Article

Insomnia and Sleep Duration in a Large Cohort of Patients With Major Depressive Disorder and Anxiety Disorders

NeuroCampus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 03/2010; 71(3):239-46. DOI: 10.4088/JCP.09m05218gry
Source: PubMed

ABSTRACT

Disturbed sleep has a high impact on daily functioning and has been correlated with psychopathology. We investigated the extent to which insomnia and sleep duration were associated with both current and remitted depressive and anxiety disorders in a large-scale epidemiologic study, taking sociodemographics, health factors, and medication use into account.
Data of 2,619 individuals from the Netherlands Study of Depression and Anxiety (NESDA) were analyzed. Psychopathology was classified as no, current, or remitted DSM-IV-based diagnosis of major depressive or anxiety disorder. Outcome measures were insomnia (Women's Health Initiative Insomnia Rating Scale score >or= 9) and sleep duration (<or= 6 hours, 7-9 hours, >or= 10 hours). Baseline measurement was conducted between September 2004 and February 2007.
Both current and remitted depressive disorder and current anxiety disorder were associated with insomnia and short sleep duration with odds ratios (ORs) for insomnia ranging from 1.42 to 3.23 and for short sleep duration ranging from 1.41 to 2.53. Associations were stronger for current than for remitted diagnoses and stronger for depressive than for anxiety disorders. Also long sleep duration was associated with current depressive disorder and anxiety disorders (OR range, 1.53-2.66). Sociodemographic factors, health indicators, and psychotropic medication use did contribute to sleep outcomes but could not explain much of the psychopathology and sleep associations.
Depressive disorder-but also anxiety disorder-is strongly associated with sleep disturbances. Insomnia and short sleep duration persist after remittance of these disorders, suggesting that these are residual symptoms or possibly trait markers. Also, long sleep duration is associated with current depressive or anxiety disorders.

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    • "These discrepancies were likely partially explainable based on sleep quality, lifestyle, psychological and physical factors, etc. Generally, women tend to exhibit lower sleep quality, higher rates of insomnia, and more complaints about difficulty falling asleep than men[25]due to psychological factors such as anxiety and depression[26]. Moreover, the effect of sleep duration on CVD or the risk of CVD is weaker for men, among whom the percentage of smokers is higher, compared with women among whom the percentage of smokers is lower[27]. "
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    ABSTRACT: Although the association between cardiovascular disease (CVD) and sleep duration is generally recognized, the results are inconsistent, and investigations examining the effects of seep duration and diet on CVD are rare. The gender-difference in the effect of the sleep duration on Framingham risk score (FRS)-related factors, 10‐year predicted CVD risk, and dietary consumption was analyzed in 14,111 subjects (Men n = 5,727; Women n = 8,384) aged ≥20 from the Korean National Health and Nutrition Examination Survey. The gender difference in the CVD risk factors according to sleep duration was observed. Only women with short sleep durations (<7 h/day) exhibited elevated FRS factors, such as systolic blood pressures (SBP) (P < 0.001), diastolic blood pressures (DBP) (P = 0.008), and the proportion of hypertension (HTN) treatments (P < 0.001), but not for men. Moreover, the 10-year predicted CVD risk, as evaluated with the FRS, was higher in women with short sleep durations (P < 0.001). Women with short sleep durations consumed significantly more dietary carbohydrates (CHO) than those with normal sleep durations (P < 0.001). Additionally, the ORs for intermediate and high 10-year predicted CVD risks and CVD–related factors, such as high age, elevated SBP, and HTN treatment, significantly increased with short sleep durations among women [OR (95 % CI) = 1.709 (1.359–2.149) for CVD risk, 1.976 (1.756–2.224) for high age, 1.535 (1.291–1.826) for elevated SBP, and 1.515 (1.320–1.739) for HTN treatment]. Short sleep duration influenced dietary carbohydrate consumption and elevated FRS-related factors as well as 10-year predicted CVD risk. Our findings demonstrated that the CVD risk has been potentially modified by short sleep durations and greater CHO consumptions.
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    • "Furthermore, sleep deprivation is associated with common psychiatric conditions such as anxiety and depression [van Mill et al., 2010]. While it is unclear to what extent sleep deprivation may be contributing to these conditions as opposed to resulting from them [van Mill et al., 2010], one study of military personnel has shown that individuals reporting symptoms of pre-deployment insomnia or short sleep (<6 hr of sleep a night) are more likely to suffer from new-onset post-deployment post-traumatic stress disorder (PTSD) Gehrman et al., 2013]. Thus, lifestyle changes and medical interventions that improve sleep quantity may lead to improved physical and emotional health. "
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    ABSTRACT: Sleep is critical to health and functionality, and several studies have investigated the inherited component of insomnia and other sleep disorders using genome-wide association studies (GWAS). However, genome-wide studies focused on sleep duration are less common. Here, we used data from participants in the Coriell Personalized Medicine Collaborative (CPMC) (n = 4,401) to examine putative associations between self-reported sleep duration, demographic and lifestyle variables, and genome-wide single nucleotide polymorphism (SNP) data to better understand genetic contributions to variation in sleep duration. We employed stepwise ordered logistic regression to select our model and retained the following predictive variables: age, gender, weight, physical activity, physical activity at work, smoking status, alcohol consumption, ethnicity, and ancestry (as measured by principal components analysis) in our association testing. Several of our strongest candidate genes were previously identified in GWAS related to sleep duration (TSHZ2, ABCC9, FBXO15) and narcolepsy (NFATC2, SALL4). In addition, we have identified novel candidate genes for involvement in sleep duration including SORCS1 and ELOVL2. Our results demonstrate that the self-reported data collected through the CPMC are robust, and our genome-wide association analysis has identified novel candidate genes involved in sleep duration. More generally, this study contributes to a better understanding of the complexity of human sleep.
    Full-text · Article · Sep 2015 · American Journal of Medical Genetics Part B Neuropsychiatric Genetics
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    • "However, the usual treatments for psychiatric disorders do not typically address the insomnia, with the consequence that for many patients their insomnia would persist even after their psychiatric symptoms had abated (Sánchez-Ortuño et al, 2012; van Mill et al, 2010). The reason for the resistance of insomnia to non-sleep interventions is that insomnia is maintained by sleep-related, non-adaptive cognitions and behaviors that are sleep specific and are independent of the comorbid condition (Taylor et al, 2005; Buysee et al, 2008; van Mill et al, 2010). Cognitive behavioural therapy for insomnia (CBT-I) specifically targets these insomnia perpetuating cognitions and behaviours and thus effectively alleviates insomnia in the presence of comorbid psychiatric and medical conditions (Watanabe et al, 2011; Shimodera et al, 2011; Sánchez-Ortuño et al, 2012; Wagley et al, 2013). "
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    ABSTRACT: Recent scientific evidences have brought a paradigm shift in our approach towards the concepts of insomnia and its management. The differentiation between primary and secondary insomnia was proved more hypothetical than actual and based upon the current evidences insomnia subtypes described in earlier system have been lumped into one-Insomnia Disorder. Research in this field suggests that insomnia occurring during psychiatric or medical disorders has a bidirectional and interactive relationship with and coexisting medical and psychiatric illnesses. The new approach looks to coexisting psychiatric or medical disorders as comorbid conditions and hence specifying two coexisting conditions. Therefore, the management and treatment plans should address both conditions. A number of sleep disorders may present with insomnia like symptoms and these disorders should be treated efficiently in order to alleviate insomnia symptoms. In such cases, a thorough history from the patient and his/her bed-partner is warranted. Moreover, some patients may need polysomnography or other diagnostic tests like actigraphy to confirm the diagnosis of the underlying sleep disorder. DSM-5 classification system of sleep-wake disorders has several advantages, e.g., it has seen insomnia across different dimensions to make it clinically more useful; it focuses on the assessment of severity and guides the mental health professional when to refer a patient of insomnia to a sleep specialist; lastly, it may encourage the psychiatrists to opt for the Sleep Medicine as a career.
    Full-text · Article · Sep 2014 · Asian Journal of Psychiatry
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