The Evolving Nexus of Sleep and Depression

Treatment of Insomnia With Traditional Chinese Medicine Presents a Promising Prospect

Insomnia, a prevalent sleep disorder, significantly impacts global health. While Western medications provide temporary relief, their risks of dependency and cognitive impairment have spurred the search for safer alternatives. Traditional Chinese Medicine (TCM) offers a promising approach to treating insomnia by focusing on harmonizing the balance of Yin and Yang and the functions of internal organs. This review explores recent research advances in TCM for insomnia treatment, integrating classical theories with modern scientific understanding of key pathological mechanisms, including neurotransmitter regulation (GABA, monoamines), immune-inflammatory responses, the HPA axis, and interactions with the gut microbiota. Growing clinical evidence supports the effectiveness of classical TCM prescriptions and treatments like acupuncture in improving sleep quality, particularly when combined with Western medications to enhance efficacy and reduce dependency. However, TCM also has its limitations. Future research directions should focus on modernizing TCM applications, addressing comorbidities associated with insomnia, exploring the role of gut microbiota, and optimizing medicinal and edible homologous products. By integrating traditional knowledge with cutting-edge technologies, TCM holds great potential for advancing personalized and effective insomnia treatments globally.

Association between occupational stress and depression among construction workers: The chain mediating of sleep disorders and anxiety

BackgroundDue to the unique nature of their work, construction workers are prone to mental health problems. However, few studies in China have explored the relationship between psychological variables about them.ObjectiveThe purpose of this study was to explore the relationship between occupational stress and depression and to analyze the mediating role of sleep disorders and anxiety.MethodsA stratified cluster sampling method randomly selected 1871 construction workers in Chongqing, China. The survey was conducted as a questionnaire. SPSS 25.0 software was used for data analysis and statistical description. SPSS PROCESS macro version 4.0 was used for the chained mediation effect test.ResultsThe detection rates of occupational stress, sleep disorders, anxiety, and depression among construction workers were 26.4%, 89.8%, 30.2%, and 18.7%, respectively. Analysis showed that these factors were positively correlated with each other. Mediation effect analysis showed that occupational stress directly influenced depression (β = 0.156, p < 0.001) and also had an indirect effect through sleep disorders and anxiety, with respective mediation effects of 4.48% and 47.93%. Sleep disorders and anxiety played a chain-mediating role between occupational stress and depression, with a mediating effect of 3.69%.ConclusionsOccupational stress affects depression directly and also indirectly through sleep disorders and anxiety. These results indicate that reducing occupational stress, sleep disorders, and anxiety may be effective in preventing depression.

Exploring the Association Between Sleep Patterns, Pubertal Health, and Phthalate Exposure-Preliminary Results from Slovakia

BACKGROUND

This study aims to explore the association between sleep patterns in children and their exposure to phthalates to assess potential health implications.

METHODS

Participants (n = 60) completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Consumer behavior scores (CBS) were calculated. The Tanner scale was used to monitor the stages of puberty. First-morning urine samples were analyzed by high-performance liquid chromatography-tandem mass spectrometry.

RESULTS

The average sleep duration was 8 h and 44 min, with boys sleeping significantly longer (p = 0.01). Notably, 51.7% of participants reported sleeping less than 9 h. The nonlinear effects of phthalate metabolite in association with PSQI were observed for hydroxy-mono-isononyl phthalate (OH-MiNP, p = 0.003) and MnOP (p < 0.001), indicating that the relationship does not follow a simple linear pattern. Simple linear regression revealed a significant positive association between the Mono-n-octyl phthalate (MnOP) and PSQI scores (p = 0.016). After adjustment for place of residence, BMI, CBS, sex, and age, the significance of associations between phthalate metabolites and sleep quality diminished, necessitating cautious interpretation. No statistically significant associations between pubertal changes and the value of PSQI as well as phthalates were observed.

CONCLUSION

Our results provide preliminary evidence of potential nonlinear associations that require validation in a larger cohort. The findings highlight the importance of monitoring phthalate exposure in children, as it may influence sleep patterns and overall health.

The association of parental insomnia symptoms with adolescent insomnia and depressive symptoms: A child-parent dyad study

Intergenerational transmission may be present in adolescents' sleep and mental health problems, but there is limited evidence currently available. The current study aimed to examine the effects of parental insomnia symptoms on adolescent insomnia and depressive symptoms. From 21 April to May 12, 2021, this study conducted a large-scale cross-sectional survey in south China, 68,751 valid child-parent matched data were collected. The current study measured parental insomnia symptoms, adolescent insomnia symptoms, adolescent depressive symptoms, and demographic characteristics. SPSS 27 statistical software was used to perform Chi-square analysis, binary logistic regression, and indirect effect testing. In this sample, maternal and paternal insomnia has a prevalence of 8.2 % and 7.5 %. Among adolescents whose mother or father had insomnia, the prevalence of insomnia reached to 15.7 % and 15.1 %, and the prevalence of depressive symptoms reached to 17.6 % and 15.6 %. Adolescents whose parents have insomnia were more likely to suffer from insomnia and depressive symptoms. Moreover, parents' insomnia positively influences adolescent depressive symptoms through the mediation of the child's insomnia. This study prompts a reevaluation of family health dynamics in clinical practice and public health policy, leading to a more holistic approach to addressing adolescent sleep patterns and depressive symptoms.

Advances in the research of comorbid insomnia and depression: mechanisms, impacts, and interventions

Insomnia and depression, both significantly impacting public health, are common psychosomatic illnesses that frequently co-occur in the same individual. Not only do these two conditions commonly co-occur, but they also exhibit a bidirectional link, where the existence of one may heighten the risk for the other. Latest research offers compelling evidence of significant overlap in biological, psychological, and sociological aspects in the comorbidity of insomnia and depression. Building on this, we aim to examine the pathophysiology of insomnia and depression, along with their comorbid mechanisms, encompassing biological routes (like genetics, HPA axis, immune-inflammatory activation, neuroendocrine regulation, microbiome alterations, and neural circuits integrating sleep and emotion regulation), as well as psychosocial routes. Consequently, proposing a self-perpetuating and mutually reinforcing "snowball effect" model of comorbid insomnia and depression, and examining corresponding preventative intervention strategies to rectify associated imbalances. Finally, this article encapsulates the challenges in this field of study and the directions for future research. Finally, the paper points out the limitations of current research (cross-sectional data being dominant, and the mechanism of multi-omics dynamics being unknown) and the future direction (longitudinal cohort combined with computational modeling to resolve temporal interactions), which will provide a theoretical basis for precision interventions.

Comparison of Logistic Regression and Machine Learning Approaches in Predicting Depressive Symptoms: A National-Based Study

OBJECTIVE

Machine learning (ML) has been reported to have better predictive capability than traditional statistical techniques. The aim of this study was to assess the efficacy of ML algorithms and logistic regression (LR) for predicting depressive symptoms during the COVID-19 pandemic.

METHODS

Analyses were carried out in a national cross-sectional study involving 21,916 participants. The ML algorithms in this study included random forest (RF), support vector machine (SVM), neural network (NN), and gradient boosting machine (GBM) methods. The performance indices were sensitivity, specificity, accuracy, precision, F1-score, and area under the receiver operating characteristic curve (AUC).

RESULTS

LR and NN had the best performance in terms of AUCs. The risk of overfitting was found to be negligible for most ML models except for RF, and GBM obtained the highest sensitivity, specificity, accuracy, precision, and F1-score. Therefore, LR, NN, and GBM models ranked among the best models.

CONCLUSION

Compared with ML models, LR model performed comparably to ML models in predicting depressive symptoms and identifying potential risk factors while also exhibiting a lower risk of overfitting.

Associations of black and sugar-sweetened coffee consumption with depressive symptoms: A longitudinal study of Chinese adolescents

BACKGROUND

Previous research revealed an association between coffee consumption and depressive symptoms. However, the results differed between studies in adults and adolescents. Additionally, limited research on coffee and depressive symptoms has distinguished between black and sugar-sweetened coffee. Furthermore, few studies have examined the potential sex differences in the abovementioned association. This longitudinal study aimed to explore the associations of black and sugar-sweetened coffee consumption with subsequent depressive symptoms in adolescents while also investigating sex disparities within these associations.

METHODS

In this longitudinal study, 10,770 individuals completing standardized questionnaires at baseline and follow-up were included in the main analysis. The data were analyzed using generalized linear mixed-effects models, and subgroup analyses were grouped according to sex.

RESULTS

After adjusting for covariates and baseline depressive symptoms status, adolescents who consumed black coffee daily (OR, 1.45; 95 % CI, 1.14-1.84) had a greater risk of experiencing depressive symptoms compared with those who did not consume it or consumed it monthly. Similarly, in comparison with none or monthly consumers, those who consumed sugar-sweetened coffee weekly (OR, 1.22; 95 % CI, 1.03-1.44) and daily (OR, 1.32; 95 % CI, 1.02-1.73) demonstrated an elevated risk of having depressive symptoms. Subgroup analyses showed that black and sugar-sweetened coffee consumption was associated with depressive symptoms only in males.

LIMITATIONS

Self-reported data on coffee consumption and depressive symptoms.

CONCLUSIONS

Adolescents who consume black or sugar-sweetened coffee weekly or daily are at a higher risk of developing depressive symptoms, with this association appearing to be more pronounced in male adolescents. Future studies are needed to confirm these findings.

Heterogeneity in sleep problems and suicide risk among adults with depression: a cross-sectional study

In this paper, we investigated the relationship between different levels of sleep and the risk of suicide among depressive patients. The sample consisted of 301 adults with depression who were recruited from a hospital in Ningxia, China. The Pittsburgh Sleep Quality Index (PSQI) and the Self-Rating Depression Scale (SDS) were applied to evaluate the quality of sleep and the degree of depression. The Suicidal Risk Factor Assessment Form evaluated suicide risk. A Latent Class Analysis (LCA) has been performed with MPLUS 7.0 to investigate the most probable category of the PSQI sub-scales. Multivariate Logistic Regression was applied to analyse the relation between Sleep Quality and Suicide Hazard in Adult Depressive Patients. Classes identified were "Global sleep impairment", "Poor sleep quality", "Short sleep duration" and "Good sleep quality." Patients with poor overall sleep quality and clear daytime dysfunction had a higher risk of suicide than those with good sleep quality. The results are helpful in understanding the relationship between the variability of sleep patterns and the risk of suicide among depressed people, and it is suggested that some sleep variables may have a higher predictive value than others. The results will provide guidance on how to improve and implement therapy for depressive disorders in adults, and to lower suicidal rates.

Poor Sleep is Common in Treatment-Resistant Late-life Depression and Associated With Poorer Antidepressant Response: Findings From the OPTIMUM Clinical Trial

BACKGROUND

Adults with treatment-resistant late-life depression (TRLLD) have high rates of sleep problems; however, little is known about the occurrence and change in sleep during pharmacotherapy of TRLLD. This analysis examined: (1) the occurrence of insufficient sleep among adults with TRLLD; (2) how sleep changed during pharmacotherapy; and (3) whether treatment outcomes differed among participants with persistent insufficient sleep, worsened sleep, improved sleep, or persistent sufficient sleep.

METHODS

Secondary analysis of data from 634 participants age 60+ years in the OPTIMUM clinical trial for TRLLD. Sleep was assessed using the sleep item from the Montgomery-Asberg Depression Rating Scale at the beginning (week-0) and end (week-10) of treatment. The analyses examined whether treatment outcomes differed among participants with persistent insufficient sleep, worsened sleep, improved sleep, or persistent sufficient sleep during depression treatment.

RESULTS

About half (51%, n = 323) of participants reported insufficient sleep at baseline. Both persistent insufficient sleep (25%, n = 158) and worsened sleep (10%, n = 62) during treatment were associated with antidepressant nonresponse. Participants who maintained sufficient sleep (26%, n = 164) or who improved their sleep (n = 25%, n = 158) were three times more likely to experience a depression response than those with persistent insufficient sleep or worsened sleep.

CONCLUSION

Insufficient sleep is common in TRLLD and it is associated with poorer treatment response to antidepressants.

Association between a healthy lifestyle and the prevalence of depression in radiology residents in China: findings from a nationwide survey

OBJECTIVE

The relationship between a healthy lifestyle and depression in radiology residents remains poorly understood. This study aims to investigate the relationship between a healthy lifestyle and depressive symptoms in radiology residents in a nationwide survey.

DESIGN

Cross-sectional study.

SETTING

The survey was conducted among radiology residents undergoing training in China between December 2020 and April 2021. This encompassed a total of 215 municipalities and 406 training centres.

PARTICIPANTS

3677 radiology residents in 31 provinces of China.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was Healthy Lifestyle Score (HLS). A multiple logistic regression analysis was performed to evaluate the association between lifestyle factors and depressive symptoms. Additionally, the weighted quantile sum (WQS) index was utilised to identify the lifestyle factor that had the greatest impact on depressive symptoms.

RESULTS

The study sample consisted of 3677 participants, among whom the prevalence of depression was 34.7%. Participants were categorised based on their Health Lifestyle Score (HLS) into three groups: low HLS (LHLS), moderate HLS (MHLS) and high HLS (HHLS), with proportions of 8.0%, 79.8% and 12.2%, respectively. Those with LHLS were found to have a significantly higher risk of depression (OR: 5.21, 95% CI: 3.72 to 7.30) and a more severe level of depression (p for trend<0.001) compared with those with HHLS. Furthermore, the Well-being Quality of Life Index (WQS) showed a significant association with depression (OR: 0.34, 95% CI: 0.28 to 0.40), with sleep being identified as the most significant factor contributing to a healthy lifestyle.

CONCLUSION

The study establishes a significant association between an LHLS (long and irregular work hours) and an elevated risk of depressive symptoms among the participants, emphasising the crucial role of sleep in this relationship. These findings underline the importance of promoting a healthy lifestyle, specifically emphasising the need for adequate sleep, among radiology residents.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Screening major depressive disorder in patients with obstructive sleep apnea using single-lead ECG recording during sleep

Objective: A large number of people with obstructive sleep apnea (OSA) also suffer from major depressive disorder (MDD), leading to underdiagnosis due to overlapping symptoms. Polysomnography has been considered to identify MDD. However, limited access to sleep clinics makes this challenging. In this study, we propose a model to detect MDD in people with OSA using an electrocardiogram (ECG) during sleep. Methods: The single-lead ECG data of 32 people with OSA (OSAD-) and 23 with OSA and MDD (OSAD+) were investigated. The first 60 min of their recordings after sleep were segmented into 30-s segments and 13 parameters were extracted: PR, QT, ST, QRS, PP, and RR; mean heart rate; two time-domain HRV parameters: SDNN, RMSSD; and four frequency heart rate variability parameters: LF_power, HF_power, total power, and the ratio of LF_power/HF_power. The mean and standard deviation of these parameters were the input to a support vector machine which was trained to separate OSAD- and OSAD+. Results: The proposed model distinguished between OSAD+ and OSAD- groups with an accuracy of 78.18%, a sensitivity of 73.91%, a specificity of 81.25%, and a precision of 73.91%. Conclusion: This study shows the potential of using only ECG for detecting depression in OSA patients.

Sleep disturbance associated with the menopause

IMPORTANCE AND OBJECTIVES

Sleep disturbance is one of the most common and debilitating symptoms experienced by women during the menopause transition. However, there are currently no therapies specifically approved for sleep disturbance associated with the menopause. Here, we consider how to characterize sleep disturbance associated with the menopause and discuss its etiology, including the latest advances in our understanding of the neuronal circuits that regulate reproduction, body temperature, sleep, and mood; and reflect on its impact on women's health and well-being. We also examine the current treatment landscape and look to the future of treatment for this condition.

METHODS

We conducted a review of the literature and combined this with discussion with experts in the fields of sleep and menopause as well as experiences from our own clinical practices.

DISCUSSION AND CONCLUSIONS

Sleep disturbance associated with the menopause is characterized by frequent night-time awakenings and increased awake time after sleep onset. Its impacts are wide-ranging, negatively affecting health as well as personal and social relationships, productivity, and work performance. There is currently an unmet need for effective, safe, and well-tolerated treatments to address this important symptom, and wider recognition of the association between sleep disturbances and the menopause is needed. Sleep disturbances associated with the menopause can result from hormone changes as well as vasomotor and mood symptoms. Growing research has contributed to our knowledge of the role of hypothalamic estrogen-sensitive kisspeptin/neurokinin B/dynorphin neurons. These neurons are thought to integrate the gonadotropin-releasing hormone pathway and the pathways responsible for the homeostatic control of body temperature and the circadian regulation of sleep-wake cycles. Understanding these neurons offers the potential to create treatments that target a key cause of sleep disturbance associated with the menopause. Further research to understand their etiology and characterize the neuronal circuits responsible could benefit the development of these targeted treatment approaches.

Social support and sleep quality in people with schizophrenia living in the community: the mediating roles of anxiety and depression symptoms

Introduction

Research has demonstrated that higher social support is associated with better psychological health, quality of life, cognition, activities of daily living, and social participation, but the relationship between social support and sleep quality remains unknown. This study aims to investigate the mediating effects of anxiety and depression in the relationship between social support and sleep among community-dwelling patients with schizophrenia.

Method

Purposive sampling was used to collect face-to-face data from 1,107 community-dwelling patients with schizophrenia in Chengdu, Sichuan Province, China, between April and July 2023. The Athens Insomnia Scale (AIS) was used to assess sleep quality; the Generalized Anxiety Disorder 7-item scale (GAD-7) was utilized to evaluate anxiety symptoms; and the Patient Health Questionnaire-9 (PHQ-9) was employed to assess depressive symptoms. The mediating effect of anxiety and depression symptoms was assessed using the bootstrap method via Model 6 (Serial multiple mediator model) of the SPSS PROCESS macro.

Results

Among the 1,107 participants, the proportions of people with schizophrenia experiencing anxiety, depressive symptoms, and poor sleep quality were 22.8, 37.7, and 42.1%, respectively. Mediation analyses indicated that although social support had no direct effect on sleep quality, anxiety and depressive symptoms fully mediated the relationship between social support and sleep quality.

Conclusion

Patients with schizophrenia experience low levels of social support and poor sleep quality. To enhance the sleep quality of individuals with schizophrenia, all levels of society (government, medical institutions, and communities) must pay more attention to mental health. Implementing diverse intervention measures to strengthen social support and improve symptoms of anxiety and depression should be considered. This approach may potentially lead to an improvement in sleep quality among individuals with schizophrenia.

Hyperibone J exerts antidepressant effects by targeting ADK to inhibit microglial P2X7R/TLR4-mediated neuroinflammation

INTRODUCTION

The antidepressant properties of Hypericum species are known. Hyperibone J, a principal component found in the flowers of Hypericum bellum, exhibited in vitro anti-inflammatory effects. However, the antidepressant effects and mechanisms of Hyperibone J remain to be elucidated. Adenosine kinase (ADK) is upregulated in epilepsy and depression and has been implicated in promoting neuroinflammation.

OBJECTIVES

This study aimed to explore the impact of Hyperibone J on neuroinflammation-mediated depression and the mechanism underlying this impact.

METHODS

This study employed acute and chronic in vivo depression models and an in vitro LPS-induced depression model using BV-2 microglia. The in vivo antidepressant efficacy of Hyperibone J was assessed through behavioral assays. Techniques such as RNA-seq, western blot, qPCR and ELISA were utilized to elucidate the direct target and mechanism of action of Hyperibone J.

RESULTS

Compared with the model group, depression-like behaviors were significantly alleviated in the Hyperibone J group. Furthermore, Hyperibone J mitigated hippocampal neuroinflammation and neuronal damage. RNA-seq suggested that Hyperibone J predominantly influenced inflammation-related pathways. In vitro experiments revealed that Hyperibone J reversed the LPS-induced overexpression and release of inflammatory factors. Network pharmacology and various molecular biology experiments revealed that the potential binding of Hyperibone J at the ASN-312 site of ADK diminished the stability and protein expression of ADK. Mechanistic studies revealed that Hyperibone J attenuated the ADK/ATP/P2X7R/Caspase-1-mediated maturation and release of IL-1β. The study also revealed a significant correlation between Tlr4 expression and depression-like behaviors in mice. Hyperibone J downregulated ADK, inhibiting Tlr4 transcription, which in turn reduced the phosphorylation of NF-κB and the subsequent transcription of Nlrp3, Il-1b, Tnf, and Il-6.

CONCLUSION

Hyperibone J exerted antineuroinflammatory and antidepressant effects by binding to ADK in microglia, reducing its expression and thereby inhibiting the ATP/P2X7R/Caspase-1 and TLR4/NF-κB pathways. This study provides experimental evidence for the therapeutic potential of Hypericum bellum.

Association of depressive symptoms and sleep disturbances with survival among US adult cancer survivors

BACKGROUND

Depression and sleep disturbances are associated with increased risks of various diseases and mortality, but their impacts on mortality in cancer survivors remain unclear. The objective of this study was to characterize the independent and joint associations of depressive symptoms and sleep disturbances with mortality outcomes in cancer survivors.

METHODS

This population-based prospective cohort study included cancer survivors aged ≥ 20 years (n = 2947; weighted population, 21,003,811) from the National Health and Nutrition Examination Survey (NHANES) 2007-2018 cycles. Depressive symptoms and sleep disturbances were self-reported. Depressive symptoms were assessed using the Patient Health Questionnaire 9 (PHQ-9). Death outcomes were determined by correlation with National Death Index records through December 31, 2019. Primary outcomes included all-cause, cancer-specific, and noncancer mortality.

RESULTS

During the median follow-up of 69 months (interquartile range, 37-109 months), 686 deaths occurred: 240 participants died from cancer, 146 from heart disease, and 300 from other causes. Separate analyses revealed that compared with a PHQ-9 score (0-4), a PHQ-9 score (5-9) was associated with a greater risk of all-cause mortality (hazard ratio [HR], 1.28; 95% CI, 1.03-1.59), and a PHQ-9 score (≥ 10) was associated with greater risk of all-cause mortality (HR, 1.37; 95% CI, 1.04-1.80) and noncancer mortality (HR, 1.45; 95% CI, 1.01-2.10). Single sleep disturbances were not associated with mortality risk. In joint analyses, the combination of a PHQ-9 score ≥ 5 and no sleep disturbances, but not sleep disturbances, was associated with increased risks of all-cause mortality, cancer-specific mortality, and noncancer mortality. Specifically, compared with individuals with a PHQ-9 score of 0-4 and no sleep disturbances, HRs for all-cause mortality and noncancer mortality in individuals with a PHQ-9 score of 5-9 and no sleep disturbances were 1.72 (1.21-2.44) and 1.69 (1.10-2.61), respectively, and 2.61 (1.43-4.78) and 2.77 (1.27-6.07), respectively, in individuals with a PHQ-9 score ≥ 10 and no sleep disturbances; HRs for cancer-specific mortality in individuals with a PHQ-9 score ≥ 5 and no sleep disturbances were 1.95 (1.16-3.27).

CONCLUSIONS

Depressive symptoms were linked to a high risk of mortality in cancer survivors. The combination of a PHQ-9 score (≥ 5) and an absence of self-perceived sleep disturbances was associated with greater all-cause mortality, cancer-specific mortality, and noncancer mortality risks, particularly in individuals with a PHQ-9 score (≥ 10).

Reduced coupling between global signal and cerebrospinal fluid inflow in patients with depressive disorder: A resting state functional MRI study

BACKGROUND

Depressed patients often suffer from sleep disturbance, which has been recognized to be responsible for glymphatic dysfunction. The purpose of this study was to investigate the coupling strength of global blood‑oxygen-level-dependent (gBOLD) signals and cerebrospinal fluid (CSF) inflow dynamics, which is a biomarker for glymphatic function, in depressed patients and to explore its potential relationship with sleep disturbance by using resting-state functional MRI.

METHODS

A total of 138 depressed patients (112 females, age: 34.70 ± 13.11 years) and 84 healthy controls (29 females, age: 36.6 ± 11.75 years) participated in this study. The gBOLD-CSF coupling strength was calculated to evaluate glymphatic function. Sleep disturbance was evaluated using the insomnia items (item 4 for insomnia-early, item 5 for insomnia-middle, and item 6 for insomnia-late) of The 17-item Hamilton Depression Rating Scale for depressed patients, which was correlated with the gBOLD-CSF coupling strength.

RESULTS

The depressed patients exhibited weaker gBOLD-CSF coupling relative to healthy controls (p = 0.022), possibly due to impairment of the glymphatic system. Moreover, the gBOLD-CSF coupling strength correlated with insomnia-middle (r = 0.097, p = 0.008) in depressed patients. Limitations This study is a cross-sectional study.

CONCLUSION

Our findings shed light on the pathophysiology of depression, indicating that cerebral waste clearance system deficits are correlated with poor sleep quality in depressed patients.

Sleep architecture and the incidence of depressive symptoms in middle-aged and older adults: A community-based study

BACKGROUND

Rapid eye movement (REM) sleep and three stages of non-REM (NREM) sleep comprise the full sleep cycle. The changes in sleep have been linked to depression risk. This study aimed to explore the association between sleep architecture and depressive symptoms.

METHODS

A total of 3247 participants from the Sleep Heart Health Study (SHHS) were included in this cohort study. REM and NREM sleep were monitored by in-home polysomnography at SHHS visit 1. Depressive symptoms was reported as the first occurrence between SHHS visits 1 and 2 (mean follow-up of 5.3 years). Multivariable logistic regression was used to investigate the relationship between sleep stages and depressive symptoms.

RESULTS

In total, 225 cases of depressive symptoms (6.9 %) were observed between SHHS visits 1 and 2. A significant linear association between NREM Stage 1 and depressive symptoms was found after adjusting for potential covariates. Multivariable logistic regression analysis showed that percentage in NREM Stage 1 was associated with the incidence of depressive symptoms (odds ratio [OR], 1.06; 95 % confidence interval [CI], 1.02-1.10; P = 0.001), as were time in NREM Stage 1 and depressive symptoms (OR, 1.02; 95 % CI, 1.01-1.03; P = 0.001). However, no significant association with depressive symptoms was found for other sleep stage.

LIMITATIONS

The specific follow-up time for depressive symptoms diagnosis was missing.

CONCLUSIONS

Increased time or percentage in NREM Stage 1 was associated with a higher risk of developing depressive symptoms. The early change in sleep architecture were important for incidence of depressive symptoms and warrants constant concerns.

Vitamin B6 alleviates chronic sleep deprivation-induced hippocampal ferroptosis through CBS/GSH/GPX4 pathway

Several studies have found that sleep deprivation (SD) can lead to neuronal ferroptosis and affect hippocampal function. However, there are currently no effective interventions. Vitamin B6 is a co-factor for key enzymes in the transsulfuration pathway which is critical for maintaining cell growth in the presence of cysteine deprivation. The results showed that SD inhibited cystine-glutamate antiporter light chain subunit xCT protein expression and caused cysteine deficiency, which reduced the synthesis of the glutathione (GSH) to trigger neuronal ferroptosis. Nissl staining further revealed significant neuronal loss and shrinkage in the CA1 and CA3 regions of the hippocampus in SD mice. Typical ferroptotic indicators characterized by lipid peroxidation and iron accumulation were showed in the hippocampus after sleep deprivation. As expected, vitamin B6 could alleviate hippocampal ferroptosis by upregulating the expression of cystathionine beta-synthase (CBS) in the transsulfuration pathway, thereby replenishing the intracellular deficient GSH and restoring the expression of GPX4. Similar anti-ferroptotic effects of vitamin B6 were demonstrated in HT-22 cells treated with ferroptosis activator erastin. Furthermore, vitamin B6 had no inhibitory effect on erastin-induced ferroptosis in CBS-knockout HT22 cells. Our findings suggested chronic sleep deprivation caused hippocampal ferroptosis by disrupting the cyst(e)ine/GSH/GPX4 axis. Vitamin B6 alleviated sleep deprivation-induced ferroptosis by enhancing CBS expression in the transsulfuration pathway.

Vitamin D Deficiency Exacerbates Poor Sleep Outcomes with Endocrine-Disrupting Chemicals Exposure: A Large American Population Study

Phthalates and bisphenol A are recognized as the predominant endocrine-disrupting substances (EDCs) in the environment, but their impact on sleep health remains unclear. Vitamin D has often been reported to play a role in sleep health and may be affected by endocrine-disrupting compounds. The study utilized data from 5476 individuals in the NHANES project to investigate the correlation between combined exposure to environmental EDCs and sleep duration through modeling various exposures. Furthermore, it emphasizes the importance of vitamin D in the present scenario. Preliminary analyses suggested that vitamin D-deficient individuals generally slept shorter than individuals with normal vitamin D (p < 0.05). Exposure to Mono-ethyl phthalate (MEP), triclosan (TRS), and Mono-benzyl phthalate (MZP), either alone or in combination, was associated with reduced sleep duration and a greater risk of vitamin D deficiency. Individuals with low vitamin D levels exposed to TRS experienced shorter sleep duration than those with normal vitamin D levels (p < 0.05). TRS and MZP were identified as crucial factors in patient outcomes when evaluating mixed exposures (p < 0.05). The results provide new data supporting a link between exposure to EDCs and insufficient sleep length. Additionally, they imply that a vitamin D shortage may worsen the sleep problems induced by EDCs.

LSD increases sleep duration the night after microdosing

Microdosing psychedelic drugs at a level below the threshold to induce hallucinations is an increasingly common lifestyle practice. However, the effects of microdosing on sleep have not been previously reported. Here, we report results from a Phase 1 randomized controlled trial in which 80 healthy adult male volunteers received a 6-week course of either LSD (10 µg) or placebo with doses self-administered every third day. Participants used a commercially available sleep/activity tracker for the duration of the trial. Data from 3231 nights of sleep showed that on the night after microdosing, participants in the LSD group slept an extra 24.3 min per night (95% Confidence Interval 10.3-38.3 min) compared to placebo-with no reductions of sleep observed on the dosing day itself. There were no changes in the proportion of time spent in various sleep stages or in participant physical activity. These results show a clear modification of the physiological sleep requirements in healthy male volunteers who microdose LSD. The clear, clinically significant changes in objective measurements of sleep observed are difficult to explain as a placebo effect. Trial registration: Australian New Zealand Clinical Trials Registry: A randomized, double-blind, placebo-controlled trial of repeated microdoses of lysergic acid diethylamide (LSD) in healthy volunteers; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381476 ; ACTRN12621000436875.

The effect of weighted blankets on sleep and related disorders: a brief review

Background

Sleep disorders such as insomnia can lead to a range of health problems. The high risk of side effects and drug abuse of traditional pharmacotherapy calls for a safer non-pharmacotherapy.

Aims

To examine the use and efficacy of weighted blankets in improving sleep and related disorders in different populations and explore the possible mechanisms.

Methods

A literature search was conducted using PubMed, Embase, Web of Science, MEDLINE, Cochrane Library and CNKI databases. Eligible studies included an intervention with weighted blankets and outcomes covering sleep and/or related disorders (behavioral disturbance, negative emotions and daytime symptoms). Studies using other deep pressure, compression, or exercise-related interventions were excluded.

Conclusions

Most of the included studies showed that weighted blankets could effectively improve sleep quality and alleviate negative emotions and daytime symptoms in patients with sleep disorders, attention deficit hyperactivity disorder, autism spectrum disorder, and other related disorders, with a possible mechanism of deep pressure touch.

Recommendations

Weighted blankets might be a promising tool for sleep interventions among individuals with sleep disorders in clinical settings. More high-quality and large-scale randomized controlled trials are needed to further validate the safety and efficacy of weighted blankets and explore precise mechanisms.

Associations between insomnia symptoms and inflammatory cytokines in adolescents with first-episode and recurrent major depressive disorder

BACKGROUND

Insomnia symptoms are often associated with increased levels of inflammatory biomarkers. However, such associations have not been adequately explored in adolescents with major depressive disorder (MDD). This study aimed to examine the associations between insomnia symptoms with inflammatory cytokines in adolescents with first-episode and recurrent MDD.

METHODS

From January to December 2021, this study included 164 adolescents with MDD and 76 healthy controls (HCs). The Center for Epidemiological Studies Depression Scale (CES-D) and the Insomnia Severity Index Scale (ISI) were used to assess depressive and insomnia symptoms, respectively. Also, plasma levels of interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-17 A and tumor necrosis factor-α (TNF-α) were measured.

RESULTS

The prevalence of mild, moderate and severe insomnia in adolescents with MDD was 40.24 %, 36.59 % and 6.71 %, respectively. The patients had higher levels of IL-1β, IL-6 and TNF-α than HCs (all p < 0.05). ISI score was positively correlated with CES-D score and levels of IL-1β, IL-6 and TNF-α in first-episode patients but not in recurrent patients. A further multivariate stepwise linear regression analysis showed that ISI score was independently associated with CES-D score (beta = 0.523, t = 5.833, p < 0.001) and TNF-α levels (beta = 0.254, t = 2.832, p = 0.006).

LIMITATIONS

The cross-sectional design leads to failure to make causal inferences.

CONCLUSION

Insomnia symptoms are common in adolescents with MDD and associated with elevated levels of inflammatory cytokines in first-episode patients. The findings suggest that inflammatory cytokines may relate to the pathogenesis of insomnia symptoms in adolescents with MDD, but further longitudinal studies are needed to explore the causal association between insomnia symptoms and inflammatory cytokines in MDD.

Hierarchy of demographic and social determinants of mental health: analysis of cross-sectional survey data from the Global Mind Project

OBJECTIVES

To understand the extent to which various demographic and social determinants predict mental health status and their relative hierarchy of predictive power in order to prioritise and develop population-based preventative approaches.

DESIGN

Cross-sectional analysis of survey data.

SETTING

Internet-based survey from 32 countries across North America, Europe, Latin America, Middle East and North Africa, Sub-Saharan Africa, South Asia and Australia, collected between April 2020 and December 2021.

PARTICIPANTS

270 000 adults aged 18-85+ years who participated in the Global Mind Project.

OUTCOME MEASURES

We used 120+ demographic and social determinants to predict aggregate mental health status and scores of individuals (mental health quotient (MHQ)) and determine their relative predictive influence using various machine learning models including gradient boosting and random forest classification for various demographic stratifications by age, gender, geographical region and language. Outcomes reported include model performance metrics of accuracy, precision, recall, F1 scores and importance of individual factors determined by reduction in the squared error attributable to that factor.

RESULTS

Across all demographic classification models, 80% of those with negative MHQs were correctly identified, while regression models predicted specific MHQ scores within ±15% of the position on the scale. Predictions were higher for older ages (0.9+ accuracy, 0.9+ F1 Score; 65+ years) and poorer for younger ages (0.68 accuracy, 0.68 F1 Score; 18-24 years). Across all age groups, genders, regions and language groups, lack of social interaction and sufficient sleep were several times more important than all other factors. For younger ages (18-24 years), other highly predictive factors included cyberbullying and sexual abuse while not being able to work was high for ages 45-54 years.

CONCLUSION

Social determinants of traumas, adversities and lifestyle can account for 60%-90% of mental health challenges. However, additional factors are at play, particularly for younger ages, that are not included in these data and need further investigation.

Cortical signatures of sleep are altered following effective deep brain stimulation for depression

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.

Depressive symptoms and sleep duration in relation to chronic kidney disease: Evidence from the China health and retirement longitudinal study

OBJECTIVE

Nowadays, the joint effects of depressive symptoms and sleep duration on the risk of chronic kidney disease (CKD) are still unclear. We aimed to prospectively assess the combined effect of depressive symptoms and sleep duration on the incidence of CKD in middle-aged and elderly Chinese population.

METHODS

A total of 10,953 participants from the China Health and Retirement Longitudinal Study (CHARLS) were included. Depressive symptoms were measured using the 10-item Center for Epidemiological Studies Depression scale (CESD-10). Sleep duration was evaluated by self-reported. CKD events were based on self-reported physicians' diagnosis or personal estimate glomerular filtration rate level (eGFR <60 mL/min/1.73 m2). Cox regression models were established to analyze the correlation between depressive symptoms, sleep duration and the risk of CKD.

RESULTS

Over a mean follow-up time was 6.76 ± 0.98 years, 851 (7.8%) participants had reported CKD events during the follow-up. Elevated depressive symptoms (HR = 1.65, 95% CI = 1.43-1.90) and short sleep duration (HR = 1.48, 95% CI = 1.27-1.72) were independently associated with an increased CKD risk after adjusting for potential confounding factors. Participants with short sleep duration (< 6 h)/elevated depressive symptoms (HR = 2.24, 95% CI = 1.89-2.65) were associated with the highest risk of CKD than those with normal sleep duration/low depressive symptoms.

CONCLUSIONS

Elevated depressive symptoms and short sleep duration were independent risk factors for CKD. There was a combined effect between depressive symptoms and sleep duration in increasing the risk of CKD.

Long-Term Consumption of Green Tea Can Reduce the Degree of Depression in Postmenopausal Women by Increasing Estradiol

Postmenopausal women face a higher risk of depression due to a combination of social and physiological factors. As a beverage rich in a variety of bioactive substances, green tea has significant effects on metabolism, inflammation and endocrine, and may reduce the risk of depression, but few studies have looked at the effects of green tea on postmenopausal women. Therefore, we designed this study to investigate the effects of long-term green tea consumption on inflammation, endocrine and depression levels in postmenopausal women. We investigated a tea-producing village and eventually included 386 postmenopausal women, both in the tea drinking and control groups. The results showed that there were significant differences in the degree of insomnia, degree of depression, BMI, SII and estradiol between the two groups. And, green tea consumption may reduce the risk of depression through the mediating pathway of sleep, SII and estradiol. In summary, long-term green tea consumption can reduce the risk of depression in postmenopausal women by reducing inflammation and increasing estradiol. This kind of living habit deserves further promotion.

Investigation on sleep quality and psychological distress in patients with pulmonary nodules

BACKGROUND

Patients with pulmonary nodules (PNs) often suffer from the psychological burden of their disease and trap in sleep problems. This is insufficiently identified and addressed in clinical practice. The aim of this study was to investigate the psychological distress and sleep quality among PN patients and identify potential risk or protective factors for sleep quality.

METHODS

We conducted a cross-sectional study, which included 731 PN patients who visited the thoracic clinic of Guangdong Provincial People's Hospital. Each participant completed a structured questionnaire consisting of demographic characteristics, clinical characteristics, the Hospital Anxiety and Depression Scale (HADS) and the Pittsburgh Sleep Quality Index (PSQI). The reliability of the HADS (Cronbach's α = 0.944) and PSQI (Cronbach's α = 0. 0.757) in this study was satisfactory.

RESULTS

A total of 328 patients (44.9%) had PSQI global scores > 5, indicating poor quality of sleep. Age ≥ 50 years (OR 1.88, 95% CI 1.35-2.58; P < 0.001), female (OR 1.56, 95% CI 1.05-2.33; P = 0.028), detection of nodule for 7-12 months (vs for more than 24 months, OR 2.14, 95%CI 1.18-3.89, P = 0.013), anxiety (OR 1.78, 95% CI 1.17-2.71; P = 0.007) and depression (OR 1.84, 95% CI 1.16-2.92; P = 0.010) were independent risk factors for impaired sleep quality. A significant correlation revealed that sleep quality was positively correlated with both anxiety and depression (Spearman r = 0.342, P < 0.001 and Spearman r = 0.314, P < 0.001, respectively). All dimensions of the PSQI scale were significantly decreased in both anxiety group and depression group compared to the psychologically normal group (P < 0.05).

CONCLUSIONS

Impaired sleep quality is highly prevalent among patients with PNs and associated with age, gender, time from the date of detection, anxiety and depression. Based on the finding of impaired sleep quality and psychological health, screening for psychological and sleep problems in PN patients will be of great clinical benefit.

Modifiable risk factors of major depressive disorder: A Mendelian randomization study

Identifying modifiable risk factors early on is essential to prevent major depressive disorder (MDD). This study systematically investigated the causal relationship between 19 modifiable risk factors and MDD. Single-nucleotide polymorphisms (SNPs) associated with 19 potentially modifiable risk factors were screened via the genome-wide association study (GWAS) enrolling individuals of European descent. Summary-level data for MDD (59,851 cases and 113,154 controls) were extracted from the UK Biobank. The inverse-variance-weighted (IVW) method was utilized as the primary analysis. Sensitivity analyses were performed using the MR-Egger method, the Maximum likelihood method, the MR-pleiotropy residual sum outlier (MR-PRESSO) method, and MR-robust adjusted profile score (MR-RAPS) method. MR-Egger regression, heterogeneity tests, pleiotropy tests, and leave-one-out tests were also performed to analyze sensitivity. The MR Steiger test was used to verify the directionality of the exposure to the outcome. Genetically predicted smoking initiation increased the risk of MDD (P = 6.00E-09), while smoking status: never and past tobacco smoking decreased the risk of MDD (all P < 0.01). In addition, education level was inversely associated with MDD risk (all P < 0.01). Genetically instrumented sleeplessness/insomnia, daytime naps, and nap during the day were positively related to the risk of MDD (all P < 0.01). Personal feelings, including guilt, hurt, tension, and worry too long after an embarrassing experience, had a suggestive increased risk for MDD (all P < 0.000). The remaining five modifiable risk factors were all causally associated with the risk of MDD, including neuroticism, neuroticism scores, body mass index (BMI), average total household income before tax, and types of physical activity in the last 4 weeks (all P < 0.01). All 19 potentially modifiable risk factors were causally associated with the risk of MDD. The main hypothesis of this MR study was that identifying and intervening in these 19 potentially modifiable risk factors could be beneficial to the prevention and treatment of MDD and further reduce mortality and economic burden.

Identification of major depression patients using machine learning models based on heart rate variability during sleep stages for pre-hospital screening

With the COVID-19 pandemic causing challenges in hospital admissions globally, the role of home health monitoring in aiding the diagnosis of mental health disorders has become increasingly important. This paper proposes an interpretable machine learning solution to optimise initial screening for major depressive disorder (MDD) in both male and female patients. The data is from the Stanford Technical Analysis and Sleep Genome Study (STAGES). We analyzed 5-min short-term electrocardiogram (ECG) signals during nighttime sleep stages of 40 MDD patients and 40 healthy controls, with a 1:1 gender ratio. After preprocessing, we calculated the time-frequency parameters of heart rate variability (HRV) based on the ECG signals and used common machine learning algorithms for classification, along with feature importance analysis for global decision analysis. Ultimately, the Bayesian optimised extremely randomized trees classifier (BO-ERTC) showed the best performance on this dataset (accuracy 86.32%, specificity 86.49%, sensitivity 85.85%, F1-score 0.86). By using feature importance analysis on the cases confirmed by BO-ERTC, we found that gender is one of the most important factors affecting the prediction of the model, which should not be overlooked in our assisted diagnosis. This method can be embedded in portable ECG monitoring systems and is consistent with the literature results.

Depression and lifestyle: Focusing on nutrition, exercise, and their possible relevance to molecular mechanisms

Accumulating evidence has suggested the important role of lifestyle factors in depressive disorder. This paper aimed to introduce and outline recent research on epidemiological and intervention studies on lifestyle-related factors in depressive disorder with a special focus on diet. Evidence on exercise, sleep. and related behaviors is also described. Here, findings from meta-analytic studies are emphasized and related studies by the author's research group are introduced. Dietary factors that increase the risk of the illness include energy overload, skipping breakfast, unhealthy diet styles such as Western diet, inflammation-prone diet, and high consumption of ultraprocessed food (UPF). Nutritional imbalances such as inadequate intake of protein, fish (Ω3 polyunsaturated fatty acids), vitamins (folate and vitamin D), and minerals (iron and zinc) increases the risk of depression. Poor oral hygiene, food allergy, addiction to alcohol, and smoking constitute risk factors. Sedentary lifestyle and increased screen time (e.g. video games and the internet) confer the risk of depression. Insomnia and disturbed sleep-wake rhythm are also involved in the pathogenesis of depression. There is accumulating evidence at the meta-analysis level for interventions to modify these lifestyle habits in the protection and treatment of depressive disorder. Main biological mechanisms of the link between lifestyle factors and depression include monoamine imbalance, inflammation, altered stress response, oxidative stress, and dysfunction of brain-derived neurotrophic factor, although other players such as insulin, leptin, and orexin also play a role. To increase resilience to modern stress and ameliorate depression through modification of lifestyle habits, a list of 30 recommendable interventions is presented.

Assessment of sleep quality and its factors among clinicians working in critical care units and operation theaters at North West Ethiopia, 2022: a multicenter cross-sectional study

The quality of sleep has an effect on the health of clinicians and the quality of patient care. Maintaining cognitive function/mood, facilitation of glucose metabolism, and strengthening of the immune system are among the roles that adequate sleep may contribute. Poor sleep quality is multifactorial, and studies had shown inconsistencies in the factors that contribute to the development of this poor sleep quality. The prevalence of poor sleep quality among clinicians working in the critical care unit and operation theater in the study setting was not investigated yet.

OBJECTIVE

The objective of this study was conducted for the purpose of assessing the quality of sleep and associated factors among clinicians working in the critical care unit and operation theater.

METHODS

A cross-sectional study was conducted from 15 May to 15 June 2022. Data were collected using a self-administered questionnaire from 421 clinicians selected by simple random sampling techniques. Sleep quality was measured by the Pittsburg sleep quality index. The data were entered into Epi-data and exported to SPSS. Frequency and percentage were used for the descriptive analysis. Binary and multivariate logistic regression analysis were used to identify factors associated with poor quality of sleep. The strength of the association was measured with an OR within the 95% CI and P-value of <0.05.

RESULT

About half 220 (52.3%) of the study participants age between 25 and 30 year old and the majority 321 (76.2%) of them were males. The prevalence of poor sleeps quality was 81.5% (95% CI: 77.9-85.5). Working night shift (AOR: 3.37, 95% CI: 1.754-6.484), having depressive symptoms (AOR: 3.25, 95% CI: 1.485-7.147) and having no regular exercises (AOR: 0.299, 95% CI: 0.166-0.537) were predisposing factors for poor sleep quality.

CONCLUSION AND RECOMMENDATION

The prevalence of poor sleep quality among clinicians working in the ICU and operation room was high. Clinicians who had no regular exercise, who worked in night shift, and who had depressive symptoms were associated with poor quality of sleep. Clinicians should have an awareness on the symptoms of depression, implement sleep hygiene education programs and promoting regular exercise. The authors recommend healthcare policy makers for improving working schedules.

Downregulation of microRNA-330-5p induces manic-like behaviors in REM sleep-deprived rats by enhancing tyrosine hydroxylase expression

AIM

In our pilot study, we found an increase in tyrosine hydroxylase (Th) mRNA expression in the prefrontal cortex of 72-h REM sleep-deprived (SD) rats, a mania model. Additionally, the expression levels of miR-325-3p, miR-326-3p, and miR-330-5p, the predicted target miRNAs on TH, were significantly decreased. Based on these results, in this study, we investigated whether miRNA-325-3p, miR-326-3p, and miR-330-5p modulate TH and manic-like behaviors in SD rats.

METHODS

Manic-like behaviors were assessed using the open field test (OFT) and elevated plus-maze (EPM) test. The direct binding activity of miRNAs to the 3'-untranslated region (3'-UTR) of the Th gene was measured in HEK-293 cells using a luciferase reporter system. We also examined mRNA and protein expression of TH after intracerebroventricular (ICV) injection of miR-330-5p agomir to SD rats, along with manic-like behaviors.

RESULTS

We observed an upregulation in mRNA and protein expression of TH and downregulation in miRNA-325-3p, miR-326-3p, and miR-330-5p expressions in the prefrontal cortex of SD rats, together with increased manic-like behaviors. The luciferase reporter assay showed that miR-330-5p could repress TH expression through direct binding to its target site in the 3'-UTR of Th, whereas miR-326-3p and miR-330-5p could not. In addition, ICV injection of miR-330-5p agomir alleviated the increase in TH expression in the prefrontal cortex of SD rats and manic-like behaviors.

CONCLUSIONS

TH expression regulation through miR-330-5p may be implicated in the pathophysiology of mania in SD rats.

Association between sleep problems and multimorbidity patterns in older adults

BACKGROUND

Sleep problems are frequent in older adults and are associated with chronic diseases. However, the association with multimorbidity patterns is still unknown. Considering the negative impacts that multimorbidity patterns can have on older adults' life, knowledge of this association can help in the screening and early identification of older adults with sleep problems. The objective was to verify the association between sleep problems and multimorbidity patterns in older Brazilian adults.

METHODS

This was a cross-sectional study conducted with data from 22,728 community-dwelling older adults from the 2019 National Health Survey. The exposure variable was self-reported sleep problems (yes/no). The study outcomes were: multimorbidity patterns, analyzed by self-report of the coexistence of two or more chronic diseases with similar clinical characteristics: (1) cardiopulmonary; (2) vascular-metabolic; (3) musculoskeletal; (4) coexisting patterns.

RESULTS

Older adults with sleep problems had 1.34 (95%CI: 1.21; 1.48), 1.62 (95%CI: 1.15; 2.28), 1.64 (95%CI: 1.39; 1.93), and 1.88 (95%CI: 1.52; 2.33) greater odds of presenting vascular-metabolic, cardiopulmonary, musculoskeletal, and coexisting patterns, respectively.

CONCLUSIONS

These results suggest that public health programs aimed at preventing sleep problems in older adults are essential to reduce possible adverse health outcomes, including multimorbidity patterns and their negative consequences for older adults' health.

Sleep quality, social rhythms, and depression among people living with HIV: a path analysis based on social zeitgeber theory

Background

People living with HIV frequently report sleep disturbances. The social zeitgeber theory, which proposes that stressful life events can interfere with sleep and even depression by destabilizing daily routines, provides new insights into identifying predictors of sleep disturbances and improving sleep in people living with HIV.

Objective

To explain the pathways affecting sleep quality in people living with HIV based on social zeitgeber theory.

Methods

A cross-sectional study was conducted to assess sleep quality, social rhythms, depression, social support, and coping styles from December 2020 to February 2021. The hypothetical model was tested and respecified by performing path analysis and a bias-corrected bootstrapping method using IBM AMOS 24 software. The report of this study followed the STROBE checklist.

Results

A total of 737 people living with HIV participated in the study. The final model presented a good fit (goodness of fit = 0.999, adjusted goodness of fit index = 0.984, normed fit index = 0.996, comparative fit index = 0.998, Tucker-Lewis index = 0.988, root mean square error of approximation = 0.030, chi-squared/degree of freedom = 1.646), explaining 32.3% of the variance in sleep quality among people living with HIV. Lower social rhythm stability was directly associated with poorer sleep quality, and depression mediated the relationship between social rhythms and sleep quality. Social support and coping styles affected sleep quality through social rhythms and depression.

Limitation

The cross-sectional study design precludes making assumptions about causality among factors.

Conclusion

This study validates and extends the applicability of the social zeitgeber theory in the HIV context. Social rhythms have direct and indirect effects on sleep. Social rhythms, sleep, and depression is not simply linked in a cascading sequence but is theoretically linked in a complex way. More studies are needed to explore the predictors of social rhythms, and interventions for stabilizing social rhythms have the potential to alleviate sleep disturbances and depression in people living with HIV.

Depression and anxiety in peruvian military personnel during the pandemic context: a cross-sectional study

BACKGROUND

During the COVID-19 pandemic, increased workload and stress could have increased mental health problems (anxiety and depression) in military personnel. However, the number of studies in military members is scarce, especially in regard to mental health. The objective of this study was determine the prevalence and factors associated with depression and anxiety in Peruvian military personnel.

METHODS

We undertook an analytical cross-sectional study. The survey was distributed face to face between November 02 and 09, 2021, during the second wave of the COVID-19 pandemic among the military personnel. We used some instruments to measure depression (Patient Health Questionnaire, PHQ-9), anxiety (Generalized Anxiety Disorder, GAD-7), insomnia (Insomnia Severity Index, ISI), food insecurity (Household Food Insecurity Access Scale, HFIAS), physical activity (International Physical Activity Questionnaires, IPAQ-S), resilience (abbreviated CD-RISC), and fear of COVID-19 scale. The exclusion criteria included those who did not completely fill out the evaluation instruments.

RESULTS

We analyzed the data of 615 military personnel that participated in the survey. Of them, 93.7% were male and the median age was 22 years old. There was a prevalence of 29.9% and 22.0% in regard to depression and anxiety symptoms, respectively. In addition, it was found that being married (PR: 0.63; 95% IC: 0.42-0.94), having a relative with mental health problems (PR: 2.16), having experienced food insecurity (PR: 1.48), insomnia (PR: 2.71), fear of COVID-19 (PR: 1.48), and a high level of resilience (PR: 0.65) were factors associated with depression. In regard to anxiety, the factors associated were working for more than 18 months since the beginning of the COVID-19 pandemic (PR: 0.52), a high level of resilience (PR: 0.50; 95% IC: 0.33-0.77), insomnia (PR: 3.32), fear of COVID-19 (PR: 2.43).

CONCLUSION

We found a prevalence of symptoms of depression and anxiety of 29.9% and 22.0%, respectively. In regard to the factors that attenuate depression, we can mention being married and having resilience; and among the aggravating factors, having a relative with mental health problems, food insecurity, insomnia, and fear of COVID-19. Finally, anxiety increased through working time, insomnia, and fear of COVID-19.

Hypnotic Medications as an Adjunct Treatment to Cognitive Behavioral Therapy for Insomnia

Cognitive behavioral therapy for insomnia (CBT-I) is the universally recommended treatment of choice for insomnia disorder based on its safety and posttreatment durability of benefit. However, CBT-I does not help all patients achieve remission. The second most evidence-based treatment, hypnotic pharmacotherapy (PCT), does not resolve perpetuating factors of insomnia, resulting in potential waning of benefit and dependence. This article presents a rationale that supports consideration of hypnotic augmentation of CBT-I (COMB), along with a review of select randomized controlled trials relevant to clinical decision-making.

Association between psychotropic medication and sleep microstructure: evidence from large population studies

STUDY OBJECTIVES

To assess the association between psychotropic medications and sleep microstructure in large community-based cohorts of older people.

METHODS

We analyzed overnight polysomnograms of 381 women from the Study of Osteoporotic Fractures (SOF) and 2,657 men from the Osteoporotic Fractures in Men Sleep Study (MrOS), who either used no psychotropic medication (n = 2,819), only benzodiazepines (n = 112), or only selective serotonin reuptake inhibitors (SSRI) (n = 107). Sleep microstructure (cyclic alternating pattern, CAP) was compared between the no medication group and psychotropic medication groups using the Mann-Whitney U test. Significant differences were investigated using multivariable linear regression adjusted for confounders.

RESULTS

CAP rate, arousal index, apnea-hypopnea index, and the frequency of slow, low-amplitude electroencephalography activation phases were significantly lower in MrOS participants using benzodiazepines than participants not taking psychotropic medication. SSRI users in MrOS experienced no altered sleep microstructure compared to those with no psychotropic use. SOF participants using benzodiazepines did not show similar associations with sleep microstructure. However, SSRI users from SOF had a significantly higher frequency of rapid, high-amplitude electroencephalography activation phases (A2 + 3) and periodic limb-movement index than participants not taking psychotropic medication. Multivariable linear regression adjusted for demographic, lifestyle, mood disorders, and health variables indicated additional significant associations between benzodiazepine usage and CAP rate and A2 + 3 index, respectively, in older men, and between CAP rate and SSRI usage in older women.

CONCLUSIONS

We identified significant associations between sleep microstructure and psychotropic drugs in MrOS and SOF, highlighting the importance of comprehensive sleep analysis, including CAP. Our results may improve understanding of the differences in sleep-wake mechanisms based on psychotropic usage.

CLINICAL TRIAL REGISTRATION

Registry: ClinicalTrials.gov; Title: Outcomes of Sleep Disorders in Older Men; Identifier: NCT00070681; URL: https://clinicaltrials.gov/ct2/show/record/NCT00070681.

CITATION

Hartmann S, Parrino L, Ensrud K, et al. Association between psychotropic medication and sleep microstructure: evidence from large population studies. J Clin Sleep Med. 2023;19(3):581-589.

Factors associated with poor sleep quality in patients with pre-dialysis chronic kidney disease: A systematic review

AIMS

To determine factors associated with poor sleep quality among patients with pre-dialysis chronic kidney disease.

DESIGN

This is a systematic review study guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements and checklist.

DATA SOURCES

Empirical evidence was sought in major electronic databases, including Embase, MEDLINE, CINAHL and Airiti library from March to September 2022.

REVIEW METHODS

Studies investigating factors associated with poor sleep quality among adult patients with chronic kidney disease were included. Study participants who received renal replacement therapy and had sleep disorders and serious illnesses such as cancer were excluded. Of the 526 studies that resulted from the search after removing duplicate articles, 20 studies were assessed for quality by using Joanna Briggs Institute and Newcastle-Ottawa Scale by two doctorial prepared nursing scientists.

RESULTS

A total of 20 studies were included in this review. The prevalence of poor sleep quality in these studies ranged from 11% to 97.5%. Demographics (older age and female), physiological conditions (higher body mass index, higher hip circumferences, higher systolic blood pressure, poor cardiovascular function, dyspnoea, pain, cramps, itchiness or moderate to extreme pruritus, lower fasting plasma glucose, electrolyte imbalance, higher total cholesterol and gastrointestinal symptoms), depression, smoking, arousal-related and cognitive arousal behaviours were associated with poor sleep quality.

CONCLUSION

Poor sleep quality was prevalent and influenced kidney function, increased mortality as well as decreased quality of life in patients with pre-dialysis chronic kidney disease. This review synthesizes factors associated with poor sleep quality. Managing these factors can mitigate and prevent poor sleep quality.

IMPACT

Healthcare providers, especially nurses, can assess the risk factors of poor sleep quality and reinforce patients' self-management. Future research should elucidate the assessment and management of risk factors and transfer these into widespread use in the routine care of patients with chronic kidney disease.

Trends and disparities in sleep quality and duration in older adults in China from 2008 to 2018: A national observational study

BACKGROUND

Poor sleep status as a common concern is a risk factor for many health problems among older people. China with an aging society lacks relevant nationwide data on the sleep status among older people. Therefore, the purpose of this study was to investigate trends and disparities in sleep quality and duration among older adults, and exploring influencing factors of poor sleep in China between 2008 and 2018.

METHOD

We used the four-waves data of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018. Sleep quality and average sleep hours per day was investigated by using questionnaires in the CLHLS. We categorized sleep duration as three groups including ≤5 h (short duration), 5-9 h (normal duration), or ≥9 h (long duration) per day. Multivariate logistic regression models were used to examine trends and risk factors of poor sleep quality, short sleep duration, and long sleep duration.

RESULTS

The prevalence of poor sleep quality significantly increased from 34.87% in 2008 to 47.67% in 2018 (p < 0.05). Short sleep duration significantly increased from 5.29 to 8.37%, whereas long sleep duration decreased from 28.77 to 19.27%. Multivariate analysis showed that female sex, poor economic status, a greater number of chronic diseases, underweight, poor self-reported quality of life, and poor self-reported health were associated with poor sleep quality and short sleep duration (p < 0.05).

CONCLUSION

Our findings revealed that older adults had increased prevalence of poor sleep quality and short sleep duration from 2008 to 2018. More attention should be paid to the increased sleep problems among older adults and early interventions should be made to improve sleep quality and guarantee enough sleep time.

Recent advances in sleep and depression

PURPOSE OF REVIEW

There is increasing interest in the connection between sleep disturbances and mood disorders. The purpose of this review is to summarize and evaluate current research on the role of sleep disturbance in the development of depression, as well as to describe recent advances in treatments that improve both sleep and depression symptoms.

RECENT FINDINGS

Relevant publications included in this review cover a wide range of topics related to sleep and depression. Data from large longitudinal studies suggest that insomnia and evening circadian preference are unique risk factors for depression. Depression treatment studies indicate poorer outcomes for those with comorbid sleep disturbances. A few recent trials of cognitive behavioral therapy for insomnia and triple chronotherapy in unipolar depression have shown promising results.

SUMMARY

Sleep disturbance is a modifiable risk factor in the development and maintenance of depression. In the context of current depression, although the data is mixed, some evidence suggests treating sleep disturbance can improve overall outcomes. Recent evidence also suggests that treating sleep disturbance may prevent the future depressive episodes.

Caffeine-Induced Sleep Restriction Alters the Gut Microbiome and Fecal Metabolic Profiles in Mice

Insufficient sleep is becoming increasingly common and contributes to many health issues. To combat sleepiness, caffeine is consumed daily worldwide. Thus, caffeine consumption and sleep restriction often occur in succession. The gut microbiome can be rapidly affected by either one's sleep status or caffeine intake, whereas the synergistic effects of a persistent caffeine-induced sleep restriction remain unclear. In this study, we investigated the impact of a chronic caffeine-induced sleep restriction on the gut microbiome and its metabolic profiles in mice. Our results revealed that the proportion of Firmicutes and Bacteroidetes was not altered, while the abundance of Proteobacteria and Actinobacteria was significantly decreased. In addition, the content of the lipids was abundant and significantly increased. A pathway analysis of the differential metabolites suggested that numerous metabolic pathways were affected, and the glycerophospholipid metabolism was most significantly altered. Combined analysis revealed that the metabolism was significantly affected by variations in the abundance and function of the intestinal microorganisms and was closely relevant to Proteobacteria and Actinobacteria. In conclusion, a long-term caffeine-induced sleep restriction affected the diversity and composition of the intestinal microbiota in mice, and substantially altered the metabolic profiles of the gut microbiome. This may represent a novel mechanism by which an unhealthy lifestyle such as mistimed coffee breaks lead to or exacerbates disease.

Correlation Between Sleep Electroencephalogram, Brain-Derived Neurotrophic Factor, AVPR1B Gene Polymorphism, and Suicidal Behavior in Patients with Depression

The purpose of this article was to investigate the level of serum brain-derived neurotrophic factor and its relationship with suicidal symptoms and severity in mentally ill suicide attempt patients, and to explore the possible role of serum brain-derived neurotrophic factor (BDNF) in the occurrence of psychotic suicidal behavior. A retrospective analysis was performed on patients with depression in the neurology department of a hospital. General physical examination, neurological specialist examination, and cranial magnetic resonance imaging (MRI) examination were performed on any selected group. We applied the 24-item Hamilton Depression Scale, Hamilton Anxiety Scale, and Mini-Intelligence Mental State Scale, and performed polysomnography and electroencephalography (EEG) monitoring to conduct statistical analysis on sleep indicators. The amplitude of low-frequency fluctuation (ALFF) values of the right frontal gyrus, left posterior cerebellar lobe, right anterior cerebellar lobe, and right occipital lingual gyrus of the patient group were significantly lower than those of the control group. The ReHo values of the right superior parietal lobule, the left precuneus, and the right occipital lingual gyrus were significantly higher than those of the control group. The genotype and allele frequency distribution of FKBP5, AVPR1B, and CRHR2 gene SNPs had no significant difference between the case group and the control group (P > 0.05). The ReHo value of the precuneus is significantly correlated with the proportion of N3 sleep, and the dysfunction of the precuneus or default network may be related to the altered sleep structure in patients with depression. The GT and TT genotypes at rs9324924 of the NR3C1 gene are associated with suicide attempts.

The individual and joint associations of depression and sleep duration with cardiometabolic diseases and mortality: A prospective cohort study

BACKGROUND AND AIMS

Depression and sleep duration were only mutually adjusted in a few studies, and it is unknown whether these two factors are independent or overlapping risk factors for cardiometabolic diseases (CMDs) and mortality. This study aimed to evaluate the individual and joint associations of depression and sleep duration with CMDs and mortality.

METHODS

A total of 261,297 participants who were free of CMD at baseline were included. Sleep duration was divided into three groups (short: <7 h/day, referent: ages 39-64 years: 7-9 h/day; ages 65+ years: 7-8 h/day, and long: ages 39-64 years: >9 h/day; ages 65+ years: >8 h/day). The main outcomes were hypertension, stroke, CHD, DM, all-cause mortality, and cardiovascular mortality.

RESULTS

Among the 261,297 participants, depression and short or long sleep duration were independently associated with increased risk of CMDs and mortality (hazard ratio [HR], 1.10-1.38) when they were mutually adjusted, except for the association between short sleep duration and stroke (HR, 1.03; 95% confidence interval [CI], 0.97-1.10). We documented significant additive interactions between depression and short sleep duration in relation to all-cause mortality (relative excess risk due to interaction [RERI], 0.19; 95% CI, 0.02-0.37) and CHD (RERI, 0.30; 95% CI, 0.11-0.48).

CONCLUSIONS

In this study, depression and short or long sleep duration were independently associated with an increased risk of CMDs and mortality. We also observed significant additive interactions between depression and short sleep duration in relation to all-cause mortality and CHD.

Association of depression symptoms and sleep quality with state-trait anxiety in medical university students in Anhui Province, China: a mediation analysis

BACKGROUND

The prevalence of depression symptoms among medical students is particularly high, and it has increased during the COVID-19 epidemic. Sleep quality and state-trait anxiety are risk factors for depression, but no study has yet investigated the mediating role of state-trait anxiety in the relationship between poor sleep quality and depression symptoms in medical students. This study aims to investigate the relationship among depression symptoms, sleep quality and state-trait anxiety in medical university students in Anhui Province.

METHODS

This was a cross-sectional survey of 1227 students' online questionnaires collected from four medical universities in Anhui Province using a convenience sampling method. We measured respondents' sleep quality, state-trait anxiety, and depression symptoms using three scales: the Pittsburgh Sleep Quality Index (PSQI), the State-Trait Anxiety Inventory (STAI) and the Self-rating Depression Scale (SDS). We analysed the mediating role of STAI scores on the association between PSQI scores and SDS scores through the Sobel-Goodman Mediation Test while controlling for covariates. P < 0.05 was considered statistically significant.

RESULTS

A total of 74.33% (912) and 41.40% (518) of the respondents reported suffering from poor sleep quality and depression symptoms. Sleep quality, state-trait anxiety, and depression symptoms were positively associated with each other (β = 0.381 ~ 0.775, P < 0.001). State-trait anxiety partially mediated the association between sleep quality and depression symptoms (Sobel test Z = 15.090, P < 0.001), and this mediating variable accounted for 83.79% of the association when adjusting for potential confounders. Subgroup analysis further revealed that STAI scores partially mediated the association between PSQI scores and SDS scores in females and rural students and fully mediated the association between PSQI scores and SDS scores in males and urban students.

CONCLUSIONS

This study found that sleep quality and state-trait anxiety have a significant predictive effect on depression symptoms. State-trait anxiety mediated the relationship between sleep quality and depression symptoms, with a more complex mechanism observed among rural and female medical students. Multiple pathways of intervention should be adopted, such as encouraging students to self-adjust, providing professional psychological intervention and timely monitoring, enriching extracurricular activities, and making changes in policies regarding long shifts and working hours.

REM-Sleep Deprivation Induces Mitochondrial Biogenesis in the Rat Hippocampus

BACKGROUND/AIM

Sleep loss is proposed as a trigger for manic episodes in bipolar disorder in humans. It has been shown that sleep and wakefulness can affect changes in mitochondrial gene expression, oxidative phosphorylation (OXPHOS) activity, and morphology in the brain. In this study, we investigated alterations in mitochondrial bioenergetic function in the brain of rats after 72-h rapid eye movement sleep deprivation (REM-SD).

MATERIALS AND METHODS

Alterations in the mitochondrial DNA (mtDNA) copy number were detected in the prefrontal cortex and hippocampus through amplification of mitochondrially encoded NADH dehydrogenase 1 (mt-Nd1) gene using quantitative real-time polymerase chain reaction. The expression levels of mitochondrial biogenesis-related proteins such as peroxisome proliferator-activated receptor gamma coactivator 1 alpha (PPARGC1A), cytochrome c oxidase subunit 4I1 (COX4I1) and sirtuin 3 (SIRT3) were assessed using western blot analysis and immunohistochemistry.

RESULTS

We found that REM-SD significantly increased the mtDNA copy number in the hippocampus but not in the prefrontal cortex. In addition, REM-SD increased the protein expression of COX4I1 in the hippocampus. Furthermore, we observed manic-like behaviors in rats exposed to 72-h REM-SD. REM-SD increased locomotion in the open-field test and the time spent in open arms in the elevated plus-maze test.

CONCLUSION

REM-SD may induce mitochondrial dysfunction in the brain, which may be involved in the induction of mania.

Relationship of depression and sleep quality, diseases and general characteristics

BACKGROUND

Depression is the most common type of depressive disorder. The most common sleep disorder associated with depression is insomnia. Insomnia and depression are closely related.

AIM

To investigate the relationship of designed questionnaire items and depression, and analyze the related factors with depression.

METHODS

Questionnaire included Patient Health Questionnaire-9 (PHQ-9) and Pittsburgh sleep quality index (PSQI), 12 kinds of diseases, 8 general characteristics, and 20 insomnia characteristics, totally 56 items were filled out by 411 patients enrolled.

RESULTS

All the 9 items of PHQ-9, 6 components of PSQI (except sleep duration), education, living situation, exercise, years of insomnia, western medicine treatment, Chinese medicine treatment, psychotherapy, kinds of insomnia, treatment expected to treat insomnia, psychological counseling, habit of 1 h before bed, habit of lunch break, diagnosed depression, coronary heart disease, mental illness showed significant difference between without and with depression group. By univariate analysis and multivariate analysis. The odds ratio of education, exercise, kinds of insomnia, habit of 1 h before bed, diagnosed depression, coronary heart disease (P = 0.01) showed significant difference. Their odds ratios were 0.71 (0.55, 0.93), 2.09 (1.32, 3.31), 0.76 (0.63, 0.91), 0.89 (0.81, 0.98), 0.32 (0.17, 0.60), 0.43 (0.23, 0.79).

CONCLUSION

We demonstrated that education, exercise, kinds of insomnia, habit of 1 h before bed, diagnosed depression and coronary heart disease affect the depression.

Discrepancy Between Desired Time in Bed and Desired Total Sleep Time, Insomnia, Depression, and Dysfunctional Beliefs About Sleep Among the General Population

OBJECTIVE

The aim of this study was to explore the factors that can influence the severity of insomnia in the general population. We also aimed to examine whether sleep effort mediates the association between dysfunctional beliefs about sleep or the discrepancy between desired time in bed and desired total sleep time (DBST) and insomnia severity in individuals.

METHODS

A total of 387 participants enrolled in this e-survey study. The symptoms were rated using the insomnia severity index (ISI), Patients Health Questionnaire-9 items, Dysfunctional Beliefs about Sleep-2 items, Glasgow Sleep Effort Scale, and Stress and Anxiety to Viral Epidemics-6 items. In addition, we defined a new sleep index named the DBST index. A linear regression analysis was performed to explore the factors predicting ISI scores, and mediation analysis was implemented to explore whether persistent preoccupation with sleep mediated the influence of dysfunctional beliefs about sleep and DBST on insomnia severity.

RESULTS

A linear regression analysis investigated depression (β=0.17, p<0.001), sleep effort (β=0.50, p<0.001), dysfunctional beliefs about sleep (β=0.13, p=0.001), and DBST (β=0.09, p=0.014) (adjusted R2=0.50, F=65.7, p<0.001). Additionally, we observed that persistent preoccupation with sleep partially mediated the influence of dysfunctional beliefs about sleep and DBST on insomnia severity.

CONCLUSION

Depression, preoccupation with sleep, dysfunctional beliefs about sleep, and DBST influenced the insomnia severity of the general population. We also observed that a persistent preoccupation with sleep partially mediated the influence of dysfunctional beliefs about sleep and the DBST index on insomnia severity.

Improved Functional Organization in Patients With Primary Insomnia After Individually-Targeted Transcranial Magnetic Stimulation

Primary insomnia (PI) is among the most prevalent sleep-related disorders and has a far-reaching impact on daytime functioning. Repetitive transcranial magnetic stimulation (rTMS) has drawn attention because of its effectiveness and safety. The purpose of the current study was to detect changes in the topological organization of whole-brain functional networks and to determine their associations with the clinical treatment effects of rTMS. Resting-state functional magnetic resonance imaging (rsfMRI) data from 32 patients with PI were collected and compared with findings from 32 age- and gender-matched healthy controls (HCs). The patients were treated with Stanford accelerated intelligent neuromodulation therapy, which is a recently validated neuroscience-informed accelerated intermittent theta-burst stimulation protocol. Graph theoretical analysis was used to construct functional connectivity matrices and to extract the attribute features of small-world networks in insomnia. Scores on the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index, Self-Rating Anxiety Scale, Self-Rating Depression Scale, and the associations between these clinical characteristics and functional metrics, were the primary outcomes. At baseline, the patients with PI showed inefficient small-world property and aberrant functional segregation and functional integration compared with the HCs. These properties showed renormalization after individualized rTMS treatment. Furthermore, low functional connectivity between the right insula and left medial frontal gyrus correlated with improvement in ISI scores. We highlight functional network dysfunctions in PI patients and provide evidence into the pathophysiological mechanisms involved and the possible mode of action of rTMS.