2C antagonist properties, provides a distinct antidepressant/anxiolytic spectrum including circadian rhythm normalization.
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Nes RB, Røysamb E, Reichborn-Kjennerud T, Tambs K, Harris JR. Subjective Wellbeing and Sleep Problems: A Bivariate Twin Study. Twin Res Hum Genet 2012. [DOI: 10.1375/twin.8.5.440] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThe relationship between subjective wellbeing (SWB) and self-reported sleep problems was investigated in a cohort of Norwegian twins aged 18 to 31 years. Questionnaire data from 8045 same- and opposite-sex twins were analyzed using structural equation modeling to explore the relative effects of genetic and environmental influences on phenotypic variance and covariance. Special attention was paid to sex-specific effects. The correlation between the phenotypes was estimated to be −.43. Univariate analyses indicated considerable genetic influences for both SWB and sleep problems, for male and female twins alike. The best fitting bivariate model specified additive genetic and individual environmental factors for both phenotypes, and nonadditive genetic effects for sleep problems, with no sex-specific effects. Genetic and environmental effects accounted for 60% and 40% of the phenotypic correlation, respectively. Additive genetic factors affecting the two phenotypes were correlated (−.85), suggesting that part of the genetic effects that positively influence SWB also protect against sleep problems. In conclusion, the results indicate considerable overlap in genetic etiology for SWB and sleep problems, for males and females alike.
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Huynh C, Guilé JM, Godbout R. Études polysomnographiques du sommeil dans le trouble de personnalité limite chez l’adulte. Presse Med 2012; 41:e63-75. [DOI: 10.1016/j.lpm.2011.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 06/10/2011] [Indexed: 10/17/2022] Open
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Thase ME, Murck H, Post A. Clinical relevance of disturbances of sleep and vigilance in major depressive disorder: a review. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2011; 12. [PMID: 21494354 DOI: 10.4088/pcc.08m00676gry] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Accepted: 08/04/2009] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The primary objective of this article is to provide a concise review of the clinical relevance of sleep and vigilance in major depressive disorder. DATA SOURCES PubMed was reviewed (1990-2009) and English-language articles were identified using the key words sleep and depression and sleep and antidepressants. Secondary searches included articles cited in sources identified by the primary search. STUDY SELECTION The narrative review provides brief descriptions of the normal physiology of sleep and changes associated with depression, as well as the impact of various treatments on these processes. DATA SYNTHESIS Although it has long been known that sleep disturbances are an important characteristic of depression, relatively few studies have been conducted with the newer-generation antidepressants. Neither of the most widely used classes of antidepressants, the selective serotonin reuptake inhibitors and the serotonin-norepinephrine reuptake inhibitors, have particularly beneficial effects on sleep and, among the medications that reliably improve sleep efficiency, including mirtazapine and the tricyclic antidepressants, problems with daytime sedation can offset therapeutic benefit. Despite relatively widespread use, trazodone has not been demonstrated to be an effective and safe hypnotic in patients taking other antidepressants. For many patients, ongoing concomitant treatment with benzodiazepines and related drugs is the preferred option, again without convincing empirical support of longer-term efficacy. Among newer and investigational antidepressants, agomelatine shows promise with respect to both overall safety and effects on insomnia, although possible negative effects on liver function warrant further study. CONCLUSIONS Sleep disturbances are a significant aspect of depressive syndromes, and relief of insomnia remains an important unmet need in antidepressant therapeutics. Development of a well-tolerated antidepressant medication that rapidly improves sleep maintenance without daytime sedation is a priority for drug development.
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Affiliation(s)
- Michael E Thase
- Department of Psychiatry, University of Pennsylvania School of Medicine and Philadelphia Veterans Affairs, Medical Center, Philadelphia, Pennsylvania, USA.
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McCoy JG, Strecker RE. The cognitive cost of sleep lost. Neurobiol Learn Mem 2011; 96:564-82. [PMID: 21875679 DOI: 10.1016/j.nlm.2011.07.004] [Citation(s) in RCA: 176] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 07/12/2011] [Accepted: 07/25/2011] [Indexed: 11/25/2022]
Abstract
A substantial body of literature supports the intuitive notion that a good night's sleep can facilitate human cognitive performance the next day. Deficits in attention, learning & memory, emotional reactivity, and higher-order cognitive processes, such as executive function and decision making, have all been documented following sleep disruption in humans. Thus, whilst numerous clinical and experimental studies link human sleep disturbance to cognitive deficits, attempts to develop valid and reliable rodent models of these phenomena are fewer, and relatively more recent. This review focuses primarily on the cognitive impairments produced by sleep disruption in rodent models of several human patterns of sleep loss/sleep disturbance. Though not an exclusive list, this review will focus on four specific types of sleep disturbance: total sleep deprivation, experimental sleep fragmentation, selective REM sleep deprivation, and chronic sleep restriction. The use of rodent models can provide greater opportunities to understand the neurobiological changes underlying sleep loss induced cognitive impairments. Thus, this review concludes with a description of recent neurobiological findings concerning the neuroplastic changes and putative brain mechanisms that may underlie the cognitive deficits produced by sleep disturbances.
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Affiliation(s)
- John G McCoy
- VA Boston Healthcare System, Research Service and Harvard Medical School, Department of Psychiatry, 940 Belmont St., Brockton, MA 02301-5596, USA.
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46
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Affiliation(s)
- V S Rotenberg
- Department of Psychiatry, Tel Aviv University, Tel Aviv, Israel.
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47
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Shechter A, Boivin DB. Sleep, Hormones, and Circadian Rhythms throughout the Menstrual Cycle in Healthy Women and Women with Premenstrual Dysphoric Disorder. Int J Endocrinol 2010; 2010:259345. [PMID: 20145718 PMCID: PMC2817387 DOI: 10.1155/2010/259345] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 10/16/2009] [Indexed: 11/17/2022] Open
Abstract
A relationship exists between the sleep-wake cycle and hormone secretion, which, in women, is further modulated by the menstrual cycle. This interaction can influence sleep across the menstrual cycle in healthy women and in women with premenstrual dysphoric disorder (PMDD), who experience specific alterations of circadian rhythms during their symptomatic luteal phase along with sleep disturbances during this time. This review will address the variation of sleep at different menstrual phases in healthy and PMDD women, as well as changes in circadian rhythms, with an emphasis on their relationship with female sex hormones. It will conclude with a brief discussion on nonpharmacological treatments of PMDD which use chronotherapeutic methods to realign circadian rhythms as a means of improving sleep and mood in these women.
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Affiliation(s)
- Ari Shechter
- Centre for Study and Treatment of Circadian Rhythms, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada H4H 1R3
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada H3A 2B4
| | - Diane B. Boivin
- Centre for Study and Treatment of Circadian Rhythms, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada H4H 1R3
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Abstract
Historically, insomnia has been viewed as a symptom of depressive illness that is expected to resolve with adequate treatment of the depressive disorder. This article reviews the evidence that increasingly challenges this simplistic view and summarizes research demonstrating the multifaceted interplay between insomnia and depression. It discusses the prevalence, clinical significance, and time course of insomnia, distinguishing between poor sleep and an insomnia disorder. The article also discusses abnormalities in sleep architecture in major depressive disorder and theories about the pathways connecting sleep and depression. It concludes with a discussion of issues related to treatment, including the effects of antidepressants on sleep and new evidence of the utility of adding an insomnia-specific therapy for improved management of depressed patients with comorbid insomnia.
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Affiliation(s)
- Rachel Manber
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA.
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49
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Perlis M, Pigeon W, Gehrman P, Findley J, Drummond S. Neurobiological Mechanisms In Chronic Insomnia. Sleep Med Clin 2009; 4:549-558. [PMID: 30983923 DOI: 10.1016/j.jsmc.2009.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This article grapples with the notion that insomnia can or should be defined in physiologic terms. It is proposed that insomnia is better understood from a neurobiological perspective. A review of the neurobiology of sleep and wakefulness is provided with a special emphasis on the implications for insomnia. Following the review it is suggested that a complete understanding of insomnia will require that the neurobiologic characterization of insomnia be informed by modern cognitive concepts and methods.
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Affiliation(s)
- Michael Perlis
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Suite 670, 3535 Market Street, Philadelphia, PA 19104
| | - Wil Pigeon
- Sleep and Neurophysiology Research Laboratory, Department of Psychiatry, University of Rochester, 300 Crittenden Boulevard, Rochester, NY 14642
| | - Phil Gehrman
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Suite 670, 3535 Market Street, Philadelphia, PA 19104
| | - Jim Findley
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Suite 670, 3535 Market Street, Philadelphia, PA 19104
| | - Sean Drummond
- Laboratory of Sleep & Behavioral Neuroscience, UCSD and VA San Diego Healthcare System, 3350 La Jolla Village Dr., MC 151B, Building 13, 3rd floor, San Diego, CA 92161
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Sinton CM, Kovakkattu D, Friese RS. Validation of a novel method to interrupt sleep in the mouse. J Neurosci Methods 2009; 184:71-8. [PMID: 19646474 DOI: 10.1016/j.jneumeth.2009.07.026] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Revised: 07/10/2009] [Accepted: 07/21/2009] [Indexed: 11/27/2022]
Abstract
Interrupted sleep, fragmented sleep or restricted sleep is a corollary of many psychiatric, neurological and respiratory disorders and also results from disruptive environments such as that of the intensive care unit (ICU). Recent rodent studies have revealed that sleep interruption (SI) can have more significant consequences for cognitive and neurophysiological variables than were expected and may even be equivalent to those of total sleep deprivation. Results from this research are therefore being increasingly recognized for their implications, which may include delayed recovery from critical illness in the ICU. Here we describe in detail a method for interrupting sleep in a murine model, which we had previously adopted to show an increase in mortality after septic insult. Interrupting sleep for 30s every 2 min over 48 h significantly decreased rapid eye movement (REM) and non-rapid eye movement (NREM) sleep. The technique, which is based on using a standard laboratory orbital shaker to oscillate the cage containing the mouse, can easily be adapted to use different parameters for SI. During recovery, mice exhibited a rebound in REM sleep time and an increase in the depth of NREM sleep as measured by delta (1-4 Hz) power in the electroencephalogram. The changes in sleep both during and after SI showed some differences from those previously observed in the rat using the same SI parameters. In conclusion, the mouse may provide a useful alternative model for studying the effects of SI.
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Affiliation(s)
- Christopher M Sinton
- Department of Internal Medicine, UT Southwestern Medical Center at Dallas, Dallas, TX 75390-8874, USA.
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