Persistent Sleep Disturbance: A Risk Factor for Recurrent Depression in Community-Dwelling Older Adults
Persistent Sleep Disturbance: A Risk Factor for Recurrent Depression in Community-Dwelling Older Adults
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DOI：
10.5665/sleep.3128
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发表时间：
2013-11-01
期刊：
影响因子：
5.6
通讯作者：
Irwin, Michael R.
中科院分区：
文献类型：
--
作者：
Lee, Eun;Cho, Hyong Jin;Irwin, Michael R.
研究目的：本研究的目的是探讨社区老年人睡眠障碍和随后抑郁症的时间和严重程度特征之间的关联。设计：一项前瞻性队列研究，评估基线和2年随访期间的睡眠障碍和抑郁症。设置：美国三个城市社区。参与者：在基线评估时诊断为既往抑郁症（n = 145）、当前抑郁症（n = 68）或从未患有精神疾病（n = 206）的社区居住老年人。第2年的重度抑郁症，由精神疾病诊断和统计手册的结构化临床访谈定义。在基线时有抑郁症病史或目前有抑郁症的患者中，在调整了群体地位、抗抑郁药和催眠镇静药的使用、抑郁症状的严重程度、慢性医疗负担和社会人口学变量后，第1年持续性睡眠障碍与第2年持续性或复发性抑郁症相关（调整后的比值比= 5.20，95%置信区间[CI] = 1.16至23.29）。在那些在第1年没有抑郁的人中，第1年持续的睡眠障碍预测第2年的抑郁复发（校正风险比= 16.05，CI = 1.21至213.06），与睡眠障碍的严重程度无关。老年人谁从来没有精神疾病发展depress.Conclusions：持续睡眠障碍在一年之久的时间与抑郁症次年。在有抑郁症病史的老年人中，识别那些持续性睡眠障碍的人可能会优化睡眠相关干预措施的疗效，以改善抑郁症缓解和/或预防晚年抑郁症。
Study Objectives: The objective of this study was to examine the associations between the temporal and severity characteristics of sleep disturbance and subsequent depression in community-dwelling older adults.Design: A prospective cohort study with assessment of sleep disturbance and depression at baseline and across 2 years of follow-up.Setting: Three urban communities in the United States.Participants: Community-dwelling older adults in whom prior depression (n = 145), current depression (n = 68), or never mentally ill (n = 206) were diagnosed at the baseline assessment.Measurements and Results: Major depression at year 2, defined by the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. Among patients with either a depression history or current depression at baseline, persistent sleep disturbance throughout year 1 was associated with persistent or recurrent depression at year 2, after adjustment for group status, antidepressant and hypnotic sedative use, severity of depressive symptoms, chronic medical burden, and sociodemographic variables (adjusted odds ratio = 5.20, 95% confidence interval [CI] = 1.16 to 23.29). Among those who were not depressed at year 1, persistent sleep disturbance throughout year 1 predicted depression recurrence during year 2 (adjusted hazards ratio = 16.05, CI = 1.21 to 213.06), independent of the severity of sleep disturbance. None of the older adults who were never mentally ill developed a depression.Conclusions: Persistent sleep disturbance during a year-long period is associated with depression the following year. Among older adults with prior depression, identification of those with persistent sleep disturbance may optimize the efficacy of sleep related interventions to improve depression remission and/or prevent late-life depression.