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1088 Heart Rate Variability During Sleep in Adults With and Without a History of Depression and the Influence of Antidepressant Use

Authors:

Abstract

Introduction Individuals with depression have an increased risk for cardiovascular disease. While lower daytime HRV may be one mechanism of this association, it is less clear whether HRV during sleep (sHRV) differs between adults with and without depression. Examining sHRV is an important measure to test given evidence that nocturnal differences in physiology are strong predictors of cardiovascular disease. Methods 118 adults who completed psychiatric interviews between the ages of 21-60 y (T1) returned 18.7 ± 4.5 years later for a re-evaluation of their mental health and assessment of sleep (T2). 71 participants were diagnosed with Major Depressive Disorder (MDD) at either T1 or T2, while 47 participants were free from depression at both time points. At T2, participants underwent an overnight polysomnogram with concurrent assessment of electrocardiography. The primary measures of sHRV were root mean square of successive differences (RMSSD) values during rapid eye movement (REM) sleep and non-REM (NREM) sleep stages N2 and N3. Lower values of RMSSD suggest lower parasympathetic activity. RMSSD values were natural log-transformed prior to analysis. Differences in RMSSD between depressive groups were examined using analysis of covariance (ANCOVA), adjusting for age, body mass index, gender, race, and antihypertensive medication use. Additional ANCOVA models adjusted for antidepressant use. Results Participants with current or a history of MDD had lower RMSSD values during REM sleep (P=.01) and a trend toward lower values during NREM (P=.06) compared to those without MDD. Antidepressant use was significantly associated with lower RMSSD during both REM (P=.002) and NREM sleep (P<.001). Depression history was no longer associated with RMSSD during NREM or REM sleep following adjustment for antidepressant use (P>.40). Conclusion These data indicate that adults with MDD exhibit lower parasympathetic activity during sleep compared to those without MDD. These associations were modified by antidepressant use, suggesting that antidepressants may partially explain the association between depression and sHRV. Future studies investigating the influence of specific antidepressants for modifying nocturnal physiology may help to better understand the link between depression and cardiovascular disease risk. Support This study was funded by National Institutes of Health (NIH) grants R01 HL104607 and K23 HL118318.
A414
SLEEP, Volume 43, Abstract Supplement, 2020
B. Clinical Sleep Science and Practice IX. Sleep and Psychiatric Disorders
the present study, we examine session-by-session effects of CBT-I
on insomnia and depression.
Methods: Fifty-four Veterans with insomnia and co-occurring
depression or posttraumatic stress disorder were randomized to
either four sessions of CBT-I or treatment as usual in a published
parent study. We report here on the effects among those who re-
ceived CBT-I (n =22). At each session participants provided a com-
pleted sleep diary and completed the Insomnia Severity Index (ISI)
and Patient Health Questionnaire-9 for depression (PHQ-9).
Results: At baseline, participants endorsed a moderate level of
both insomnia (ISI score=18.5 [SD=4.2]) and depression (PHQ-9
score=15.6 [SD=5.2]). Amean decrease of 4.0 points in ISI total
score was observed between sessions 1 and 2 [t(21)=-3.88, p<.001]
and a 3.3 points between sessions 2 and 3 [t(19)=-2.63, p<.05].
Mean PHQ-9 scores decreased by 2.9 points between sessions 1
and 2 [t(21)=-2.84, p<.01] and a 2.8 points between sessions 2
and 3 [t(19)=-2.77, p<.05]. In contrast, changes in ISI and PHQ-9
scores between baseline and session 1, and sessions 3 and 4 did not
reach signicance.
Conclusion: The majority of improvements in both insomnia and
depression were observed following sessions 1 and 2 of CBT-I.
Findings suggest that even a limited exposure to CBT-I may have
a clinically signicant impact on functioning across multiple do-
mains. Whether such early improvements represent an optimal
balance compared with the more modest additional improvements
achieved by adding more sessions is discussed.
Support: This work was supported by the VISN 2 Center of
Excellence for Suicide Prevention at the Canandaigua VAMC.
1088
HEART RATE VARIABILITY DURING SLEEP IN ADULTS
WITH AND WITHOUT A HISTORY OF DEPRESSION AND
THE INFLUENCE OF ANTIDEPRESSANT USE
Egeler,M.E.1 Bowman,M.1 Thayer,J.F.2 Brindle,R.C.3 Hall,M.1
Kline,C.E.1
1University of Pittsburgh, Pittsburgh, PA, 2University of
California Irvine, Irvine, CA, 3Washington and Lee University,
Lexington, VA.
Introduction: Individuals with depression have an increased risk for car-
diovascular disease. While lower daytime HRV may be one mechanism
of this association, it is less clear whether HRV during sleep (sHRV)
differs between adults with and without depression. Examining sHRV
is an important measure to test given evidence that nocturnal differ-
ences in physiology are strong predictors of cardiovascular disease.
Methods: 118 adults who completed psychiatric interviews be-
tween the ages of 21-60 y (T1) returned 18.7± 4.5years later for a
re-evaluation of their mental health and assessment of sleep (T2).
71 participants were diagnosed with Major Depressive Disorder
(MDD) at either T1 or T2, while 47 participants were free from
depression at both time points. At T2, participants underwent an
overnight polysomnogram with concurrent assessment of electro-
cardiography. The primary measures of sHRV were root mean
square of successive differences (RMSSD) values during rapid eye
movement (REM) sleep and non-REM (NREM) sleep stages N2
and N3. Lower values of RMSSD suggest lower parasympathetic
activity. RMSSD values were natural log-transformed prior to
analysis. Differences in RMSSD between depressive groups were
examined using analysis of covariance (ANCOVA), adjusting for
age, body mass index, gender, race, and antihypertensive medica-
tion use. Additional ANCOVA models adjusted for antidepres-
sant use.
Results: Participants with current or a history of MDD had lower
RMSSD values during REM sleep (P=.01) and a trend toward
lower values during NREM (P=.06) compared to those without
MDD. Antidepressant use was signicantly associated with lower
RMSSD during both REM (P=.002) and NREM sleep (P<.001).
Depression history was no longer associated with RMSSD during
NREM or REM sleep following adjustment for antidepressant use
(P>.40).
Conclusion: These data indicate that adults with MDD exhibit
lower parasympathetic activity during sleep compared to those
without MDD. These associations were modied by antidepressant
use, suggesting that antidepressants may partially explain the asso-
ciation between depression and sHRV. Future studies investigating
the inuence of specic antidepressants for modifying nocturnal
physiology may help to better understand the link between depres-
sion and cardiovascular disease risk.
Support: This study was funded by National Institutes of Health
(NIH) grants R01 HL104607 and K23 HL118318.
1089
WATER INTAKE MODERATES THE RELATIONSHIP
BETWEEN SLEEP QUALITY AND DEPRESSIVE
SYMPTOMS: THE LATINO HEALTH AND WELL-BEING
STUDY
Blanc,J.1 Williams,N.1 Jean-Louis,G.1,2 Lemon,S.2 Rosal,M.2
1New York University Langone Health, NEW YORK, NY,
2University of Massachusetts Medical School, Worcester, MA,
3University of Massachusetts Medical School, Worcester, MA.
Introduction: This study examined the relationships between sleep
quality and depressive symptoms, and whether this relationship
is moderated by frequency of water intake in a sample of Latino
adults.
Methods: Participants in this community-based study were 574
Latino adults from Lawrence, Massachusetts. Assessments included
surveys and anthropological measures. Variables in this study in-
cluded sleep quality (Pittsburgh Sleep Quality Index- PSQI), de-
pressive symptoms (Center for Epidemiologic Studies Depression
Scale -CES-D) and frequency of water intake in the previous three
months (investigator-developed question). Covariates included
demographics, stress (Perceived Stress Scale-PSS), and body mass
index (BMI). Multiple linear regression analyses were conducted
to explore associations between sleep and depressive symptoms.
Potential moderating effect of frequency of water intake was as-
sessed using hierarchical, moderated, multiple regression analysis.
Results: The sample was 51.2% female, with a mean age of
46.6 years (SD=15.4) and mean BMI of 29.6 (SD=5.9); 31% of
the sample had CES-D scores > 22 (cut off for elevated depressive
symptoms), the mean PSQI score was 13.11(SD=3.4) and 92% re-
ported water intake two or more times daily. Sleep quality correl-
ated positively with depression (r=.558; p=.000). After adjusting
for covariates, sleep quality was strongly associated with depres-
sion (B=.417; SE=13; p =.000). The relationship between sleep
quality and depressive symptoms was moderated by frequency of
water intake (B= -.186, SE =1.107; p= 0.11).
Conclusion: This study is among the rst to examine the asso-
ciation between sleep quality and depressive symptoms among
Latino adults, and to show that frequency of water intake may
moderate this association in this population.
Support: This study was supported by funding from the NIH: R01
MH085653; 1U48DP006381; and T32HL129953.
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