Eveningness and Insomnia: Independent Risk Factors of Nonremission in Major Depressive Disorder
Eveningness and Insomnia: Independent Risk Factors of Nonremission in Major Depressive Disorder
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DOI：
10.5665/sleep.3658
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发表时间：
2014-05-01
期刊：
影响因子：
5.6
通讯作者：
Wing, Yun-Kwok
中科院分区：
文献类型：
--
作者：
Chan, Joey Wing Yan;Lam, Siu Ping;Wing, Yun-Kwok
背景资料：目前尚不清楚时间型与抑郁症未缓解之间是否存在关联，以及这种关联是否与失眠的混杂效应有关。方法：对一组抑郁症患者进行时间型评估（通过Mornings-Eveningness Questinnaire [MEQ]）、抑郁症状、失眠严重程度和临床结果。在招募的253例受试者中（年龄50.8 ± 10.2岁;女性：82.6%;应答率90.0%），分别有19.4%、56.1%和24.5%的患者被归类为晚上型、中间型和早晨型。夜间型的受试者有更高的失眠严重程度，更严重的抑郁症状，更高的自杀倾向。夜猫子与抑郁未缓解相关，比值比（OR）为3.36（95%可信区间[CI] 1.35- 8.34，P < 0.01），与失眠严重程度无关。此外，失眠是抑郁症未缓解的独立显著因素（OR = 1.12，95% CI 1.05 ~ 1.19，P < 0.001）。结论：夜间睡眠与抑郁症未缓解独立相关，提示昼夜节律参与抑郁症的发病机制。我们的研究结果支持需要对睡眠和昼夜节律紊乱进行全面评估，以及将睡眠和昼夜节律干预整合到抑郁症的管理中。
Background: It is unclear whether there is an association between chronotype and nonremission of depression, and whether the association is related to the confounding effect of insomnia.Method: A cohort of patients with major depressive disorder were assessed for chronotype (by Morningness-Eveningness Questinnaire [MEQ]), depressive symptoms, insomnia severity and clinical outcomes in a naturalistic follow- up study.Results: Of the 253 recruited subjects (age 50.8 +/- 10.2 y; female: 82.6%; response rate 90.0%), 19.4%, 56.1% and 24.5% patients were classified as eveningness, intermediate, and morningness, respectively. Evening-type subjects had higher insomnia severity, more severe depressive symptoms, and higher suicidality. Eveningness was associated with nonremission of depression with an odds ratio (OR) of 3.36 (95% confidence interval [CI] 1.35- 8.34, P < 0.01), independent of insomnia severity. In addition, insomnia was an independent significant factor in contributing to nonremission of depression (OR = 1.12; 95% CI 1.05- 1.19, P < 0.001).Conclusion: The independent association of eveningness with nonremission of depression suggested a significant underpinning of circadian involvement in major depressive disorder. Our findings support the need for a comprehensive assessment of sleep and circadian disturbances as well as integration of sleep and chronotherapeutic intervention in the management of depression.