Insomnia and Daytime Sleepiness Are Risk Factors for Depressive Symptoms in the Elderly
Insomnia and Daytime Sleepiness Are Risk Factors for Depressive Symptoms in the Elderly
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DOI：
10.5665/sleep.1170
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发表时间：
2011-08-01
期刊：
影响因子：
5.6
通讯作者：
Dauvilliers, Yves
中科院分区：
文献类型：
--
作者：
Jaussent, Isabelle;Bouyer, Jean;Dauvilliers, Yves
研究目的：以前的研究报道，失眠和白天过度嗜睡（EDS）可能预示着成年人的抑郁症。然而，这些协会还没有调查社区居住的老年人考虑到失眠症状，EDS，sleep medication.Design：四年的纵向研究。设置：法国三城市Study.Participants：3824名年龄≥ 65岁，基线时无抑郁症状的受试者。在基线、2年和4年随访时，使用流行病学中心抑郁量表评估抑郁症状（DEP-s）。Logistic回归模型控制潜在的混杂因素，以确定是否睡眠障碍与事件DEP-s，并确定个人失眠症状的影响。失眠症状和EDS独立增加了DEP-s事件的风险（OR = 1.23，95%CI = 1.01-1.49和OR = 2.05，95%CI = 1.30-2.3）。睡眠质量差和难以启动和维持睡眠-但不是清晨醒来-被确定为DEP的危险因素，风险随着失眠症状的频率增加而增加。睡眠药物不仅是独立于失眠症状（OR = 1.62，95% CI = 1.26-2.09）的老年抑郁症的危险因素，而且也独立于EDS（OR = 1.71，95% CI = 1.33-2.20）的老年抑郁症的危险因素。在临床实践中，睡眠障碍和长期使用睡眠药物可能是抑郁症的早期指标或潜在可逆的危险因素，这表明需要进一步的临床干预研究。
Study Objectives: Previous studies have reported that insomnia and excessive daytime sleepiness (EDS) may predict depression in adults. However, these associations have not been investigated in community-dwelling elderly taking into account insomnia symptoms, EDS, and sleep medication.Design: Four-Year longitudinal study.Setting: The French Three-City Study.Participants: 3824 subjects aged >= 65 years and free of depressive symptoms at baseline.Measurements and Results: Questionnaires were used to evaluate "insomnia symptoms, "EDS, and sleep medication at baseline. Depressive symptoms (DEP-s) were assessed using the Center for Epidemiologic Studies-Depression scale at baseline, and at 2-year and 4-year follow-up. Logistic regression models controlling for potential confounders were generated to determine whether sleep disturbances were associated with incident DEP-s and to determine the effect of individual insomnia symptoms. Insomnia symptoms and EDS independently increased the risk of incident DEP-s (OR = 1.23, 95% CI = 1.01-1.49 and OR = 2.05, 95% CI = 1.30-2.3, respectively). Poor sleep quality and difficulty in initiating and in maintaining sleep-but not early morning awakening-were identified as risk factors of DEP-s, with risk increasing with the frequency of insomnia symptoms. Sleep medication was not only a risk factor for DEP-s independent of insomnia symptoms (OR = 1.62, 95% CI = 1.26-2.09), but also independent of EDS (OR = 1.71 95% = 1.33-2.20).Conclusions: Insomnia symptoms, EDS, and the use of medication independently increase the risk of subsequent depression in the elderly. In clinical practice, disturbed sleep and prolonged use of sleep medication may be early indicators or potentially reversible risk factors for depression, suggesting the need for further clinical interventional research.